Episode 174: The Comeback Step: Game-Changing Foot & Ankle Surgery

In this The Sports Docs Podcast episode, Dr. Ashley Bassett and Dr. Catherine Logan sit down with foot and ankle experts Dr. David Pedowitz and Dr. Josh Metzl.

From evolving surgical techniques to implant innovation and accelerated return-to-play timelines, this conversation highlights how modern approaches are reshaping outcomes for high-level athletes.

Achilles Tendon Injuries

Who Needs Surgery?

•  Best suited for young, active athletes, especially in explosive or cutting sports 

•  While nonoperative care has improved: 

  • Tendon elongation remains a key concern 

  • Push-off strength deficits can impact performance 

•  Surgical repair offers: 

  •  Faster strength recovery 

  •  More predictable return to sport 

Evolution of Surgical Technique

•  Shift from open surgery → minimally invasive (MIS) and percutaneous approaches

•  Benefits: 

  •  ↓ wound complications 

  •  Improved cosmesis 

  •  Faster rehabilitation 

• Double-row fixation restores native footprint and improves gap resistance 

PARS Technique (Percutaneous Achilles Repair System)

•  Combines precision of open repair with less soft tissue disruption

•  Key features: 

  •  Small incision with percutaneous suture passage 

  •  Reproducible jig-guided technique 

  •  Strong, locking suture construct 

•  Ideal for acute midsubstance ruptures

Pearls:

•  Master jig orientation before live cases 

•  Maintain tension during suture passage 

•  Protect the sural nerve

Pitfalls:

•  Incisions too small → poor visualization 

•  Overtensioning the repair 

Repair Constructs: PARS vs SpeedBridge

• SpeedBridge (double-row, knotless): 

  •  ↓ tendon elongation 

  •  Strong biomechanical construct 

  •  Slight ↑ risk of heel pain 

• PARS: 

  •  Less invasive 

  •  Lower wound complication rates 

Insertional Achilles Pathology

•  Typically treated with open or MIS SpeedBridge techniques

•  MIS FiberTak SpeedBridge advantages: 

  •  Smaller incisions 

  •  Less implant material 

  •  Strong fixation with rip-stop construct

  •  Supports early weight-bearing and mobilization

Return to Play

• 90% return to sport after surgery

•  Typical timeline: 

  • Running: progressive, athlete-specific 

  • Full return: ~6–9 months 

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Arthrex Team Physician Controversies 2026

Our Hosts:

Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com