Treace Medical Concepts Q4 2025 Earnings Call - Pivot to Full-Spectrum Bunion Platform, Guides Flat-to-Down 2026 While Cutting Cash Burn 50%

Operator: Good day. Thank you for standing by. Welcome to the Treace Medical Concepts fourth quarter and full year 2025 earnings conference call. At this time, all participants are in a listen-only mode. Please be advised that today’s conference is being recorded. After the speaker’s presentation, there will be a question-and-answer session. To ask a question, please press star one one on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. I would now like to hand the conference over to your speaker today, Tripp Taylor, Investor Relations.

Tripp Taylor, Investor Relations, Treace Medical Concepts: Good morning, everyone, and welcome to our fourth quarter 2025 earnings conference call. Participating from the company today will be John Treace, Chief Executive Officer, and Mark Hare, Chief Financial Officer. John and Mark will discuss our fourth quarter financial results in 2026 outlook. We will then host a question-and-answer session following our prepared remarks. Our press release can be found in the Investor Relations section of our website at investors.treace.com. This call is being recorded and will be archived in the investor section of our website. Before we begin, we would like to remind you that it is our intent that all forward-looking statements made during today’s call will be protected under the Private Securities Litigation Reform Act of 1995. Any statements that relate to expectations or predictions of future events and market trends, as well as our estimated results or performance, are forward-looking statements.

All forward-looking statements are based upon our current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. All forward-looking statements are based upon currently available information, and Treace Medical assumes no obligation to update these statements. Accordingly, you should not place undue reliance on these statements. Please refer to our SEC filings, included on our Form 10-K for 2025, filed before market open today, February 27th, and can be found in the Investor Relations section of our website at investors.treace.com for a detailed presentation of risks. With that, I will now turn the call over to John.

John Treace, Chief Executive Officer, Treace Medical Concepts: Thank you, Tripp. Good morning, everyone, and thank you for joining us on our fourth quarter 2025 earnings conference call. During 2025, Treace Medical entered a transformational phase, building upon our leadership as recognized bunion experts and evolving from a Lapiplasty-focused company into a comprehensive bunion solutions company. With the recent commercialization of multiple new bunion procedure innovations, we are now positioned to address virtually 100% of surgeons’ current technique preferences for all types of bunion correction, offering 5 best-in-class instrumented systems spanning all 4 categories of bunion deformities. We’ve been highly focused on accelerating our bunion procedure volume growth while also broadening our technology offerings to increase wallet share and expand our serviceable TAM.

Our elevated case volume growth in the back half of 2025 reinforces our confidence that we have the right strategies in place to continue to expand our market penetration and restore top-line revenue growth later in 2026 and into the future. We also drove steady improvement in Adjusted EBITDA and significantly reduced our cash burn for 2025. Before diving deeper into our expectations for 2026, I want to note that dynamics discussed on our last call that pressured 2025, including case volume growth, offset by headwinds related to broader economic conditions and softer consumer sentiment, as well as a product mix shift within our expanded portfolio, are still present to begin the year.

Given these market conditions, we’re initiating our outlook for full year 2026 revenue to be in the range of $200 million-$212 million, representing a decline of 6%-0% compared to full year 2025. We expect revenue declines to continue until our seasonally strongest fourth quarter. We expect fourth quarter revenue growth will largely be driven by accelerating case volumes, the lapping of the mix shift dynamics, as well as a contribution from our planned 2026 product launches. We remain focused on continued improvements in profitability and reducing cash burn in 2026. As a reminder of our progress to date, in 2024, we used $50.5 million in cash and reported an $11 million loss in Adjusted EBITDA.

In 2025, we used $27.3 million of cash, a 46% reduction versus 2024. We reduced our Adjusted EBITDA loss to $3.9 million in 2025, a 64% improvement over the prior year. We took several actions in 2025 to reduce our operating expenses and cash usage. Many of these changes will continue to benefit us throughout 2026. We, therefore, anticipate that we will again reduce our cash burn by approximately 50% in 2026 compared to 2025. We’re not done. We will continue to identify additional opportunities to drive our top-line growth and leverage our P&L in 2026. I want to focus on our strategies, the progress we made in 2025, and where we expect to deliver in 2026.

To start, let me tell you about our strategies to improve our top-line performance in 2026 and beyond. First, we will focus on leveraging our large existing customer base to drive adoption of our new 2025 bunion product launches. Second, we’ll continue to build upon our leadership position with Lapiplasty technology, adding new technologies that can attract new surgeons. Third, we will expand our product offerings to grow wallet share and tap into new TAM, expanding procedural adjacencies.... To start, I want to give you an update on the new bunion technologies we launched during 2025, their strategic importance, and the reception they’re getting in the marketplace. We believe our three new bunion systems effectively double the accessible market that we have today with Lapiplasty. Effectively driving these deep into the marketplace is a very high priority for us.

First, our differentiated Nanoplasty and Percuplasty, 3D MIS systems, expand our reach into the high-volume osteotomy segment, which we estimate represents approximately 70% of the 450,000 annual bunion procedures performed in the U.S. We estimate that only 10%-15% of metatarsal osteotomies are being performed using MIS approaches today. We believe this is largely due to the steep learning curves, high variability of outcomes, and lack of attention to correcting the third frontal plane component of the deformity, the failure of which to do so has been associated with an increased risk of bunion recurrence. Our new 3D MIS bunion correction systems offer patients procedures that can result in less pain and fast recovery times with minimal visible scars.

Importantly, these are procedures that are quick for surgeons to learn and are highly instrumented to enable a controlled correction of all three planes of the deformity to minimize risk of recurrence. We believe this expands the appeal of our 3D MIS osteotomy procedures to both surgeons and patients today. Could encourage a much larger portion of the 4.4 million U.S. bunion sufferers to seek surgical treatment over time. Next, our SpeedMTP system, which is designed to serve roughly 20% of bunion patients who have arthritic great toe or MTP joints, as well as patients who suffer from isolated MTP joint arthritis. This large patient population makes MTP fusion one of the most common procedures performed by foot and ankle surgeons, making it a strategically important area for Treace to target with better solutions and continue to innovate.

With our core Lapiplasty system, we believe we’ve captured 25% on average of our 3,300 customers’ total bunion-related procedure volume. These three new systems are dialed in to target the remaining 75%, and we are laser-focused on penetrating that untapped opportunity. Our strategy is working. Just over 2 quarters into the full launch of these new systems, we’re encouraged by the rapid adoption and resulting acceleration we’re seeing in our overall bunion-related procedure volumes. As of Q4, over 25% of our surgeon base has already incorporated one or more of these 3 new bunion systems into their practice, and our Q4 procedure volume growth increased over the mid-single-digit rates we achieved and reported on in Q3. Next, in addition to our new products, advancing our leadership in Lapiplasty technology and expanding its user base remains at the forefront of our strategy.

Lapidus fusion represents approximately 30% of the estimated 450,000 U.S. annual bunion procedures, is the largest dollar segment of the market, where Treace is the recognized category leader. As MIS approaches are gaining in popularity among surgeons and patients, we continue to remain focused on advancing our Lapiplasty platform, making the procedure simpler, faster, and minimally invasive, as demonstrated by our Micro-Lapiplasty platform, which was launched in 2024. In 2026, we plan to commercialize our next-generation Lapiplasty platform, known as Lapiplasty Lightning. Lightning combines next generation 3D correction instrumentation and SpeedPlate TMT implants, which are built upon our proprietary SpeedPlate hybrid fixation technology. SpeedTMT is a high-performance implant designed to appeal to an incremental surgeon audience, those that prefer a single plate fixation construct versus our traditional 2-plate or biplanar approach.

Lightning instrumentation is designed to reduce procedural steps, improve efficiency, and provide surgeons with greater accuracy and control of their 3D correction. We expect full availability of our Lightning instrumentation and our SpeedTMT implants later in the year. Another way we’re appealing to more surgeons with Lapiplasty is by advancing the shift towards personalized surgery, leveraging our IntelliGuide PSI platform. IntelliGuide is industry’s first and only preoperative planning and patient-specific cut guide system for correcting bunion and midfoot deformities. IntelliGuide offers surgeons improved efficiency and precision and is particularly helpful in complex and revisional cases. We believe the combination of Lightning, SpeedTMT, and IntelliGuide position us well to extend our leadership position and attract more surgeon users to our Lapiplasty platform in 2026 and beyond. Now turning to our third strategy, expanding our offerings to more broadly serve our growing customer base.

In 2025, we expanded our SpeedPlate and sterile instrument portfolios with multiple new offerings. We also entered the biologics market with our CortiFuse flowable cortical fiber graft, as well as our line of procedure-specific allograft wedges. These new biologic offerings allow our sales force to more comprehensively service our surgeons’ needs in their cases. In 2026, we plan to launch additional offerings to grow our customer wallet share and tap into incremental procedure adjacencies. In the back half of this year, we plan to launch two new important products that expand our TAM by an estimated $300 million. First, our SuperBite variable pitch compression screw system. This is a very important addition to our portfolio as it equips our sales force for the first time with the most common form of fixation used in foot and ankle surgery.

The SuperBite system features advanced design attributes, making it ideal for both minimally invasive and conventional surgical approaches. We will make our first entry into the midfoot, hindfoot segment of the market with the launch of our new SpeedXM Fusion system. SpeedXM leverages our SpeedPlate fixation technology, bringing the benefits of dynamic compression and enhanced stability for fusion of the larger bones of the mid and hindfoot, as well as for flatfoot reconstructive procedures. SpeedXM is highly complementary with our SuperBite screw system, as the two technologies are often used in concert, along with biologics, to stabilize and fuse these larger bones, thus giving Treace great incremental access to high ASP adjacent procedures that we do not serve today. Of course, with all our current and new product offerings, we continue to provide best-in-class education through our Bunion Masters hands-on training programs.

These events are designed to support surgeons in confidently integrating our procedures and technologies into their practices. Following these trainings, to further enable successful patient outcomes for our surgeons, we provide additional initial case support from our fleet of dedicated clinical specialists and ongoing support from our bunion-focused direct sales team, a team that we plan to expand in 2026 with the addition of more experienced foot and ankle sales professionals. Our confidence in the future is grounded in the success we’ve achieved in the past, as well as the early indications we’re seeing, which reinforces our confidence that we have the right strategies in place moving forward. We’ve expanded our active surgeon base from nearly 1,300 users in 2020 to over 3,300 users in 2025, and these surgeons are using more of our products as they adopt our growing portfolio of best-in-class solutions.

Fourth quarter procedure volume growth increased over the mid-single-digit rates achieved in Q3, reflecting the strength and effectiveness of our comprehensive bunion portfolio and strategy. As we look ahead, we believe we’re well positioned to accelerate our procedure volume growth rates while also growing our customer wallet share and expanding our TAM as we broaden our footprint in the foot and ankle market. We expect these initiatives, combined with disciplined investments, will continue to drive market share gains, improve profitability, and shareholder value. With that, let me now turn the call over to Mark to review our financial performance. Mark?

Mark Hare, Chief Financial Officer, Treace Medical Concepts: Thank you, John. Good morning, everyone. Revenue in the fourth quarter was $62.5 million, a decrease of 9% compared to the prior year period. The decline was mainly driven by the shift in revenue mix towards lower-priced products. Gross margin was 80.6% in the fourth quarter of 2025, compared to 80.7% in the fourth quarter of 2024. Total operating expenses were $56.3 million in the fourth quarter of 2025, compared to total operating expenses of $55.7 million in the fourth quarter of 2024. The increase reflects restructuring charges and increased litigation expenses in the quarter compared to prior year.

Fourth quarter net loss was $9.4 million, or $0.15 per share, compared to a net loss of $0.5 million, or $0.01 per share, in the fourth quarter of 2024. Adjusted EBITDA for the fourth quarter was $6.2 million, compared to $11.1 million in the fourth quarter of 2024. Full year 2025 Adjusted EBITDA loss was $3.9 million, compared to full year 2024 Adjusted EBITDA loss of $11.0 million, a 64% improvement over the prior year. Cash, cash equivalents, and marketable securities totaled $48.4 million as of December 31, 2025. The company’s new credit facility provides an additional $115 million of liquidity, subject to certain conditions.

The company used $27.3 million of cash during the full year of 2025, a decrease of 46% compared to $50.5 million in 2024. Before concluding, let me turn to our outlook for full year 2026. As John mentioned, we’re initiating our full year guidance. We expect full year 2026 revenue to be in the range of $200 million-$212 million, representing a decline of 6%-0% compared to the full year of 2025. We expect revenue declines to continue until our seasonally strongest fourth quarter. Fourth quarter revenue growth will largely be driven by accelerating case volumes, the lapping of the mix shift dynamics, as well as contribution from our planned 2026 product launches.

Looking closer at the first quarter, similar to prior years, following in our seasonally strongest quarter, we anticipate Q1 revenue will step down approximately 27% compared to Q4 2025. Then we expect year-over-year growth rates to improve each quarter thereafter. In addition, the company expects a loss in Adjusted EBITDA in the range of $4 million-$6 million for the full year 2026, as compared to a loss of $3.9 million in full year 2025. We also expect a reduction in cash usage of approximately 50% for full year 2026 as compared to full year 2025. Supported by a strong and flexible balance sheet, we believe we are well positioned to continue executing our strategic and growth initiatives for the foreseeable future. With that, I’ll turn the call over to the operator to open the line for questions.

John Treace, Chief Executive Officer, Treace Medical Concepts: Thank you. As a reminder, to ask a question, please press star 11 on your telephone and wait for your name to be announced. To withdraw your question, please press star 11 again. One moment for questions. Our first question comes from Danielle Antalffy with UBS. You may proceed.

Danielle Antalffy, Analyst, UBS: Hey, good morning, guys. Thanks so much for taking the question. We’ve heard from a number of players, you know, over the course of 2025, that the foot and ankle market was seemingly unusually soft. You know, I followed you guys for a long time. This has been a relatively high-growth market. John, I’d love to hear your thoughts on what’s going on in this market. As far as your guidance goes, the overall market itself, what’s reflected from a growth perspective? Do we return back to normal, continued softness here? Anything you can say to that?

John Treace, Chief Executive Officer, Treace Medical Concepts: Sure. Hi, Danielle. Thank you. Thank you for the question. You know, as we’ve indicated on past calls, during 2025, our surgeons were reporting deferrals of cases.

... we believe that made it a softer year and potentially a declining year in overall bunion surgical volume. You know, as you noted, other companies have mentioned the foot and ankle market being soft, you know, particularly in elective foot and ankle procedures in 2025, or even that may have contracted a little bit. You know, given we’ve got an increase in our Q4 case volumes versus Q3, I think it really does demonstrate that we’re taking share with this new comprehensive bunion portfolio and strategy, even in a softer market. When it comes to our outlook for 2026, you know, we’re expecting that increase in case volume, that’s going to be offset by product ASP mix-related headwinds for the first half of the year.

That’ll begin to abate in Q3 as we start to lap the introduction of these lower ASP, you know, higher volume driving 2025 product introductions. Additionally, in Q3, you know, we’ll increasingly, as we go into Q4, benefit from the introduction of the new 2026 product launches. You know, these carry a little higher case ASP, such as our Lapiplasty Lightning and SpeedTMT, and the combination effect that we get from our SpeedXM midfoot plating and SuperBite screws. We also have some new sales reps that are going to be ramping up in the back half of the year, and we have some easier comps there. We feel good about the cadence. We feel good about the new products we’re introducing and the impact they’re going to have.

As far as the market dynamics go, we’re kind of contemplating a similar dynamic to what we experienced in 2025.

Danielle Antalffy, Analyst, UBS: Okay, understood. That’s helpful. I’m just curious, as far as, the scaling of the biologics portfolio that you talked about, how that will impact operating margins. I know you guys are committed to EBITDA positive, but just curious about any nuances there. Thanks so much.

John Treace, Chief Executive Officer, Treace Medical Concepts: Yeah, Danielle, this is Mark. Thanks for the question. Yeah, we’re excited that we continue to expand our product offerings, and so that’s just going to be another product in our bag that our sales reps can now provide to surgeons who are looking for those biologic solutions. We’ve got good margins on those. We don’t think that it’s negatively going to impact us at all, but to provide additional revenue going forward into 2026 as we have this new offering. I don’t think there’s anything negative about it at all. It’s all upside for us as we have this product portfolio.

Danielle Antalffy, Analyst, UBS: Thank you.

Operator: Thank you. Our next question comes from Ben Klieve with Lake Street Capital Markets. You may proceed.

Ben Klieve, Analyst, Lake Street Capital Markets: Good morning, gentlemen. Thanks for taking the questions. Excuse me. First off, for me, on the products expanding the TAM, can you maybe share a little bit more about those, how long they’ve been in development? You know, any experience of the folks that have had their hands on them yet? You know, any additional color there would be helpful.

John Treace, Chief Executive Officer, Treace Medical Concepts: Sure, Ben, thanks for the question. Yeah, the SuperBite screws, these have been in development. You know, typically, our product development timelines are, you know, 18 months or so. We’ve been working with an elite team of minimally invasive surgeons on these, as well as our traditional SAV development team. We put a lot of work into it. They’re very refined. They have some really nice features that make them, you know, very high performance. The ability to put this in our sales rep’s bag really adds breadth to their line, the ability to control a greater portion of the overall surgical case, we’re excited about this. It’s the first time they’re going to have one of the most commonly used forms of fixation in the foot and ankle.

It’s gonna be very synergistic with a lot of the current products they have, additive to the case ASPs. The second product we talked about was the SpeedXM. That’s our midfoot plating system. Again, it’s been in development for quite some time. Very refined, a lot of cadaveric testing. We’ve had a lot of surgeons put their hands on this, and we’re looking forward to rolling it out, you know, mid-next year. This is for fusing larger bones that are further back in the foot, like the talonavicular, the calcaneocuboid, navicular cuneiform, flat foot reconstruction, triple arthrodesis. These are larger bones, more in the back of the foot. These are procedure adjacencies that are often related to the bunion and convenient call points for our sales force.

We’re excited that they’ll have the ability now to tap into these new incremental high ASP procedures with these two complementary technologies.

Ben Klieve, Analyst, Lake Street Capital Markets: you said mid this year or mid next year?

John Treace, Chief Executive Officer, Treace Medical Concepts: coming mid this year.

Ben Klieve, Analyst, Lake Street Capital Markets: Okay. All right. Maybe I misheard you. Sorry. Then, secondly, for me, on the quarter of your surgeons that have tried the new osteotomy solutions, you know, what are the ones that they pick up first? You know, how does it kind of fit into their algorithm? You know, any additional color would be helpful.

John Treace, Chief Executive Officer, Treace Medical Concepts: Sure, sure. There’s two platforms there, Ben. We’ve got the MTP fusion system, which is getting a lot of traction. This is the first dedicated offering that Treace Medical has offered into that large space, that large subsegment of bunion patients, that the bunion patient comes in, they have a painful bump, but they actually have arthritis in the big toe joint. That’s roughly 20% of the patients that surgeons see for a bunion. There’s an entirely other class of patient that fits for that Speed MTP, that MTP fusion, that doesn’t have a bunion, but has big toe arthritis isolated. It’s one of the most common procedures performed by our surgeons, and now we’re playing in that space.

The price point is at a premium to the MIS osteotomy products we offer, so we like that, and we’re seeing a really good pickup there. Regarding the MIS products, we have two.... The way we’ve been hitting the marketplace and sort of segmenting the user base, if surgeons have not tried minimally invasive, you know, bunion surgery before, Nanoplasty is a more welcoming and easy step for them because it does not require them to learn how to use a rotary powered cutting bur. They can use their conventional saw. We have excellently designed instrumentation that allows them to control the whole procedure, correct all three cardinal planes of the bunion deformity, and do it in a, you know, comfortable and reproducible fashion. Nanoplasty serves that customer group predominantly that hasn’t engaged in minimally invasive osteotomy surgery.

The other group are the surgeons that have engaged in minimally invasive, osteotomy surgery, and they have some level of proficiency, and that’s our Percuplasty. We go after them with our Percuplasty system. We have superior screw designs that don’t require drilling, so it makes it faster to insert. Our jig system has just received very high acclaim from everybody we’ve put it into their hands. That’s allowing them the more controlled, instrumented procedure, the ability to reproducibly correct all 3 planes of the bunion and do it in a fast and efficient manner.

You know, you add these technologies to our entire portfolio, and, you know, what surgeons are seeing is a comprehensive suite of offerings that are best in class, whether they need to fuse an MTP joint, do a lapidus or Lapiplasty, or do a minimally invasive osteotomy procedure for their patients. We’re really well equipped. Salesforce is in a great position now with all these products on all these fronts, and we’re driving it forward, and we’re driving our case volumes.

Ben Klieve, Analyst, Lake Street Capital Markets: Well, it’s great to see the volume grow. Thanks for taking the questions, gentlemen.

John Treace, Chief Executive Officer, Treace Medical Concepts: Thank you, Ben.

Operator: Thank you. Our next question comes from Ryan Zimmerman with BTIG. You may proceed.

Ryan Zimmerman, Analyst, BTIG: good morning. Can you hear me okay?

John Treace, Chief Executive Officer, Treace Medical Concepts: We hear you loud and clear, Ryan.

Ryan Zimmerman, Analyst, BTIG: All right, great. Thanks for taking our question. Maybe, starting with the guide, both for Mark and John. You know, when you think about what’s embedded in the high end and the low end of the guide, what is the toggle or what are the variables that you’ve kind of embedded in the guidance, you know, that get you to the low end, that get you to the high end? How much of that is market dynamics versus maybe products, product mix shift? If you can kind of, you know, deconstruct that a little bit, I think that’d be appreciated.

Mark Hare, Chief Financial Officer, Treace Medical Concepts: Yeah, Ryan, this is Mark. I’ll take a first shot at that. you know, we did offer a range this year, and it partly goes to some of these dynamics that John talked about earlier, that we saw exiting 2025, that there were some changes in patient dynamics, and some, what we were referring to previously as some macroeconomic headwinds. There is some uncertainty as we come into this year, so we wanted to make sure that that range comprehends some of that market uncertainty. That would probably be towards the lower end of that range to the extent that there isn’t some improvement or, you know, that some of these dynamics don’t improve this year versus last year, or they worsen.

I think, you know, on the upside is where we continue to have incremental uptake of our new products, those that we launched last year. Again, we’ve talked about case volume increases in both Q3 and Q4. We’re anticipating case volume increases throughout 2026 as well, year-over-year. To the extent more surgeons are adopting these new cases, new procedures, and to the extent there’s greater uptake on our new product launches that are coming out, John just talked about SuperBite as well as SpeedXM. These are new product launches that are coming out this year, and to the extent there’s greater uptake on those, then there’s opportunities to go to the high end of the range. Right now, we feel comfortable at the midpoint of the range.

There are some variables in the marketplace and with our product offering, that’s where we feel comfortable for now.

Ryan Zimmerman, Analyst, BTIG: Yeah. Okay. That’s very helpful, Mark. You know, John, you’ve added a lot of product, you know, over, I’m going to say the last, what? 18, 24 months, if you will. You know, historically, the sales force was a Lapiplasty-focused sales force, right? It was kind of like, you know, tunnel vision. It was you know, that segment of the market. How do you balance the focus of the sales force? You know, you’re adding a lot of these products. There’s pushes and pulls on pricing dynamics with those products as a result of that. I’m just curious, kind of, you know, is there a risk of dilution in terms of focus in the sales force?

You know, just your general thoughts on kind of, you know, how you balance those dynamics with all the products you’re adding?

John Treace, Chief Executive Officer, Treace Medical Concepts: Thanks, Ryan. Really, really insightful question. You know, we’ve done a lot of work with our sales team for the past, you know, over 1 year now, getting them ready for this, getting them trained. You know, these technologies aren’t technologies necessarily. They’re having to push or force their products and technologies that our customer base, you know, is desiring and kind of demanding. The way we look at it is we keep them focused on that bunion sweet spot, and then as the surgeons have adjacency procedures that they want to serve with our product line, we have them to serve them. And that’s why this SuperBite screw line is so important, SpeedXM is so important, and the next generation technologies we’re bringing out with Lapiplasty are going to be very important as well.

We find that these are the types of products that our salesforce’s customers are wanting from Treace Medical. SpeedXM is a perfect example. They love the SpeedPlate technology, and they’re asking us: Can you develop this for these other larger bones? I could use them with your new screws that are coming out. We’re listening to our customers very closely, and we’re trying to develop our product line in concert with, you know, kind of the path of least resistance for the salesforce.

Ryan Zimmerman, Analyst, BTIG: Okay. Very, very helpful, John. I appreciate the answering those questions. Thank you, guys.

John Treace, Chief Executive Officer, Treace Medical Concepts: Sure thing. Thanks, Ron.

Rick Wise, Analyst, Stifel: Thanks, Ron.

Operator: Thank you. Our next question comes from Rick Wise with Stifel. You may proceed.

Rick Wise, Analyst, Stifel: Good morning to you both. John, you highlighted, I think your words were something like, "You can now address 100% of the bunion opportunities or bunion-related opportunities with the, you know, broadened pipeline." I’m just curious how you’re seeing with what you already have and what you’re expecting competitively. How does your broader product line, how does the expanding sales force, this repositioning of the company, how is it affecting competitive dynamics? Is this really gonna... I’m not asking it skeptically. I mean, it’s got to shake things up a little bit.

John Treace, Chief Executive Officer, Treace Medical Concepts: Hi, Rick. Yeah, great question. You know, it’s a competitive marketplace. A lot of people are trying to, you know, play in it, a lot of large competitors, small competitors. You know, we just returned from our largest surgeon conference of the year, the ACFAS conference in Las Vegas. Huge attendance, you know, over 2,000 of our most common foot and ankle surgeons, you know, participating there. We had a great booth. All these technologies were on display. We had very high traffic at our booth. I can tell you our cadaver training labs that we held at the meeting were oversubscribed and attended beyond what we expected.

I think there’s a lot of appreciation for what Treace Medical brings in terms of being bunion experts and being able to help surgeons navigate through the changing landscape of patient interest and what type of procedures, you know, they’re gonna wanna be offering in their practice. Knowing that Treace Medical has this full suite, 5 different categories of best-in-class solutions that can comprehensively serve those surgeons, you know, patient bunion needs across the spectrum, I think that’s a very comfortable position for surgeons to be with Treace Medical. Our reps know the procedures inside and out. You know, we hold their hands, we give the surgeons excellent training, we reinforce the uptake on the products in the OR with our expert clinical specialists to make sure those first cases go smooth, and they get great patient outcomes.

They’re, you know, taken care of by, you know, very focused, bunion direct sales force. Again, a lot of enthusiasm for these products, and we think it’s gonna continue to build.

Rick Wise, Analyst, Stifel: Thank you for that. Mark, maybe you could expand on your cash flow outlook comments. Obviously, you’ve done a great job reducing your rate of cash burn, and you seem to have a lot of optimism you can make a significant dent in cash burn in the year ahead. Better sales will help mix, I’m guessing, but talk us through the initiatives that you’re contemplating incrementally for 2026, and why we shouldn’t be concerned that this is gonna limit the company’s ability to, you know, on the marketing front or sales expansion front, to get the sales growth side of the job done. Thank you.

John Treace, Chief Executive Officer, Treace Medical Concepts: Hey, Rick. We’ve for the last several quarters now, talked about our laser focus on profitability improvement and cash management. We took a lot of steps last year to begin to improve our overall cost structure and our PNL. A lot of those changes that we made last year will benefit us throughout the full year of 2026. Some of those cost reductions, we reported some restructuring charges last year, we’ll be able to annualize those benefits throughout 2026. We’ve talked a little bit about a couple other things that were unique to 2025.

As we’ve launched all of these incremental bunion systems and adjacent products, we really hit a high water mark with regards to our medical education, and we really invested in training all of our existing surgeons, and we reached out and did a lot of additional training to surgeons that had not been Treace customers. Although we will very much remain focused on medical education and training surgeons, we won’t have the same level in 2026 that we did in 2025. That’s going to naturally come down a little bit. We’ve also talked about some of the natural leverage that comes in our sales force.

We’ve hired a lot of sales reps, as they come off some of their fixed, their fixed salaries, there’s some natural leverage in the sales organization as well. The other thing is we’ve talked at the last couple of calls, we’ve talked a little bit about our DTC efforts and activities and investments, we are not investing as much as we have historically. One of the main reasons is really what we were doing in earlier days was building brand recognition and brand awareness for both patients and surgeons. Now we’ve got

Mark Hare, Chief Financial Officer, Treace Medical Concepts: ... over what we estimate a third of the U.S. surgeons using Treace products last year. We’ve got this huge, large base of surgeon customers, we can leverage down some of that DTC investment that we don’t believe will impact our top line growth. The last thing that I’ll mention with respect to cash management or cash usage is, last year, with the introduction of several new bunion systems, we had incremental and higher CapEx or capital expenditures for our instrumentation trays that we own, and we depreciate, but we make them available to our sales reps and to the surgeon to perform these new cases. That was at a higher level last year, and we don’t need to have the same level of capital investment in 2026.

Not only is the OpEx going to come down, and you’ll see some nice leverage there, but even on the CapEx as well. The combination of all those things is what gives us confidence that we can reduce our cash burn by 50%, which is significant this year, on top of the significant reductions that we just experienced last year.

Operator: That’s great color, Mark. Thank you. Thank you. Our next question comes from Richard Newitter with Truist Securities. You may proceed.

Richard Newitter, Analyst, Truist Securities: Hi. Excuse me. Thank you, guys. I have two questions. Maybe the first one, just a little bigger picture. You know, appreciate that, you know, you see mid-single digit case volume growth. There’s a lot of crosscurrents with mix shift, and then I doubt those are gonna go away because you’re gonna continue to have to evolve the portfolio, and the marketplace is gonna continue to be increasingly competitive. The, the bigger picture question against that backdrop is, what’s the end goal here for, or how do you see your kind of sustainable, longer-term, normalized growth rate when you layer in some sense of normalcy on the bigger bag, a more productive salesforce with that bigger bag?

you know, is this a mid-single digit grower, sustainably longer term, just given where all the macro headwinds are, and, you know, maybe get some share gains that offset? Is this a high single digit sustainable grower now? Just trying to get a sense for kind of where you’re headed realistically, longer term. I have a follow-up.

Mark Hare, Chief Financial Officer, Treace Medical Concepts: Yeah, Rich, this is Mark. Let me begin with that, and John may have some additional color. We are broadening the portfolio. Some of these items that we’ve talked about have lower ASPs, and yet some of these new products and offerings that we’re providing really have strong ASPs as well. Maybe a slight step down to Lapiplasty, but these are strong ASPs, and we’ll continue to broaden our portfolio, not only in the bunion space, but the adjacencies that John talked about. There’s gonna be some of that dynamic that overall, the ASPs or the revenue per case may come down from where we’ve been historically. As we think about the foot and ankle market, some of the questions already today, and we’ve talked about it a little bit.

We believe that there were some macro trends in 2025 that maybe were different from what we’ve seen historically. Historically, we’d say that the foot and ankle market is somewhere in the mid-single digits, and growth rate year-over-year, that’s what we’ve seen historically. We believe that with our focus exclusively on foot and ankle and with our primary focus on the bunion, that we can and should do at least what the market does and more. That’s because of our product profile, our direct channel sales force that can drive these products, and it’s our focus. We believe that we’re uniquely positioned in the marketplace to do what the market is doing broadly and then some. That’s what we would anticipate going forward.

Richard Newitter, Analyst, Truist Securities: Okay. I’m just curious, relative to your original expectations, you know, when you made the strategic pivot, if you will, what felt like a strategic pivot to us, to the MIS osteotomy versus Lapiplasty. You know, how macro developments aside, you know, how is that strategy playing out relative to kind of competitive conversions or trialing that maybe are coming back? You know, is everything progressing according to plan, notwithstanding some of the mix and macro kind of externalities?

John Treace, Chief Executive Officer, Treace Medical Concepts: No, yeah. Hi, Rich, John here. Yeah, very, very positive reception to these new technologies. You know, what we’re known for is developing really elegant instrumentation that takes challenging procedures and makes them very straightforward for surgeons. You know, these minimally invasive ways of doing the bunion, they’re hard and surgeons need help, and we’re giving them the tools to be able to get trained and put these into their practice quickly. You know, we already have 25% in just 2 quarters into launching these new technologies. 25% of our 3,300 customers have already used one or more of these new technologies, have incorporated them into their practice, and we believe that’s gonna continue to build throughout the year.

Larger percentage of our overall surgeon base using these new technologies, and on average, those surgeons embracing more of those three new bunion systems as we progress throughout the year. That’s what we’re laser focused on, and we’re seeing a very positive reception. Couldn’t have been highlighted more than the reaction we just saw at our largest annual meeting of surgeons, where we, you know, had very high turnout to get hands-on with these products in the lab, learn from our top faculty how to employ them into their practice, and we’re looking forward to, you know, picking up a lot of new users as they return home. I think everything’s going as planned.

Our MTP fusion product is tapping into a market we’ve never played in before, and we’re becoming a pretty quickly here, a very large share player in that space. I think it speaks to the power of our model and our strategy and the ability of our sales team to execute.

Mark Hare, Chief Financial Officer, Treace Medical Concepts: Thank you.

John Treace, Chief Executive Officer, Treace Medical Concepts: Sure.

Operator: Thank you. Our next question comes from Lily Lozado with JP Morgan. You may proceed.

Lily Lozado, Analyst, JP Morgan: Great, thanks for taking the question. I’m hoping we can go back to some of the assumptions underpinning the guide. It sounds like you have to get past these Lapiplasty and mix headwinds and have strong uptake in MIS osteotomy to get back to growth in the fourth quarter. To what extent does a rebound in the fourth quarter and the guidance for the year rest on meaningful share capture in MIS osteotomy? I appreciate you don’t provide specific guidance by product, but any color on what the guide assumes in terms of how successful MIS osteotomy is and how Lapiplasty volumes are trending relatively would be helpful.

John Treace, Chief Executive Officer, Treace Medical Concepts: Hi, Lily, it’s John. Thanks for the question. I’ll take a shot at this, and Mark can maybe chime in as well. You know, we have some assumptions that are built into our guide, both low and high end on uptake on our MIS osteotomy platform, our MTP fusion platform, how Lapiplasty and the new Lapiplasty products, such as SpeedTMT, are going to perform. Of course, the new products we’re bringing out, starting in the, you know, middle of the year, the SuperBite screws and SpeedXM. All of those are built in. We have assumptions for them.

We believe they’re reasonable and achievable, and we’re gonna progress through the year, and we’re trying to be prudent, and to the degree we can do better, we’ll do better. We’re sticking to the plan for now and executing on it.

Lily Lozado, Analyst, JP Morgan: Great. Just as a follow-up, can you talk about how the rollout of these new products affects how we should be thinking about your strategy, penetrating the market deep versus wide? It sounds like there’s a cohort of docs that maybe just never gravitated towards Lapiplasty, and these new products give you something to offer them. Should we think about new surgeon adds trending higher than in years past, and is that more of a focus now than before? Thanks so much.

John Treace, Chief Executive Officer, Treace Medical Concepts: Sure. Yeah, some of them are some of these products are obviously built to bring on new surgeons that have not been users of Lapiplasty in the past. The Lightning instrumentation is gonna be, you know, new and novel and has a lot of appeal to it. We just had a training on that, an alpha kind of preview training at our ACFAS conference. Very great reception from the surgeons that saw it there. The SpeedTMT implant, that appeals to a very large surgeon audience that we have not appealed to before with Lapiplasty, because this group of surgeons likes to use one fixation plate versus two, which has been our traditional. We think we can appeal to new users there.

I’m sorry, maybe I lost the other part of your question, Lily, if you don’t mind reminding me or Mark can pick it up.

Mark Hare, Chief Financial Officer, Treace Medical Concepts: Maybe, Lily, I’ll jump in a little bit. This is Mark Hair. I think our primary strategy has been to first build a very large customer surgeon base, and we’re really proud of the work that we’ve done. It’s taken a number of years, and we’ve really made great strides in increasing this customer surgeon base over the last three or four years. Now that we’ve got this large surgeon base, and what John T. Treace talked about earlier, is that we’ve really only gotten maybe a quarter, 25% of their cases, because they’re doing other types of cases we just haven’t had an offering. I think the first opportunity, strategic opportunity, is to add these new products to our existing surgeon base. That’s strategy and focus number one.

We know that there’s a many more bunion procedures that we have not been getting historically, and that’s the biggest opportunity for us right now. With that said, John is exactly right, we strongly believe that in addition to that focus on our large surgeon base, there are other surgeons that have just not really spoken to or become Treace’s customers, and it could because of their preferences. In MIS is one example. We just haven’t been in the MIS osteotomy space, and now we can play there. It gives us an opportunity to provide those offerings to our large surgeon base and also reach outside of our customer base to bring incremental surgeons. I don’t think this year that we’re looking to expand in dramatic form outside of our current surgeon base.

We will add new surgeons this year. We’ve already done so and will continue to do so, but I think that the bigger opportunity right now is to drive deeper into our existing 3,300 plus customer surgeon base.

Operator: Thank you. This concludes the conference. Thank you for your participation. You may now disconnect.