Paragon 28 is a medical device company exclusively focused on foot and ankle orthopedic surgery. The company makes surgical implants, disposables, and instrumentation used by orthopedic surgeons and podiatrists to treat conditions including fractures, bunions, flatfoot, ankle deformities, and Charcot foot. Paragon 28 sells directly to surgeons and hospitals in the U.S. through a network of largely exclusive independent sales reps — approximately 249 producing U.S. reps as of year-end 2024 — and sells internationally across 23 countries through a mix of direct reps, agents, and distributors. The sales model is highly relationship-driven, with significant investment in cadaveric training labs and medical education. Paragon 28's product portfolio covers six sub-categories: forefoot (including bunion correction), fracture fixation, ankle (including total ankle replacement), flatfoot, Charcot foot, and orthobiologics. Revenue is driven by rep count, active surgeon customer count, and revenue per rep as surgeons adopt more of the portfolio. Gross margins run in the mid-70% range, with costs weighted toward variable sales commissions, R&D, and medical education. The business model requires upfront capital investment in surgical instrument sets placed at hospitals before revenue is earned. Paragon 28's core argument is that its exclusive focus on foot and ankle produces purpose-built implants that outperform products repurposed from other anatomies by larger diversified competitors like Stryker and Johnson & Johnson. The company is also building Smart 28, an AI-driven preoperative planning and patient-specific instrumentation platform monetized on a per-case basis.