The PODdoctors with Dr. Dauphinee and Dr. Hussain

Episode Description: Dr. Damien Dauphinee sits down with Josh Vose, CEO of Tulavi Therapeutics, and Andrea Para, Senior Director of Medical Affairs and Strategy, to explore a breakthrough in peripheral nerve surgery. The conversation covers how the Allay Hydrogel Cap is transforming neuroma treatment with a sutureless, resorbable technology that delivers dramatic pain relief and puts advanced nerve care within reach of every surgeon.

Key Takeaways:

● The Allay Hydrogel Cap received de novo FDA classification in July 2024, representing a new category of in-situ forming nerve cap technology distinct from traditional biologic caps

● In a retrospective multicenter analysis of 23 patients, no neuroma formation was observed in either prophylactic or therapeutic groups, with an average pain score reduction of 5.5 points

● The sutureless application eliminates the need for microsurgery training, enabling general surgeons and non-fellowship-trained physicians to achieve outcomes previously limited to microsurgical specialists

● Traditional neuroma treatments like TMR show only 50% pain reduction and 25% cure rates in revision cases, while early Allay results are demonstrating superior and more consistent outcomes

● Patients are discontinuing opioids within days of surgery, a finding replicated across multiple surgical sites and a significant departure from typical post-neurectomy recovery

● The hydrogel is 90% water, remains stable for three to four months past the neuroma formation window, and fully hydrolyzes within eight months, leaving no scarring or remnants

● Surgeons should dissect back to normal, healthy nerve tissue before capping, and ensure adequate nerve length to position horizontally in the form for optimal gel application

● The "unmasking phenomenon," where resolving dominant nerve pain reveals secondary musculoskeletal or nerve issues, is common and requires careful patient counseling and precise post-op pain assessment

● Tulavi is expanding into TMR applications, pediatric use (patients over 25 kg), and has pipeline products targeting nerve repair expected in early to mid-2027

Guest Info:

Josh Vose, MD, MBA

CEO, Tulavi Therapeutics

Background: Chemical engineer (Georgia Tech) turned surgeon-operator with 25+ years building peripheral nerve and surgical device startups. MD from the Medical College of Georgia in Augusta; general surgery training in Boston. Former CEO of Peak Surgical (Plasma Blade, acquired by Medtronic) and Sia (resorbable mesh for breast reconstruction, acquired by Integra). Joined Tulavi to commercialize the Allay Hydrogel Cap and scale peripheral nerve solutions beyond microsurgery-only centers.

LinkedIn: https://www.linkedin.com/in/josh-vose-7306661

Website: www.tulavi.com

Andrea Para, PhD

Senior Director of Medical Affairs and Strategy, Tulavi Therapeutics

Background: Medtech strategist, patient advocate, and bioengineer with 14+ years across medtech R&D, hospital and medtech consulting, and strategic planning. BS, MS, and PhD in Bioengineering from Georgia Tech, where her doctoral thesis under Dr. David Ku focused on preventing rapid platelet accumulation under very high shear stress. Previously Director of Exploration at Edwards Lifesciences, Sr. Manager for Product Development and Strategy at Accenture, Consulting Director at Vizient, and R&D Engineer II at St. Jude Medical working on next-generation heart valves. Also Principal/CEO of Medivici LLC, providing technical due diligence for medical device and IVD investors. Joined Tulavi in November 2025.

LinkedIn: https://www.linkedin.com/in/andrea-para

Website: www.tulavi.com

Resources:

● "Saving Limbs, Saving Lives: Advanced Treatments to Prevent Amputations in Diabetic Populations" by Dr. Damien Dauphinee (Kindle): www.amazon.com

● Tulavi Therapeutics: www.tulavi.com

● Dr. Eddie Cobray's publication on first 11 patients with Allay Hydrogel Cap (published approximately four months before recording)

● American Society of Peripheral Nerve (ASPN) abstract: retrospective multicenter analysis of 23 patients

● Vizient Innovative Technology Contract: www.vizientinc.com

● Association of Extremity Nerve Surgeons (AENS): www.aens.us

● Incept (medtech accelerator, parent company family of Tulavi)

● Gerson Lehrman Group (GLG): www.glg.it

Connect:

● The Pod Doctors: www.thepoddoctors.com

● The Pod Doctors on Spotify, Apple Podcasts, Stitcher, and YouTube

● Tulavi Therapeutics: www.tulavi.com

● The Pod Doctors on Facebook and Twitter

#ThePodDoctors #Podiatry #FootAndAnkle #PodiatricMedicine #WoundCare #DiabeticFootCare #PeripheralNerve #Neuroma #FootSurgery #LimbPreservation #TulaviTherapeutics #AllayHydrogelCap #NerveCap #PeripheralNerveSurgery #NeuromaTreatment #MedicalDevices #SurgicalInnovation #PainManagement #OpioidReduction #Neurectomy

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee explores the latest innovations in wound care technology, with a spotlight on SAM (Synthetic Antimicrobial Matrix), a breakthrough solution that integrates lidocaine for effective pain management. Joined by Dr. Victoria Miles and Brad Wiggins from Imbed Biosciences, we discuss how this cutting-edge technology is reshaping burn care and podiatric surgery. The conversation highlights SAM’s dual-action approach, supporting wound healing while delivering meaningful pain relief, leading to improved postoperative outcomes and a reduced reliance on opioid medications. 

Listen as they examine how innovation and evidence-based medicine come together to elevate patient care and improve quality of life.

Top Takeaways:

• Introduction to SAM (Synthetic Antimicrobial Matrix) and its role in next-generation wound care
• How lidocaine integration enhances pain management at the wound site
• Insights from Dr. Victoria Miles and Brad Wiggins of Embed Biosciences
• Applications of SAM technology in burn care and podiatric surgery
• Benefits of a dual-action matrix: accelerated healing and meaningful pain relief
• Impact on postoperative outcomes and reduced reliance on opioid medications
• The importance of clinical research and early case studies in validating new technologies
• Real-world patient experiences demonstrating improved comfort and recovery
• The future of wound care innovation and its role in improving patient quality of life

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss plantar fibromas, benign tumors that form in the plantar fascia of the foot. The doctors discuss the characteristics, causes, and treatment options for these growths, emphasizing that while they can cause discomfort, they are typically not a cause for alarm. The conversation covers various diagnostic methods, including ultrasound and MRI, and explores conservative and surgical treatment approaches. Listeners will gain insights into the importance of addressing these fibromas before they lead to more serious complications, as well as the nuances of surgical intervention when necessary. 

Top Takeaways:

• The evolution of advanced therapies for diabetic limb preservation showcased a significant increase in treatment options over the last two decades.
• Plantar fibromas, while often benign, can cause significant discomfort and should be evaluated through careful examination and imaging techniques like ultrasound.
• Treatment for plantar fibromas often begins conservatively with physical therapy and may escalate to injections or surgical options if necessary.
• Understanding the potential for benign versus malignant processes is crucial in managing plantar fibromas effectively and safely.
• The importance of proper post-operative care and rehabilitation after surgical removal of plantar fibromas cannot be overstated for optimal recovery.

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss the surgical correction of big toe hammertoe, a condition that, while seemingly benign, can pose significant risks for individuals with neuropathy, particularly those with diabetes. The Doctors discuss the complexities of treating this condition and share insights from a specific case involving a high-risk diabetic patient, highlighting the delicate balance between managing diabetes and ensuring proper foot health. The episode covers surgical techniques, including the use of screws for fixation, and the recovery process, which allows for quick weight-bearing activities post-surgery.

Top Takeaways:

• The podcast episode discusses the significant advancements in diabetic limb preservation over the last 20 years, highlighting new technologies and treatment options.
• Doctor Damian Dauphine emphasizes the importance of understanding complex cases in diabetic patients to prevent amputations.
• The surgical correction of big toe hammertoe, particularly its complications in patients with neuropathy.
• The risks associated with untreated hammertoe deformities can lead to dangerous ulcers, especially in diabetic patients.
• The anatomy of the big toe and the surgical procedures involved in correcting contractures.
• The importance of post-operative care and recovery strategies for patients undergoing foot surgery.

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss the prevalent issue of athlete's foot, its symptoms, and the best treatment options. They provide a detailed analysis of three primary treatment methods for athlete's foot: topical antifungals, moisture control, and oral antifungals. Highlighting the importance of treating even minor symptoms, particularly in diabetic patients, they share professional recommendations to prevent severe complications.

Quotes

• "It’s been estimated that one in four people have some level of fungal pathology going on at some time or another. So super common athletes foot, it's a fungal infection typically of the interspaces between your toes because it stays moist, and it typically presents with burning, itching, and scaling of the skin.” -Dr. Raafae Hussain

• "People will have athlete’s foot for years and not realize that they have it because they don't feel the itching. We have to cure them of that thought process and say, no, that's athlete's foot until proven otherwise.” -Dr. Damien Dauphinee

Top Takeaways:

• Topical Antifungals: Start treatment using topical antifungals like fungifoam that pull moisture off the foot while killing the fungus.
• Moisture Control: Employ methods for controlling foot moisture including moisture-absorbing shoe liners and antiperspirant products like Drysol.
• Oral Antifungals: For severe, recalcitrant cases, consider oral antifungals but be mindful of their potential side effects on the liver.
• Importance for Diabetics: Diabetic patients must pay attention to athlete's foot due to their higher risk of complications like foot ulcers and infections.
• Treating Shoes and Feet: Clean shoes thoroughly using products like Lysol and ensure they are dry before use to prevent re-infection.

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss one of the most common foot ailments: plantar fasciitis. This episode's comprehensive guide covers everything from the basics of plantar fasciitis to the most effective treatments currently available. The doctors discuss the anatomy and mechanics of plantar fasciitis, emphasizing the importance of distinguishing between heel spurs and plantar fasciitis pain. They also highlight the significance of stretching, the use of proper orthotics and footwear, and the benefits of steroid injections.

Quotes

• "Orthotics are about architectural support, not just cushioning. Stiffer devices are more effective than gel insoles for plantar fasciitis.” -Dr. Raafae Hussain

• "Standing calf stretches are technique dependent, and that's where the ProStretch shines by leveraging gravity for optimal stretch.” -Dr. Damien Dauphinee

Top Takeaways:

• Steroid Injections: Steroid injections can help in reducing inflammation and pain, making it easier to follow through with other treatments like stretching and wearing orthotics.
• Advanced Treatment Options: For chronic cases not responsive to conventional therapies, treatments like Topaz and amnio injections offer promising results.
• Diagnostic Imaging: Utilizing tools like ultrasound to measure plantar fascia thickness can aid in determining the severity of the condition and tailoring the treatment plan accordingly.

What You Will Learn:

• Effective stretching exercises, such as standing calf stretches, towel stretches, and using tools like the ProStretch, play a crucial role in managing plantar fasciitis.
• Choosing well-made, supportive shoes and custom orthotics can significantly alleviate plantar fasciitis symptoms. 

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, evaluate the complexities of an Achilles tendon repair using a Flexor Hallucis Longus (FHL) tendon transfer. This particular case involved a patient with a history of clubfoot, multiple surgeries, and a significant Achilles tendon rupture. The doctors explain their surgical approach to repairing the damaged Achilles tendon by harvesting the FHL tendon. They emphasize the importance of this technique in providing the necessary strength and functionality for the patient to regain a normal gait. 

Quotes

• "We did what's called an interference screw or anchor. We drill a pocket hole for that tendon to go through, and then we'll put an anchor in right next to it that will hold that tendon up against that bone without any type of limitations.” -Dr. Raafae Hussain

• “The non-absorbable suture will tear your gloves and tear your finger before it'll break. You can really crank on this stuff, which is perfect for stout, tender repairs where you're going to be putting a tremendous amount of force through this tendon.” -Dr. Damien Dauphinee

Top Takeaways:

• Achilles Tendon Repair with FHL Transfer: The utilization of the FHL tendon to enhance the strength and functionality of a damaged Achilles tendon.
• Surgical Case Details: Insight into a complex foot surgery involving a patient with previous clubfoot reconstructions.
• Advanced Surgical Techniques: The use of advanced techniques, such as the whip stitch and interference screw, to ensure successful tendon transfer.

What You Will Learn:

• The importance of post-surgery protocols, including non-weight bearing periods and early active range of motion exercises.
• Surgical procedure steps and the reasoning behind specific surgical choices.

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss a case involving a severe Achilles tendon injury in a young athlete. They highlight the importance of having backups for backups when relying on imaging, as MRIs can sometimes be misleading. Dr. Dauphinee and Dr. Hussain explain the surgical procedure they performed, including the use of a cadaveric calcaneal Achilles graft. They also discuss the post-operative care and rehabilitation process. 

Quotes

• "When tamping the bone you can use screws, wires, staples, plates, but I think the most common is a single screw.” -Dr. Raafae Hussain

• “The moral of the story from a surgeon's standpoint is, MRIs can lie to you Have a backup for your backup.” -Dr. Damien Dauphinee

Top Takeaways:

• Cadaveric Achilles grafts can be a viable option to bridge extensive gaps.
• Encouraging interdisciplinary learning through real-life cases is vital for medical professionals' growth and preparedness for complex surgeries.

What You Will Learn:

• Postoperative care involves lengthier immobilization and physical therapy when using cadaveric grafts, highlighting the need for tailored recovery protocols.
• MRIs can sometimes provide misleading information; it's important to be prepared with multiple treatment plans.
• Proper fixation using screws and consideration for nerve location, such as sural nerves, is crucial during Achilles tendon surgery.

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, cover the intricacies and surgical treatment of fibular nerve release, a crucial procedure for patients experiencing various complications often associated with nerve entrapments in the lower limbs. They discuss the nitty-gritty of podiatric surgery, specifically the peroneal, or technically the fibular nerve, and its susceptibility to injury or entrapment. Doctors Dauphine and Hussein then discuss the surgical nuances of nerve release, providing critical insights into how such procedures substantially improve patient outcomes.

Quotes

• "Nerve flossing is a really great technique. We'll get folks into the physical therapists and have them start nerve-flossing as quickly as we can. Usually, right after we get the stitches out at two weeks.” -Dr. Raafae Hussain

• “You've got to always keep in mind that when patients are complaining of burning, stabbing, shooting pain, tightness at nighttime, that is nerve-related pain for sure.” -Dr. Damien Dauphinee

Top Takeaways:

• Fibular nerve release is improving patient outcomes, with modern technology playing a pivotal role.
• Detailed nerve anatomy understanding and careful surgical techniques are essential for the successful treatment of the fibular nerve and its branches.
• The surgical approach to decompressing the fibular nerve involves meticulous dissection 
• Diagnostic blocks are a helpful tool in identifying specific nerve entrapments that could contribute to conditions like restless leg syndrome (RLS).
• Nerve flossing is crucial to prevent adhesions and maintain nerve health.

What You Will Learn:

• Surgical procedures to address nerve entrapment
• Using diagnostic blocks as a tool
• How the application of protective materials like umbilical cord tissue prevent scarring and promote healing
• Postoperative care that encourages movement

Resources:

Visit our website: https://thepoddoctors.com/

In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss bunion surgery and its various outcomes, especially focusing on revision bunionectomy. They explore the numerous techniques to correct bunions, emphasizing the importance of matching the surgical approach to the patient's specific condition. The doctors also suggest that one solution does not fit all, and the choice of procedure can greatly impact long-term satisfaction and functionality. They also suggest personalized surgical plans, which are crucial for achieving the best outcomes in foot and ankle health.

Quotes

• "The difference between doing an open versus MIS is minimally incisional surgery. The benefit is that you don't have a long incision.” -Dr. Raafae Hussain

• “Most bunion surgeries that fail, are a failure of the choice of the bunionectomy.” -Dr. Damien Dauphinee

Top Takeaways:

• The success of bunion surgeries largely depends on selecting the proper procedure that aligns with the patient's degree of deformity and clinical presentation.
• The Lapidus Bunionectomy: among other techniques, is becoming increasingly popular for treating severe and hypermobile bunions
• Minimally invasive surgeries (MIS) for bunions require careful patient selection, with ideal candidates being young, healthy, and free of complicating factors like smoking or diabetes.
• Revision bunion surgeries are sometimes the consequence of an initial procedure that did not sufficiently address all aspects of the deformity
• Fusion of the big toe joint can be a highly effective solution for long-term relief in patients with recurring bunions or persistent joint breakdown.

What You Will Learn:

• Different options for revision bunion surgery
• Common complications and concerns
• Patient Selection Criteria for MIS Bone Healing
• How to Choose the Right Bunion Surgery and Surgeon

Resources:

Visit our website: https://thepoddoctors.com/