Treace Medical Concepts (NASDAQ:TMCI) management told investors it is entering what it called a “transformational phase,” expanding beyond its historical Lapiplasty focus to become a broader “comprehensive bunion solutions company.” On the company’s fourth quarter and full-year 2025 earnings call, executives emphasized accelerating procedure volume growth and increasing “wallet share” within its customer base, while acknowledging continued near-term revenue pressure from a shift toward lower-priced products and softer elective procedure demand.
2026 outlook reflects ongoing mix and market headwinds
Treace initiated full-year 2026 revenue guidance of $200 million to $212 million, which management said implies a decline of 6% to 0% versus 2025. CEO John Treace said the same dynamics discussed on the prior call—case volume growth offset by broader economic conditions, softer consumer sentiment, and a product mix shift—are still present entering 2026.
On profitability, Treace guided to an adjusted EBITDA loss of $4 million to $6 million in 2026, compared to a loss of $3.9 million in 2025. Management reiterated a goal to further reduce cash usage, with Hair and Treace both stating the company anticipates approximately a 50% reduction in cash burn in 2026 versus 2025.
Q4 results: revenue down on mix shift; losses widened
Hair reported fourth-quarter revenue of $62.5 million, down 9% year over year, attributing the decline mainly to a shift in revenue mix toward lower-priced products. Gross margin was 80.6%, essentially flat compared with 80.7% in the prior-year quarter.
Total operating expenses in Q4 were $56.3 million, slightly above $55.7 million a year earlier, reflecting restructuring charges and increased litigation expenses, according to Hair. Net loss for the quarter widened to $9.4 million, or $0.15 per share, compared with a net loss of $0.5 million, or $0.01 per share, in Q4 2024. Adjusted EBITDA for Q4 was $6.2 million, down from $11.1 million a year earlier.
Expanded portfolio targets more of surgeons’ bunion volume
Treace positioned its product expansion as a way to address “virtually 100%” of surgeons’ current bunion technique preferences, stating it now offers five instrumented systems spanning four categories of bunion deformities. The company’s strategy, as described by the CEO, centers on three priorities:
- Leveraging its existing customer base to drive adoption of 2025 product launches
- Continuing to advance the Lapiplasty platform to attract new surgeons
- Expanding offerings to increase wallet share and extend into adjacent procedures
Treace said three newer systems—Nanoplasty and Percuplasty (its “3D MIS” osteotomy systems) and SpeedMTP (MTP fusion)—are designed to address the portion of bunion-related procedures it historically did not serve. Management said that with the core Lapiplasty system, Treace has captured about 25% on average of its 3,300 customers’ total bunion-related procedure volume, and that the newer systems target the remaining 75%.
Just over two quarters into the full launch of those three systems, management said adoption has been rapid. Treace stated that by Q4, over 25% of its surgeon base had incorporated at least one of the three new systems into their practice, and that Q4 procedure volume growth increased versus the “mid-single-digit” rate reported in Q3.
Lapiplasty roadmap includes “Lightning,” SpeedTMT and IntelliGuide
While expanding beyond Lapiplasty, the company said it still views Lapiplasty as a central growth driver. Management cited Lapidus fusion as roughly 30% of the estimated 450,000 annual U.S. bunion procedures and described it as the largest dollar segment of the market. Treace said it plans to commercialize a next-generation Lapiplasty platform in 2026 called Lapiplasty Lightning, which combines new 3D correction instrumentation with SpeedPlate TMT implants based on the company’s hybrid fixation technology.
Treace said SpeedTMT is intended to appeal to surgeons who prefer a single-plate fixation construct versus its traditional two-plate approach, and that full availability of Lightning instrumentation and SpeedTMT implants is expected later in 2026. The company also highlighted its IntelliGuide PSI preoperative planning and patient-specific cut guide system, which it said can improve efficiency and precision, particularly in complex and revision cases.
Liquidity and cost actions underpin cash burn reduction target
Hair said Treace ended 2025 with $48.4 million in cash, cash equivalents, and marketable securities, and that its new credit facility provides an additional $115 million of liquidity subject to certain conditions.
The company used $27.3 million of cash in 2025, down 46% from $50.5 million in 2024. Treace attributed its anticipated 2026 cash usage improvement to a mix of factors including annualizing restructuring benefits, lower medical education spend compared with 2025’s elevated training cadence tied to multiple launches, sales force leverage as new hires ramp, reduced direct-to-consumer investment relative to earlier brand-building efforts, and lower capital expenditures for instrumentation trays than in 2025.
On the Q&A, management also addressed market softness. Treace said surgeons reported case deferrals in 2025 and that the company is contemplating a similar dynamic in 2026, while arguing that its Q4 volume acceleration indicates share gains even in a softer environment. Executives repeatedly emphasized that deeper penetration of the existing 3,300+ surgeon base is the primary opportunity, while acknowledging the expanded portfolio may also bring in surgeons whose preferences previously did not align with Lapiplasty.
About Treace Medical Concepts (NASDAQ:TMCI)
Treace Medical Concepts, Inc is a medical technology company specializing in the development and commercialization of innovative surgical solutions for foot and ankle conditions. The company’s flagship product, the Lapiplasty 3D Bunion Correction System, addresses the underlying joint instability that causes bunion deformity through a patented, multi-plane correction approach. The system combines proprietary instrumentation, fixation plates, and a comprehensive surgical protocol designed to improve patient outcomes and reduce recurrence rates.
The Lapiplasty System has received clearance from the U.S.
