By: 5 August 2014

GlobalData, a market intelligence leader delivering the latest industry reports in the orthopaedic market, looks at the market’s race to reign in the growing foot and ankle market


An increasing number of orthopaedic companies are now targeting the extremities as an area capable of producing double-digit growth in sales. The foot and ankle market, in particular, has gained a lot of traction due to an expanding patient pool, as well as the multiple clinical unmet needs inherent to procedures like ankle fusion, total ankle replacement (TAR), and other types of foot reconstruction. While the foot and ankle market is considerably smaller than hip and knee reconstruction, orthopaedic giants cannot ignore the untapped potential of this market when their core markets are mired in stagnancy. In the past two years, the search for growth has led to several new lines of screws, plates, implants, and biomaterials introduced to the market, and an increase in merger and acquisition (M&A) activity in the foot and ankle segment. In late June, the race to reign in the foot and ankle market heated up after Stryker announced its acquisition of Small Bone Innovations (SBi), the manufacturer of the only PMA-approved TAR implant, the Scandinavian Total Ankle Replacement (STAR) system.

The ankle represents one of the most promising subsectors in the foot and ankle market, and GlobalData expects to see continued robust growth in this space going forward. According to GlobalData, more than 10,000 TAR procedures were performed across the world in 2013, and the global TAR market is expected to grow at a Compound Annual Growth Rate (CAGR) of 12.6% in the coming years, driven by companies’ intense investment in expanding surgeon training and raising consumer awareness.

In 2014, the TAR market has seen Zimmer’s continued promotion of its Trabecular Metal Total Ankle system, and Wright Medical’s full release of its INFINITY Total Ankle System. Later in 2014, Tornier will start a commercial launch of its Salto Talaris XT Revision Total Ankle Prosthesis, and Exactech is planning a limited release of its TAR system on a clinical basis, with a commercial launch in 2015. At this point, SBi and Tornier take the lead in TAR market share at 33% and 30%, respectively, with Wright Medical in third place with a 17% market share, based on GlobalData’s estimate. The takeover of SBi’s STAR system will immediately vault Stryker into leadership in the TAR market, and help the company enhance its product portfolio with diversification in the foot and ankle segment. It will be interesting to see how Stryker leverages its comprehensive orthopaedic portfolio and long-standing market position to make headway and create momentum in the foot and ankle space.

The highly fragmented foot and ankle market is crowded with smaller M&A candidates. The major deals in 2013 include Zimmer’s acquisition of Germany-based NORMED Medizin-Technik, and Wright Medical’s takeover of France-based Biotech International. The targets of the two deals were both smaller European extremities-focused companies with solid product portfolios and established distribution channels. Even with multiple austerity measures in place to reign in public spending, Europe still represents a space that promises growth for the foot and ankle market. Meanwhile, Wright Medical has also taken logical steps to expand its presence in the US domestic market by snatching up two US foot and ankle companies earlier this year. All of these deals will translate to a year with head-to-head competitions.

Heading further into 2014, the overall growth rate of the foot and ankle market is expected to remain in the low-teens range, which will offer a nice respite from the other challenging orthopaedic markets, such as large joint reconstruction and spinal fusion. Following Stryker’s lead, GlobalData anticipates a slow wave of consolidation in the lower extremity arena in the upcoming years. However, companies should understand that the foot and ankle market is not recession-proof, and that it will also experience the macroeconomic headwinds in the orthopaedic industry sooner or later.


Junior editor at Fintech Intel