Paragon 28 (FNA) 10-Q 10 Nov 22 2022 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2022	Nov. 07, 2022
Cover [Abstract]
Document Type	10-Q
Document Period End Date	Sep. 30, 2022
Document Quarterly Report	true
Document Transition Report	false
Entity File Number	001-40902
Entity Registrant Name	Paragon 28, Inc.
Amendment Flag	false
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q3
Entity Central Index Key	0001531978
Current Fiscal Year End Date	--12-31
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	27-3170186
Entity Address, Address Line One	14445 Grasslands Drive
Entity Address, City or Town	Englewood
Entity Address, State or Province	CO
Entity Address, Postal Zip Code	80112
City Area Code	720
Local Phone Number	912-1332
Title of 12(b) Security	Common stock, $0.01 par value per share
Trading Symbol	FNA
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		77,126,895

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Current assets:
Cash	$ 56,325	$ 109,352
Trade receivables	35,960	25,939
Inventories, net	54,771	40,241
Income taxes receivable	705	920
Other current assets	1,947	3,078
Total current assets	149,708	179,530
Property and equipment, net	58,591	32,181
Intangible assets, net	20,850	16,505
Goodwill	26,975	6,329
Deferred income taxes	841	0
Total assets	256,965	234,545
Current liabilities:
Accounts payable	13,979	13,028
Accrued expenses	19,507	18,232
Other current liabilities	6,889	1,929
Current maturities of long-term debt	735	153
Income taxes payable	497	615
Total current liabilities	41,607	33,957
Long-term liabilities:
Long-term debt net, less current maturities	42,492	7,476
Other long-term liabilities	907	840
Deferred income taxes	59	78
Income taxes payable	527	0
Total liabilities	85,592	42,351
Commitments and contingencies (Note 12)
Stockholders' equity:
Common stock, $0.01 par value, 300,000,000 shares authorized; 77,990,290 and 77,360,806 shares issued, and 77,076,771 and 76,447,287 shares outstanding as of September 30, 2022 and December 31, 2021, respectively	769	763
Additional paid in capital	207,109	197,868
Accumulated deficit	(29,026)	(463)
Accumulated other comprehensive (loss) income	(1,497)	8
Treasury stock, at cost; 913,519 shares as of September 30, 2022 and December 31, 2021	(5,982)	(5,982)
Total stockholders' equity	171,373	192,194
Total liabilities & stockholders' equity	$ 256,965	$ 234,545

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares	Sep. 30, 2022	Dec. 31, 2021
Common stock par value	$ 0.01	$ 0.01
Common stock share authorized	300,000,000	300,000,000
Common stock share issued	77,990,290	77,360,806
Common stock shares, outstanding	77,076,771	76,447,287
Treasury stock share issued	913,519	913,519

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Net revenue	$ 46,006	$ 35,851	$ 129,875	$ 104,689
Cost of goods sold	8,491	7,096	22,920	20,209
Gross profit	37,515	28,755	106,955	84,480
Operating expenses
Research and development costs	6,337	4,118	18,100	11,254
Selling, general, and administrative	39,667	28,968	114,857	79,009
Total operating expenses	46,004	33,086	132,957	90,263
Operating loss	(8,489)	(4,331)	(26,002)	(5,783)
Other income (expense)
Other income (expense)	59	(98)	610	(124)
Interest expense, net	(1,093)	(573)	(2,865)	(1,174)
Total other expense	(1,034)	(671)	(2,255)	(1,298)
Loss before income taxes	(9,523)	(5,002)	(28,257)	(7,081)
Income tax expense	201	105	306	437
Net loss	(9,724)	(5,107)	(28,563)	(7,518)
Less: cumulative dividends on Series B convertible preferred stock	0	(574)	0	(1,516)
Net loss attributable to common stockholders	(9,724)	(5,681)	(28,563)	(9,034)
Foreign currency translation adjustment	(588)	(121)	(1,505)	(575)
Comprehensive loss	$ (10,312)	$ (5,802)	$ (30,068)	$ (9,609)
Weighted-average number of common stocks outstanding:
Basic	76,850,949	47,005,334	76,595,118	46,926,344
Diluted	76,850,949	47,005,334	76,595,118	46,926,344
Net loss per share attributable to common stockholders:
Basic	$ (0.13)	$ (0.12)	$ (0.37)	$ (0.19)
Diluted	$ (0.13)	$ (0.12)	$ (0.37)	$ (0.19)

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF CONVERTIBLE PREFERRED SERIES EQUITY & STOCKHOLDERS' EQUITY (Unaudited) - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in-Capital	Retained Earnings (Accumulated Deficit)	Accumulated Other Comprehensive Income (loss)	Treasury Stock	Preferred Stock Series A Convertible Preferred Stock	Preferred Stock Series B Convertible Preferred Stock
Temporary equity, beginning balance, shares at Dec. 31, 2020							13,812,500	6,608,700
Temporary equity, beginning balance at Dec. 31, 2020							$ 4,250	$ 36,842
Beginning balance, shares at Dec. 31, 2020		46,738,540
Beginning balance at Dec. 31, 2020	$ 30,393	$ 467	$ 22,107	$ 12,418	$ 823	$ (5,422)
Net loss	(7,518)			(7,518)
Issuance of common stock, shares		151,515
Issuance of common stock	1,000	$ 1	999
Common stock repurchase, shares		(85,049)
Common stock repurchase	(561)					(561)
Series B convertible preferred stock dividend								$ 1,516
Series B convertible preferred stock dividend, permanent equity	(1,516)			(1,516)
Options exercised, shares		234,206
Options exercised	443	$ 2	441
Foreign currency translation	(575)				(575)
Stock-based compensation	2,747		2,747
Temporary equity, ending balance, shares at Sep. 30, 2021							13,812,500	6,608,700
Temporary equity, ending balance at Sep. 30, 2021							$ 4,250	$ 38,358
Ending balance, shares at Sep. 30, 2021		47,039,212
Ending balance at Sep. 30, 2021	24,413	$ 470	26,294	3,384	248	(5,983)
Temporary equity, beginning balance, shares at Jun. 30, 2021							13,812,500	6,608,700
Temporary equity, beginning balance at Jun. 30, 2021							$ 4,250	$ 37,784
Beginning balance, shares at Jun. 30, 2021		46,969,305
Beginning balance at Jun. 30, 2021	29,092	$ 470	25,171	9,065	369	(5,983)
Net loss	(5,107)			(5,107)
Series B convertible preferred stock dividend								$ 574
Series B convertible preferred stock dividend, permanent equity	(574)			(574)
Options exercised, shares		69,907
Options exercised	91		91
Foreign currency translation	(121)				(121)
Stock-based compensation	1,032		1,032
Temporary equity, ending balance, shares at Sep. 30, 2021							13,812,500	6,608,700
Temporary equity, ending balance at Sep. 30, 2021							$ 4,250	$ 38,358
Ending balance, shares at Sep. 30, 2021		47,039,212
Ending balance at Sep. 30, 2021	24,413	$ 470	26,294	3,384	248	(5,983)
Beginning balance, shares at Dec. 31, 2021		76,447,287
Beginning balance at Dec. 31, 2021	192,194	$ 763	197,868	(463)	8	(5,982)
Net loss	(28,563)			(28,563)
Common stock repurchase	(266)		(266)
Series B convertible preferred stock dividend, permanent equity	$ 0
Options exercised, shares	617,578	629,484
Options exercised	$ 2,361	$ 6	2,355
Foreign currency translation	(1,505)				(1,505)
Employee stock purchase plan	100		100
Stock-based compensation	7,052		7,052
Ending balance, shares at Sep. 30, 2022		77,076,771
Ending balance at Sep. 30, 2022	171,373	$ 769	207,109	(29,026)	(1,497)	(5,982)
Beginning balance, shares at Jun. 30, 2022		76,537,568
Beginning balance at Jun. 30, 2022	176,938	$ 764	202,367	(19,302)	(909)	(5,982)
Net loss	(9,724)			(9,724)
Options exercised, shares		539,203
Options exercised	2,060	$ 5	2,055
Foreign currency translation	(588)				(588)
Employee stock purchase plan	100		100
Stock-based compensation	2,587		2,587
Ending balance, shares at Sep. 30, 2022		77,076,771
Ending balance at Sep. 30, 2022	$ 171,373	$ 769	$ 207,109	$ (29,026)	$ (1,497)	$ (5,982)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Cash flows from operating activities
Net loss	$ (28,563)	$ (7,518)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	9,624	6,094
Provision for excess and obsolete inventories	(91)	2,226
Stock-based compensation	7,052	2,747
Employee stock purchase program	100	0
Amortization of debt issuance costs	417	372
Change in fair value of earnout liabilities	(575)	60
Deferred income taxes	(1,110)	0
Loss on disposal of property and equipment	902	118
Other	(1,029)	317
Changes in other assets and liabilities, net of acquisitions:
Accounts receivable	(10,227)	(807)
Inventories	(15,316)	(7,860)
Other current assets	1,442	(3,952)
Accounts payable	951	3,404
Accrued expenses and other current liabilities	176	2,935
Income tax receivable/payable	297	668
Net cash used in operating activities	(35,950)	(1,196)
Cash flows from investing activities
Purchase of office building	(18,300)	0
Purchases of property and equipment	(15,637)	(10,270)
Proceeds from sale of property and equipment	642	581
Purchases of intangible assets	(1,720)	(1,196)
Acquisition, net of cash received	(18,504)	(15,000)
Net cash used in investing activities	(53,519)	(25,885)
Cash flows from financing activities
Proceeds from draw on term loan	20,000	0
Proceeds from issuance of long-term debt	16,000	25,985
Payments on long-term debt	(367)	(5,991)
Payments of debt issuance costs	(420)	(3,080)
Proceeds from issuance of common stock	0	1,001
Payments on treasury stock repurchased	0	(561)
Proceeds from exercise of stock options	2,224	442
Payments on earnout liability	(500)	0
Net cash provided by financing activities	36,937	17,796
Effect of exchange rate changes on cash	(495)	(340)
Net decrease in cash	(53,027)	(9,625)
Cash at beginning of period	109,352	17,501
Cash at end of period	56,325	7,876
Supplemental disclosures of cash flow information:
Cash paid for taxes	788	381
Cash paid for interest	2,111	670
Purchase of property and equipment included in accounts payable	2,363	58
Series B convertible preferred stock dividend	$ 0	$ 1,516

Business and Basis of Presentat

Business and Basis of Presentation	9 Months Ended
	Sep. 30, 2022
Accounting Policies [Abstract]
Business and Basis of Presentation	NOTE 1. BUSINESS AND BASIS OF PRESENTATION Business Paragon 28, Inc. (collectively with its subsidiaries, “we”, “us”, “our”, “P28” or the “Company”) develops, distributes, and sells medical devices in the foot and ankle segment of the orthopedic implant marketplace. Our approach to product development is procedurally focused, resulting in a full range of procedure-specific foot and ankle products designed specifically for foot and ankle anatomy. Our products and product families include plates and plating systems, screws, staples, and nails aimed to address all major foot and ankle procedures including fracture fixation, hallux valgus - which includes bunion and hammertoe, ankle, progressive collapsing foot deformity (PCDF) or flatfoot, charcot foot and orthobiologics. P28 is a United States (“U.S.”) based company incorporated in the State of Colorado, with headquarters in Englewood, Colorado. Our sales representatives and distributors are located globally with the majority concentrated in the U.S., Australia, South Africa, and the United Kingdom. Initial Public Offering In October 2021, the Company completed its initial public offering (“IPO”), in which it issued and sold 8,984,375 shares of its common stock at the public offering price of $ 16.00 per share, including 1,171,875 shares of its common stock upon the exercise of the underwriters’ option to purchase additional shares. The Company received net proceeds after deducting underwriting discounts and commissions and offering expenses of $ 129,118 . In connection with the IPO, all of the shares of the Company’s outstanding convertible preferred stock automatically converted into an aggregate of 20,421,200 shares of the common stock. Basis of Presentation and Consolidation The accompanying Condensed Consolidated Financial Statements include the accounts of Paragon 28, Inc. and its subsidiaries, all of which are wholly-owned. The accompanying Condensed Consolidated Financial Statements have been prepared in conformity with accounting principles generally accepted in the U.S. (“U.S. GAAP”) and pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) for interim financial information. Accordingly, they do not include all of the information required by U.S. GAAP for complete financial statements. The interim Condensed Consolidated Financial Statements reflect all adjustments that are of a normal recurring nature and that are considered necessary for a fair representation of the results for the periods presented and should be read in conjunction with the audited Consolidated Financial Statements and notes thereto for the year ended December 31, 2021, which include a complete set of footnote disclosures, including our significant accounting policies. The audited Consolidated Financial Statements and notes thereto for the year ended December 31, 2021 are included in the Company’s Annual filing on Form 10-K filed with the SEC on March 8, 2022. The results for interim periods are not necessarily indicative of the results that may be expected for a full fiscal year or for any other future period. All intercompany balances and transactions have been eliminated in consolidation.

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2022
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	NOTE 2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Use of Estimates The preparation of the financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Because future events and their effects cannot be determined with precision, actual results could differ significantly from these estimates. Any changes in these estimates will be reflected in the Company’s Condensed Consolidated Financial Statements. Significant items subject to such estimates and assumptions include the determination of the collectability of trade receivables, inventory obsolescence, impairment of long-lived assets, recoverability of goodwill and intangible assets, contingent earn-out liabilities, income taxes and stock-based compensation. Foreign Currency Translation The Condensed Consolidated Financial Statements are presented in U.S. dollars. The Company’s non-U.S. subsidiaries have a functional currency (i.e., the currency in which operational activities are primarily conducted) that is other than the U.S. dollar, generally the currency of the country in which such subsidiaries are domiciled. Such subsidiaries’ assets and liabilities are translated into U.S. dollars at quarter-end exchange rates, while revenue and expenses are translated at average exchange rates during the quarter based on the daily closing exchange rates. Adjustments that result from translating amounts from a subsidiary’s functional currency to U.S. dollars are reported in Accumulated Other Comprehensive (Loss) Income, net of tax. Business Combinations We allocate the purchase consideration to the identifiable net assets acquired, including intangible assets and liabilities assumed, based on estimated fair values at the date of the acquisition. The excess of the fair value of the purchase consideration over the fair value of the identifiable assets and liabilities, if any, is recorded as goodwill. During the measurement period, which is up to one year from the acquisition date, we may adjust provisional amounts that were recognized at the acquisition date to reflect new information obtained about facts and circumstances that existed as of the acquisition date. Determining the fair value of assets acquired and liabilities assumed requires significant judgment, including the selection of valuation methodologies including the income approach, the cost approach, and the market approach. Significant assumptions used in those methodologies include, but are not limited to, the expected values of the underlying metric, the systematic risk embedded in the underlying metric, the volatility of the underlying metric, the risk-free rate, and the counterparty risk. The use of different valuation methodologies and assumptions is highly subjective and inherently uncertain and, as a result, actual results may differ materially from estimates. Trade Receivables, Less Allowance for Doubtful Accounts The Company estimates an allowance for doubtful accounts based upon an evaluation of the current status of receivables, historical experience, and other factors as necessary. It is reasonably possible that the Company’s estimate of the allowance for doubtful accounts will change. As of September 30, 2022 and December 31, 2021 the balance for allowance for doubtful accounts was not material. Inventories, Net The Company estimates a reserve for obsolete and slow-moving inventory based on current inventory levels, historical sales and future projected demand. Charges (benefit) for excess and obsolete inventory are included in Cost of goods sold and were $ 366 and $ 1,004 for the three months ended September 30, 2022 and 2021, respectively and were $( 62 ) and $ 2,229 for the nine months ended September 30, 2022 and 2021, respectively . The inventory reserve was $ 16,218 and $ 19,374 as of September 30, 2022 and December 31, 2021 , respectively. Intangibles The costs associated with applying for patents and trademarks are capitalized. Patents are amortized on a straight-line basis over the lesser of the patent’s economic or legal life, which is seventeen years . Costs associated with capitalized patents include third-party attorney fees and other third-party fees as well as costs related to the following: the preparation of patent applications, government filings and registration fees, drawings, computer searches, and translations related to specific patents. Trademarks that are anticipated to be renewed every ten years have an indefinite life and are not amortized but tested for impairment annually. Once it is determined a trademark will no longer be renewed, the trademark is amortized over the remainder of the trademark’s registration period. Customer relationships are amortized over an estimated useful life of three to seven years on a straight-line basis. Other intangibles, which mainly consist of noncompete arrangements, are amortized over an estimated useful life of three years on a straight-line basis. Developed technology is amortized over an estimated useful life of twelve years on a straight-line basis. Amortizable intangible assets are assessed for impairment upon triggering events that indicate that the carrying value of an asset may not be recoverable. Recoverability is measured by a comparison of the carrying amount to future net undiscounted cash flows expected to be generated by the associated asset. If the asset’s carrying value is determined to not be recoverable, the impairment to be recognized is measured by the amount by which the carrying amount exceeds the fair market value of the intangible assets. No impairment charges were recorded in any of the periods presented. Indefinite-lived trademark assets are reviewed for impairment annually or whenever events or changes in circumstances indicate that the carrying value of an asset may not be recoverable. The Company can elect to first apply the optional qualitative impairment assessment to determine whether the indefinite-lived intangible asset is more-likely-than-not impaired. If, on the basis of the qualitative impairment assessment, an entity asserts that it is more likely than not that the indefinite-lived intangible asset is impaired, the Company would be required to calculate the fair value of the asset for an impairment test. Impairment loss is recognized if the carrying amount of the asset exceeds its fair value. A qualitative assessment considers macroeconomic and other industry-specific factors, such as trends in short-term and long-term interest rates and the ability to access capital, and company specific factors such as trends in revenue generating activities, and merger or acquisition activity. If the Company elects to bypass qualitatively assessing its indefinite-lived intangible assets, or it is not more likely than not that the fair value of the intangible asset exceeds its carrying value, management estimates the fair value of the intangible asset and compares it to the carrying value. The estimated fair value of the intangible asset is established using an income approach based on a discounted cash flow model that includes significant assumptions about the future operating results and cash flows of the intangible asset or assets. Goodwill Goodwill represents the excess of the purchase price as compared to the fair value of net assets acquired and liabilities assumed. Goodwill is not amortized, but is tested for impairment annually or when indications of impairment exist. We can elect to qualitatively assess goodwill for impairment if it is more likely than not that the fair value of a reporting unit exceeds its carrying value. Impairment exists when the carrying amount, including goodwill, of the reporting unit exceeds its fair value, resulting in an impairment charge for this excess (not to exceed the carrying amount of the goodwill). Our annual impairment testing date is October 1. The impairment, if determined, is recorded within Operating expenses in the Condensed Consolidated Statements of Operations and Comprehensive Income (Loss) in the period the determination is made. There were no impairments recorded during the periods presented. Contingent Earn-out Consideration Business combinations may include contingent earn-out consideration as part of the purchase price under which the Company will make future payments to the seller upon the achievement of certain milestones. The fair value of the contingent earn-out consideration is estimated as of the acquisition date at the present value of the expected contingent payments and is subsequently remeasured at each balance sheet date. Two methodologies may be considered in the valuation: the scenario-based model (“SBM”) and Monte Carlo simulation. The SBM relies on multiple outcomes to estimate the likelihood of future payoff of the contingent consideration. The resulting earnout payoff is then probability-weighted and discounted at an appropriate risk adjusted rate in order to arrive at the present value of the expected earnout payment. The Monte Carlo simulation is used to value the non-linear contingent considerations based on projected financial metrics. Each trial of the Monte Carlo simulation draws a value from the assumed distribution for the underlying metric. The earnout payoff for each simulation trial is calculated based on that particular simulated path for the underlying metrics and then discounted to present value using the risk-free rate, adjusted for counterparty credit risk. The value of the earnout is estimated as the average value from all simulation trials. The fair value estimates use unobservable inputs that reflect our own assumptions as to the ability of the acquired business to meet the targeted benchmarks and discount rates used in the calculations. The unobservable inputs are defined in ASC Topic 820, “Fair Value Measurements and Disclosures,” as Level 3 inputs. We review the probabilities of achievement of the earnout milestones to determine impact on the fair value of the earnout consideration on a quarterly basis over the earn-out period. Actual results are compared to the estimates and probabilities of achievement used in our forecasts. Should actual results of the acquired business increase or decrease as compared to our estimates and assumptions, the estimated fair value of the contingent earn-out consideration liability will increase or decrease, up to the contractual limit, as applicable. Changes in the estimated fair value of the contingent earn-out consideration are recorded in other (expense) income in the Consolidated Statements of Operations and Comprehensive (Loss) Income and are reflected in the period in which they are identified. Changes in the estimated fair value of the contingent earn-out consideration may materially impact or cause volatility in our operating results. Revenue Recognition Revenue is recorded, net of estimated losses for bad debts, when our performance obligation is satisfied which is when our customers take title of the product, and typically when the product is used in surgery. As such, the timing of revenue recognition may differ from the timing of invoicing to our customers. We have recorded unbilled accounts receivable related to this timing difference of $ 3,987 and $ 3,637 as of September 30, 2022 and December 31, 2021 , respectively. Accounting Pronouncements Issued Not Yet Adopted In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842) (“ASU 2016-02”), which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e., lessees and lessors). The new standard requires lessees to apply a dual approach, classifying leases as either finance or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method or on a straight-line basis over the term of the lease, respectively. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term of greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases today. ASU 2016-02 supersedes the previous leases standard, ASC 840, Leases. ASU 2016-02, as subsequently amended for various technical issues, is effective for emerging growth companies following private company adoption dates in fiscal years beginning after December 15, 2021, and interim periods with fiscal years beginning after December 15, 2022. The Company is currently evaluating the new guidance, but does not believe it will have a material impact on the Consolidated Financial Statements. In June 2016, the FASB issued ASU 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”), which requires entities to estimate all expected credit losses for certain types of financial instruments, including trade receivables, held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. The updated guidance also expands the disclosure requirements to enable users of financial statements to understand the entity’s assumptions, models and methods for estimating expected credit losses over the entire contractual term of the instrument from the date of initial recognition of that instrument. ASU 2016-13, as subsequently amended for various technical issues, is effective for emerging growth companies following private company adoption dates for fiscal years, and for interim periods within those fiscal years, beginning after December 15, 2022, with early adoption permitted. The Company is currently evaluating the new guidance to determine the impact it will have on the Consolidated Financial Statements. In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) (“ASU 2019-12”), which is part of the FASB’s overall simplification initiative to reduce the costs and complexity of applying accounting standards while maintaining or improving the usefulness of the information provided to users of financial statements. ASU 2019-12 simplifies accounting guidance for intra-period allocations, deferred tax liabilities, year-to-date losses in interim periods, franchise taxes, step-up in tax basis of goodwill, separate entity financial statements, and interim recognition of tax laws or rate changes. ASU 2019-12 is effective for emerging growth companies following private company adoption dates in fiscal years beginning after December 15, 2021, and interim periods within fiscal years beginning after December 15, 2022, with early adoption permitted. The adoption of this guidance is not expected to have a significant impact on the Company's Consolidated Financial Statements and related disclosures.

Business Combinations

Business Combinations	9 Months Ended
	Sep. 30, 2022
Business Combinations [Abstract]
Business Combinations	NOTE 3. BUSINESS COMBINATIONS Disior On January 10, 2022 ("Disior Acquisition Date"), the Company entered into a Securities Purchase Agreement (“SPA”) with Disior LTD. (“Disior”) and acquired 100 % of the outstanding equity of Disior (the "Disior Acquisition"). Disior is a leading three-dimensional analytics pre-operative planning software company based in Helsinki, Finland, focused on the complex foot and ankle anato my. The Disior Acquisition allowed the Company to broaden its capabilities within the pre-operative and intra-operative stages of the foot and ankle care and expand the Company's Smart 28 ecosystem. The aggregate purchase price of the Disior Acquisition was approximately $ 26,246 inclusive of an earn-out provision with a fair value of $ 6,550 and certain net working capital adjustments and deferred payments totaling a net payable of $ 222 . The SPA provided for potential earn-out consideration to the seller in connection with the achievement of certain milestones with various expiration dates through the second anniversary of the Disior Acquisition Date. The earn-out has a maximum payment not to exceed $ 8,000 in the aggregate. If an individual milestone is not met by the specified milestone expiration date, the earn-out related to that specific milestone will not be paid. The acquisition was primarily funded by a $ 20,000 draw on the Company's term loan. The Company has accounted for the acquisition of Disior under ASC Topic 805, Business Combinations (“ASC 805”). Disior’s results of operations are included in the Condensed Consolidated Financial Statements beginning after January 10, 2022, the Disior Acquisition Date. The following table summarizes the purchase price: Consideration Paid Cash consideration $ 19,696 Contingent consideration 6,550 Total consideration $ 26,246 Acquisition-related costs, which consisted of fees incurred for advisory, legal, and accounting services, w ere $ 0 and $ 761 for the three and nine months ended September 30, 2022, respectively, and were included in Selling, general and administrative expenses in the C ompany’s Condensed Consolidated Statements of Comprehensive Loss. No acquisition-related costs were incurred during the three and nine months ended September 30, 2021. Certain amounts recorded in connection with the Disior Acquisition are still considered preliminary as we finalize our fair value estimates and provisional amounts. Provisional amounts include items related to working capital adjustments, identified intangibles, and earnout consideration. During the measurement period, which is up to one year from the Disior Acquisition Date, we may adjust provisional amounts that were recognized at the Disior Acquisition Date to reflect new information obtained about facts and circumstances that existed as of the Disior Acquisition Date. The following table summarizes the fair values of the assets acquired and liabilities assumed as of the Disior Acquisition Date: Measurement Preliminary allocation period adjustments Adjusted allocation Assets acquired: Cash and cash equivalents $ 1,192 $ — $ 1,192 Other current assets 410 — 410 Intangible assets 4,900 — 4,900 Goodwill 20,343 303 20,646 Total assets acquired $ 26,845 $ 303 $ 27,148 Liabilities assumed: Accruals and other current liabilities $ 615 $ — $ 615 Deferred tax liabilities, net 287 — 287 Total liabilities assumed $ 902 — $ 902 Net assets acquired $ 25,943 $ 303 $ 26,246 Based on an adjustment to working capital as defined by the purchase agreement and included as part of the purchase price in the final settlement statement, we made one measurement period adjustment of $ 303 as of September 30, 2022. Identified intangible assets consist of tradenames and developed technology. The fair value of each were determined with the assistance of an external valuation specialist using a combination of the income, market, cost approach, and relief from royalty rate method, in accordance with ASC 805. The purchase consideration was allocated to the identifiable net assets acquired based on estimated fair values at the date of the acquisition. The purchase consideration and its allocation are preliminary and may be adjusted to reflect new information obtained about facts and circumstances that existed as of the acquisition date. The excess of the fair value of the purchase consideration over the fair value of the identifiable assets and liabilities, if any, was recorded as goodwill. The goodwill is attributable to the expected synergies with the Company’s existing operations. The useful life on intangible assets was determined by management to be in line with the Company’s policy on intangible assets. Both determinations are outlined in the table below: Fair Value Estimated Useful Life Developed Technology $ 4,500 12 Tradenames 400 Indefinite $ 4,900 The entire amount of the purchase price allocated to goodwill will not be deductible for income tax purposes under the Finnish Income Tax Act. There is no supplemental proforma presentation of operating results of the acquisition of Disior due to the immaterial impact on the Company’s Consolidated operations for the three and nine months ended September 30, 2021 . Additive Orthopaedics On May 28, 2021 (“Closing Date”), the Company entered into an Asset Purchase Agreement (“APA”) with Additive Orthopaedics, LLC (“Additive” or “Seller”) and completed an acquisition of substantially all of the operating and intangible assets of Additive, for total cash consideration of $ 15,000 at closing. The APA also provided for potential earn-out consideration to the Seller in connection with the achievement of certain milestones, including both project-based and revenue-based milestones, with various expiration dates through the fourth anniversary of the Closing Date. The earn-out has a maximum payment not to exceed $ 9,500 , in the aggregate. If an individual milestone is not met by the specified milestone expiration date, the earn-out related to that specific milestone will not be paid. The contingent earn-out consideration had an estimated fair value of $ 2,870 as of the Closing Date. Acquisition related costs were approximately $ 524 during the nine months ended September 30, 2021 and were included in Selling, general, and administrative expenses in the Consolidated Statements of Operations and Comprehensive Loss. No acquisition related costs were incurred during the three and nine months ended September 30, 2022. Additive’s 3D-printed Patient Specific Talus Spacer is the only U.S. Food and Drug Administration-approved patient-specific total talus replacement implant authorized in the U.S. for the treatment of avascular necrosis. The acquisition of Additive allowed the Company to further expand into the patient specific implant market. The Company has accounted for the acquisition of Additive under ASC Topic 805, Business Combinations (“ASC 805”). Additive’s results of operations are included in the Condensed Consolidated Financial Statements beginning after May 28, 2021, the acquisition date. The following table summarizes the purchase consideration transferred in connection with the acquisition of Additive and consists of the following: Consideration Paid Cash consideration $ 15,000 Contingent consideration 2,870 Total consideration $ 17,870 The following table summarizes the fair values of the assets acquired and liabilities assumed as of the Closing Date: Assets acquired: Accounts receivable $ 761 Inventory 113 Intangible assets 11,560 Goodwill 6,329 Total Assets Acquired 18,763 Liabilities assumed: Accounts payable 796 Accrued expenses $ 97 Total Liabilities Assumed 893 Net assets acquired $ 17,870 Identified intangible assets consist of noncompete arrangements, customer relationships, and developed technology. The fair value of each were determined with the assistance of an external valuation specialist using a combination of the income, market, and asset approach, in accordance with ASC 805. The purchase consideration was allocated to the identifiable net assets acquired based on estimated fair values at the date of the acquisition. The excess of the fair value of the purchase consideration over the fair value of the identifiable assets and liabilities, if any, was recorded as goodwill. The goodwill is attributable to the expected synergies with the Company’s existing operations. The entire amount of the purchase price allocated to goodwill will be deductible for income tax purposes pursuant to Internal Revenue Code Section 197 over a 15-year period. The useful life determination was made by management in line with the Company’s policy on assets. Both determinations are outlined in the table below: Fair Value Estimated Useful Life Noncompete arrangements $ 30 3 Customer relationships 240 3 Developed technology 11,290 12 $ 11,560 There is no supplemental proforma presentation of operating results of the acquisition of Additive due to the immaterial impact on the Company’s Consolidated operations for the three and nine months ended September 30, 2021 .

Goodwill and Intangible Assets

Goodwill and Intangible Assets	9 Months Ended
	Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	NOTE 4. GOODWILL AND INTANGIBLE ASSETS Goodwill As of September 30, 2022 and December 31, 2021, goodwill was $ 26,975 and $ 6,329 , respectively; the activity is as follows: Balance, December 31, 2021 $ 6,329 Acquisitions 20,646 Balance, September 30, 2022 $ 26,975 Intangibles Intangible assets as of September 30, 2022 are as follows: Estimated Useful Life Gross Carrying Amount Accumulated Amortization Net Carrying Amount Trademarks and tradenames, indefinite-lived Indefinite $ 853 $ — $ 853 Patents, definite-lived 15.1 6,466 2,301 4,165 Customer relationships 3 - 7 1,733 201 1,532 Developed technology 12 15,790 1,507 14,283 Other intangibles 3 30 13 17 Total intangible assets, net $ 24,872 $ 4,022 $ 20,850 Intangible assets, excluding the Disior intangible assets, increa sed $ 1,720 during the nine months ended September 30, 2022 primarily due to the purchase of new patents and customer relationships. Intangible assets as of December 31, 2021 , are as follows: Estimated Useful Life Gross Carrying Amount Accumulated Amortization Net Carrying Amount Trademarks, indefinite-lived Indefinite $ 413 $ — $ 413 Patents, definite-lived 13.2 5,335 1,133 4,202 Customer relationships 3 - 7 1,167 47 1,120 Developed technology 12 11,290 549 10,741 Other intangibles 3 35 6 29 Total intangible assets, net $ 18,240 $ 1,735 $ 16,505 Amortization expense is included in Selling, general, and administrative expenses and was $ 440 a nd $ 494 for the three months ended September 30, 2022 and 2021, respectively. Amortization expense for the nine months ended September 30, 2022 and 2021 totaled $ 2,290 and $ 635 , respectively. Expected future amortization expense is as follows: 2022 (Remaining) $ 424 2023 1,695 2024 1,643 2025 1,604 2026 1,604 2027 1,603 No impairment charges related to intangibles and goodwill were recorded for the three and nine months ended September 30, 2022 and 2021 .

Contingent Earn-Out Considerati

Contingent Earn-Out Consideration	9 Months Ended
	Sep. 30, 2022
Business Combinations [Abstract]
Contingent Earn-Out Consideration	NOTE 5. CONTINGENT EARN-OUT CONSIDERATION The following table provides a reconciliation of our Level 3 earn-out liabilities for the nine months ended September 30, 2022: Balance, December 31, 2021 $ 2,310 Acquisition date fair value of earn-out liabilities 6,550 Achieved milestone paid ( 500 ) Change in fair value of earn-out liabilities ( 575 ) Balance, September 30, 2022 $ 7,785 The current portion of contingent earn-out liability is included in Other-current liabilities and the non-current portion is included in Other long-term liabilities on the Condensed Consolidated Balance Sheets. As of September 30, 2022, the current portion was $ 6,878 . During the three and nine months ended September 30, 2022, we reassessed the estimate of the earn-out liabilities which resulted in a decrease o f $ 35 and $ 575 , respectively, cl assified as other income within the Condensed Consolidated Statement of Operations and Comprehensive Loss. In addition, we completed and paid our second project milestone for Additive Orthopaedics as of September 30, 2022.

Debt

Debt	9 Months Ended
	Sep. 30, 2022
Debt Disclosure [Abstract]
Debt	NOTE 6. DEBT Long-term debt as of September 30, 2022 and December 31, 2021 consists of the following: September 30, 2022 December 31, 2021 MidCap Term Loan $ 30,000 $ 10,000 Bank of Ireland Note Payable 112 245 Vectra Term Loan Facility 15,733 — $ 45,845 $ 10,245 Less: deferred issuance costs ( 2,618 ) ( 2,616 ) Total debt, net of issuance costs 43,227 7,629 Less: current portion ( 735 ) ( 153 ) Long-term debt, net, less current maturities $ 42,492 $ 7,476 MidCap Credit Agreements On May 6, 2021, the Company entered into a new credit agreement with MidCap Financial Trust to provide a total of $ 70,000 including up to a $ 30,000 revolving loan (“MidCap Revolving Loan”) and up to a $ 40,000 term loan (“MidCap Term Loan”), secured by substantially all the Company’s assets, debt, and equity (“MidCap Credit Agreements”). The MidCap Term Loan is comprised of two tranches, the first of which provides a commitment amount of $ 10,000 , and the second a commitment of $ 30,000 . The MidCap Term Loan and Midcap Revolving Loan bear a variable interest rate of LIBOR plus 6 % and LIBOR plus 3 %, respectively, and mature on the earlier of May 1, 2026 or a change in control event (the "Termination Date"). The entire principal balances of the MidCap Revolving Loan and MidCap Term Loan are due on the Termination Date. Interest payments are payable monthly, with optional principal prepayments allowed under the MidCap Credit Agreements. The Midcap Loan Agreements require us to maintain certain financial covenants as defined in the Midcap Loan Agreements. Total debt issuance costs associated with the MidCap Credit Agreements was $ 3,288 . Amortization expense associated with such debt issu ance costs totaled $ 165 and $ 409 for the three and nine months ended September 30, 2022 , respectively, and $ 192 and $ 318 for the three and nine months ended September 30, 2021, respectively, and is included in Interest expense on the Condensed Consolidated Statements of Operations and Comprehensive Loss. Vectra Bank Colorado Loan Agreements On March 27, 2020, the Company entered into an Amended and Restated Loan Agreement (the “Vectra Loan Agreement”) with Vectra Bank Colorado. The Vectra Loan Agreement refinanced the Company's existing Term Loan and existing Buyout Loan into a single term loan in the aggregate principal amount of $ 6,802 (the “2020 Term Loan”) and increased the maximum principal amount of the existing Revolving Loan to $ 15,000 (the 2020 Revolving Loan and together with the 2020 Term Loan, “2020 Loans”). The maturity date for both loans was September 30, 2020 and it was subsequently extended to October 5, 2023 . The Vectra Loan Agreement was secured by substantially all the Company’s assets. The Vectra Loan Agreement contained financial and other customary covenants and bore an interest rate of 3 %. The Company repaid the 2020 Loans in 2021 in connection with entering into the Midcap Term Loan Agreement described above. On March 24, 2022 the Company entered into a secured term loan facility (the “Zions Facility”) with Zions Bancorporation, N.A. dba Vectra Bank Colorado in the principal amount of $ 16,000 . The loans under the Zions Facility (i) bear interest at a variable rate per annum equal to the sum of (a) a one-month Term SOFR based rate, plus (b) 1.75 %, adjusted on a monthly basis and (ii) m ature on March 24, 2037 . Principal and interest payments are payable monthly , with optional prepayments allowed without premium or penalty. Total de bt issuance costs associated with the Zions Facility was $ 271 . Amortization expense associated with such debt issuance costs totaled $ 4 and $ 9 for the three and nine months ended September 30, 2022, respectively. Bank of Ireland Note Payable On June 12, 2020, the Company entered a term loan with Bank of Ireland in a principal amount of $ 474 (the “Bank of Ireland Note Payable”). The Bank of Ireland Note Payable bears an annual interest rate of 4 % and is due in equal monthly installments over a 36 -month period, including interest. The Bank of Ireland Note Payable contains financial and other customary covenants.

Convertible Preferred Series Eq

Convertible Preferred Series Equity and Stockholders' Equity	9 Months Ended
	Sep. 30, 2022
Stockholders' Equity Note [Abstract]
Convertible Preferred Series Equity And Stockholders' Equity	NOTE 7. CONVERTIBLE PREFERRED SERIES EQUITY AND STOCKHOLDERS’ EQUITY On October 8, 2021, the Company filed a certificate of amendment with the Secretary of State of the State of Delaware, pursuant to which, the Company effected a 5 -for-1 forward stock split of the Company’s authorized, issued and outstanding common stock, the Company’s authorized, issued and outstanding Series A convertible preferred stock, and the Company’s authorized, issued and outstanding Series B convertible preferred stock (the “Stock Split”). All share amounts and per share data presented in the accompanying Consolidated Financial Statements have been retrospectively adjusted to reflect the forward stock split for all periods presented. Under its Amended and Restated Certificate of Incorporation, the Company has a total of 310,000,000 shares of capital stock authorized for issuance, consisting of 300,000,000 shares of common stock, par value of $ 0.01 per share, and 10,000,000 new shares of convertible preferred stock, par value of $ 0.0001 per share. Common Stock In October 2021, the Company completed its initial public offering ("IPO"), in which it issued and sold 8,984,375 shares of its common stock at the public offering price of $ 16.00 per share, including 1,171,875 shares of its common stock upon exercise of the underwriters' option to purchase additional shares. Series A Convertible Preferred Stock In December 2011, the Company issued an aggregate of 3,250,005 shares of its Series A convertible preferred stock at a price of $ 0.30769 per share, resulting in total proceeds of approximately $ 1,000 . In February and November 2012, the Company issued an aggregate of 10,562,495 shares of its Series A convertible preferred stock at a price of $ 0.30769 per share, resulting in total proceeds of approximately $ 3,250 . In connection with the IPO, all of the shares of the Company’s outstanding Series A convertible preferred stock automatically converted into an aggregate of 13,812,500 shares of the common stock. Convertible Series B Preferred Stock In July 2020, the Company issued an aggregate of 6,608,700 shares of its Series B convertible preferred stock at a price of $ 5.75 per share, resulting in total net proceeds of approximately $ 36,030 , net of issuance costs of $ 1,970 . In connection with the IPO, all of the shares of the Company’s outstanding Series B convertible preferred stock automatically converted into an aggregate of 6,608,700 shares of the common stock. Pursuant to the terms of the Series B convertible preferred stock offering, the $ 2,328 of cash dividends accrued as of October 19, 2021 were cancelled upon conversion of the Series B preferred stock into common stock. Treasury Stock The Company purchased a total o f 0 and 85,050 shares of its common stock during the nine months ended September 30, 2022 and 2021, respectively, for $ 0 and $ 561 , respectively. The Company did no t purchase any shares of its common stock during the three months ended September 30, 2022 and 2021 . All repurchased shares were recorded in Treasury stock at cost.

Earnings (loss) Per Share

Earnings (loss) Per Share	9 Months Ended
	Sep. 30, 2022
Earnings Per Share [Abstract]
Earnings (Loss) Per Share	NOTE 8. EARNINGS (LOSS) PER SHARE Basic net (loss) income per share is computed by dividing net (loss) income attributable to common stockholders (the numerator) by the weighted average number of common stock outstanding for the period (the denominator). Diluted net income per common stock attributable to common stockholders is computed by dividing net income by the weighted average number of common stocks outstanding during the period adjusted for the dilutive effects of common stock equivalents using the treasury stock method or the method based on the nature of such securities. In periods when losses from continuing operations are reported, the weighted-average number of common stock outstanding excludes common stock equivalents because their inclusion would be anti-dilutive. The computation of net loss per share for the three and nine months ended September 30, 2022 and 2021, respectively was as follows: Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Net loss attributable to common stockholders Net loss attributable to Paragon 28, Inc. $ ( 9,724 ) $ ( 5,107 ) $ ( 28,563 ) $ ( 7,518 ) Less: Dividends on Series B convertible preferred stock — ( 574 ) — ( 1,516 ) Net loss attributable to common stockholders $ ( 9,724 ) $ ( 5,681 ) $ ( 28,563 ) $ ( 9,034 ) Weighted-average common stock outstanding: Basic 76,850,949 47,005,334 76,595,118 46,926,344 Diluted 76,850,949 47,005,334 76,595,118 46,926,344 Loss per share: Basic $ ( 0.13 ) $ ( 0.12 ) $ ( 0.37 ) $ ( 0.19 ) Diluted $ ( 0.13 ) $ ( 0.12 ) $ ( 0.37 ) $ ( 0.19 ) The following outstanding potentially dilutive securities were excluded from the calculation of diluted net loss per share attributable to common stockholders because their impact would have been antidilutive for the period presented: As of September 30, 2022 2022 2021 Stock options 7,304,770 5,307,200 Restricted stock units 144,547 — Series A convertible preferred stock — 13,812,500 Series B convertible preferred stock — 6,608,700

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 30, 2022
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	NOTE 9. STOCK-BASED COMPENSATION Employee Stock Purchase Plan The Employee Stock Purchase Plan (“ESPP”) was adopted by the Company’s Board of Directors on October 8, 2021. The 2021 Plan was adopted by the Company’s stockholders on October 19, 2021 and became effective on the date prior to the first date of the effectiveness of the registration statement on Form S-1 filed by the Company. The ESPP initially provides participating employees with the opportunity to purchase up to an aggregate of 1,329,040 shares of the Company’s common stock at 85 % of the market price at the lesser of the date the purchase right is granted or exercisable. The Company currently holds offerings consisting of six month periods commencing on January 1 and July 1 of each calendar year, with a single purchase date at the end of the purchase period on June 30 and December 31 of each calendar year. The ESPP provides that the number of shares reserved and available for issuance will automatically increase each January 1, beginning on January 1, 2022 and ending on January 1, 2031, by the lesser of 1 % of all classes of the Company’s common stock outstanding on the immediately preceding December 31, or such smaller number of shares as determined by the Company’s Board or the committee. On January 1, 2022, the number of shares reserved and available for issuance for the ESPP was increase d by 764,473 shares. As of September 30, 2022 , 2,076,453 shares remained available for issuance . Eligible employees can contribute up to 15 % of their gross base earnings for purchases under the ESPP through regular payroll deductions. Purchase of shares under the ESPP is limited for each employee at $ 25,000 worth of the Company’s shares of common stock (determined using the lesser of (i) the market price of a share of common stock on the first day of an applicable purchase period and (ii) the market price of a share of comm on stock on the purchase date) for each calendar year in which a purchase right is outstanding. During the nine months ended September 30, 2022 and 2021, the Company issued 17,060 and 0 shares, respectively, upon exercise of purchase rights. The Company recognizes compensation expense on a straight-line basis over the service period. During the three months ended September 30, 2022, and 2021, the Company recognized $ 100 and $ 0 , respectively, of compensation expense related to the ESPP. During the nine months ended September 30, 2022 and 2021, the Company recognized $ 100 and $ 0 , respectively, of compensation expense related to the ESPP. Below are the assumptions used for the nine months ended September 30, 2022 in determining the fair value of shares under the ESPP. No shares were issued duri ng the nine months ended September 30, 2021. Nine Months Ended September 30, 2022 Expected volatility 70.3 % Expected dividends — Expected term (in years) 0.50 Discount rate 10.0 % Risk-free rate 2.79 % 2021 Incentive Award Plan The 2021 Incentive Award Plan (“2021 Plan”) was adopted by the Company’s Board of Directors on October 8, 2021. The 2021 Plan was adopted by the Company’s stockholders on October 19, 2021 and became effective on the date prior to the first date of the effectiveness of the registration statement on Form S-1 filed by the Company. The 2021 Plan authorizes the Company to issue an initial aggregate maximum number of shares of common stock equal to (i) 7,641,979 shares plus (ii) the number of shares that are available for issuance under the 2011 Plan plus (iii) any shares that are subject to 2011 Plan that become available for issuance (via expiration, forfeitures, etc.) plus (iv) an increase commencing on January 1, 2022 and continuing annually on the anniversary thereof through January 1, 2031, equal to the lesser of (a) 5 % of the shares of all classes of the Company’s common stock outstanding on the last day of the immediately preceding calendar year or (b) such smaller number of shares as determined by the Company’s Board or the committee. On January 1, 2022, the number of shares reserved and available for issuance for the 2021 Plan was increased by 3,822,364 shares. As of September 30, 2022 , the Company had reserved 10,760,114 shares of common stock for future grants. Stock Options There were 359,054 and 816,250 options granted during the nine months ended September 30, 2022 and 2021, respectively. During the three months ended September 30, 2022 and 2021, the Company recognize d $ 2,254 a nd $ 1,032 , respectively, of compensation expense related to stock options. During the nine months ended September 30, 2022 and 2021, the Company recognized $ 6,351 and $ 2,747 , respectively, of compensation expense related to stock options. Stock-based compensation expenses are recorded in Selling, general and administrative expenses in the Condensed Consolidated Statements of Operations and Comprehensive Loss. The Company received cash in the amount of $ 1,923 an d $ 91 from the exercise of stock options for the three months ended September 30, 2022 and 2021, respectively. The Company received cash in the amount of $ 2,224 and $ 442 from the exercise of stock options for the nine months ended September 30, 2022 and 2021, respectively. The tax benefit from equity options exercised were $ 436 and $ 19 for the three months ended September 30, 2022 and 2021 , respectively. The tax benefit from equity options exercised were $ 504 and $ 93 for the nine months ended September 30, 2022 and 2021, respectively. During the first nine months of 2022, the Company granted certain officers and contractors of the Company an aggregate of 311,840 tim e-based options at a weighted average strike price o f $ 16.08 . During the first nine months of 2021, the Company granted certain officers and contractors of the Company an aggregate of 816,250 time-based options at a weighted average strike price of $ 6.60 . Below are the assumptions used for the nine months ended September 30, 2022 and 2021 in determining the fair value of each option award: Nine Months Ended September 30, 2022 2021 Expected volatility 52.0 % 52 % - 54 % Expected dividends — — Expected term (in years) 5.60 5.75 - 6.25 Risk-free rate 2.01 % 0.47 % - 0.93 % The aggregate intrinsic value of the options outstanding as of September 30, 2022 is $ 59,651 . The aggregate intrinsic value of vested and exercisable options as of September 30, 2022 is $ 43,280 . The weighted average fair value of options granted during the nine months ended September 30, 2022 and 2021 was $ 9.26 a nd $ 5.04 , respectively, on the dates of grant. As of September 30, 2022, there was approxi mately $ 21,662 total unrecognized compensation cost related to non-vested stock option compensation arrangements, which is expected to be recognized over a weighted average period of 3.03 years. The following summarizes the Company’s stock option plan and the activity for the nine months ended September 30, 2022: Shares Weighted-Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Outstanding, December 31, 2021 7,953,018 $ 9.02 8.16 Granted 359,054 16.08 Exercised or released ( 617,578 ) 3.89 Forfeited or expired ( 389,724 ) 11.84 Outstanding, September 30, 2022 7,304,770 $ 9.66 7.64 Exercisable, September 30, 2022 3,324,831 $ 4.80 6.17 Vested and expected to vest at September 30, 2022 7,304,770 $ 9.66 7.64 Restricted Stock Units The following summarizes the Company’s restricted stock units activity for the nine months ended September 30, 2022. Restricted Stock Units Weighted-Average Fair Value Outstanding, December 31, 2021 79,886 $ 17.84 Granted 87,641 17.12 Vested ( 14,062 ) 16.00 Forfeited or expired ( 8,918 ) 16.82 Outstanding, September 30, 2022 144,547 $ 17.64 Vested and expected to vest at September 30, 2022 144,547 $ 17.64 During the three and nine months ended September 30, 2 0 21 , no Restricted Stock Units (“RSUs”) were granted, vested or forfeited. The grant date fair value for RSUs is the market price of the common stock on the date of grant. The total fair value of RSUs vested during the three and nine months ended September 30, 2022 was $ 0 and $ 225 , respectively. The total fair value of RSUs vested during the three and nine months ended September 30, 2021 was $ 0 . During the three and nine months ended September 30, 2022, the Company re cognized $ 332 an d $ 701 , respectively, of compensation expense related to RSUs. There was no compensation expense related to RSUs recognized during the three and nine months ended September 30, 2021. Stock-based compensation expenses are recorded in Selling, general and administrative expenses in the Condensed Consolidated Statements of Operations and Comprehensive Loss. As of September 30, 2022 , there was approximately $ 1,997 total unrecognized compensation cost related to non-vested RSUs, which is expected to be recognized over a weighted average period of 1.90 years.

Employee Benefit Plan

Employee Benefit Plan	9 Months Ended
	Sep. 30, 2022
Retirement Benefits [Abstract]
Employee Benefit Plan	NOTE 10. EMPLOYEE BENEFIT PLAN The Company sponsors a defined contribution plan for eligible employees who are 21 years of age with three months of service can voluntarily contribute up to 100 % of their eligible compensation. The Company has elected a Safe Harbor plan in which the Company must contribute 3 % of eligible compensation. In addition, the Company may make discretionary contributions which are determined and authorized by the Board of Directors each plan year. The Company made matching contributions to its employee benefit plan of $ 266 and $ 129 for the three months ended September 30, 2022 and 2021 , respectively, and $ 734 and $ 425 for the nine months ended September 30, 2022 and 2021 , respectively, which are recorded in Selling, general and administrative expenses in the Condensed Consolidated Statements of Operations and Comprehensive Loss.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Income Taxes	NOTE 11. INCOME TAXES The effective tax rates for the nine months ended September 30, 2022 and 2021 are as follows: Nine Months Ended September 30, 2022 2021 Effective tax rate ( 1.057 %) ( 6.300 %) For the three months ended September 30, 2022 and 2021 , the Company recorded tax expense of $ 201 and $ 105 , respectively. For nine months ended September 30, 2022 and 2021 , the Company recorded tax expense of $ 306 and $ 437 , respectively. The Company’s 2022 and 2021 income tax expense and rates differed from the amount of income tax determined by applying the U.S. Federal income tax rate to pre-tax income primarily as a result of the U.S., Finland, Germany and Italy jurisdictions that have a full valuation allowance recorded on deferred tax assets. In addition, the tax rate is lower than the U.S. statutory federal tax rate as a result of foreign earnings that are taxed at lower tax rates. The Company continues to monitor the realization of its deferred tax assets and assesses the need for a valuation allowance. The Company analyzes available positive and negative evidence to determine if a valuation allowance is needed based on the weight of the evidence. This objectively verifiable evidence includes the current & prior two years' profit and loss positions after considering pre-tax book income plus or minus permanent adjustments as well as other positive & negative evidence available. This process requires management to make estimates, assumptions, and judgments that are uncertain in nature. The Company has established a valuation allowance with respect to deferred tax assets in the U.S., Finland, Germany, and Italy and continues to monitor and assess potential valuation allowances in all its jurisdictions. The CHIPS and Science Act of 2022 (CHIPS) and the Inflation Reduction Act (IRA) of 2022 were recently signed into law by President Biden on August 9, 2022 and August 16, 2022, respectively. The legislation introduces new options for monetizing certain credits, a corporate alternative minimum tax, and a stock repurchase excise tax. The Company is currently evaluating the impact of the CHIPS and IRA Act(s), but at present does not expect that the any of the provisions included in the Act(s) would result in a material impact to the Company’s deferred tax assets, liabilities or income taxes payable.

Commitments And Contingencies

Commitments And Contingencies	9 Months Ended
	Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	NOTE 12. COMMITMENTS AND CONTIGENCIES Legal Proceedings We are involved in various lawsuits, claims, inquiries, and other regulatory and compliance matters, most of which are routine to the nature of our business. When it is probable that a loss will be incurred and where a range of the loss can be reasonably estimated, the best estimate within the range is accrued. When the best estimate within the range cannot be determined, the low end of the range is accrued. The ultimate resolution of these claims could affect future results of operations should our exposure be materially different from our estimates or should liabilities be incurred that were not previously accrued. Potential insurance reimbursements are not offset against potential liabilities. During 2018 Wright Medical Technology, Inc. (“Wright Medical”) sued the Company, claiming patent infringement targeting essentially all of our patents. The case was subsequently updated to include trade secret misappropriations. We have filed motions to dismiss Wright's allegations and have a trial date set for June 2023. We currently believe that we have substantial and meritorious defenses to Wright Medical’s claims and intend to vigorously defend our position, including through the trial and appellate stages if necessary. As the case is ongoing, we are unable to determine the likelihood of an outcome or estimate a range of reasonably possible settlement, if any. Accordingly, we have not made an accrual for any possible loss. The outcome of any litigation, however, is inherently uncertain, and an adverse judgment or settlement in the Wright Medical proceeding, if any, could materially and adversely affect our business, financial position and results of operations or cash flows. In addition to Wright Medical’s claims set forth above, we received, in December 2021, an additional complaint from Wright Medical covering patents separate and apart from the Wright Asserted Patents. We do not at this time believe this complaint represents a material liability to our company. We have incurred, and expect that we will continue to incur, significant expense in defending against the allegations made by Wright Medical.

Related Party Transactions

Related Party Transactions	9 Months Ended
	Sep. 30, 2022
Related Party Transactions [Abstract]
Related Party Transactions	NOTE 13. RELATED PARTY TRANSACTIONS The Company has a license agreement dated July 1, 2017 for certain intellectual property with an entity that is affiliated with one of the directors of the Company, under which the Company pays a royalty of four percent ( 4 %) of net revenue related to the licensed intellectual property for the 15 years following the date of first sale, including a minimum annual payment of $ 250 . The term of the agreement is 20 years , and automatically renews for five-year periods thereafter. Payments to the entity under this license agreement totaled $ 28 and $ 29 for the three months ended September 30, 2022 and 2021, respectively. Payments to the entity under this license agreement totale d $ 221 and $ 236 for the nine months ended September 30, 2022 and 2021, respectively. Amounts payable to this entity as of September 30, 2022 and December 31, 2021 were $ 129 and $ 163 , respectively. The Company paid professional services fees to a related party totaling $ 0 and $ 148 for the three months ended September 30, 2022 and 2021, respectively, and such fees are included in Selling, general, and administrative expense in the Condensed Consolidated Statements of Operations and Comprehensive Loss. The Company paid professional services fees to a related party totaling $ 266 and $ 485 for the nine months ended September 30, 2022 and 2021, respectively. Amounts payable as of September 30, 2022 and December 31, 2021 to this related party were $ 184 and $ 66 , respectively.

Segment and Geographic Informat

Segment and Geographic Information	9 Months Ended
	Sep. 30, 2022
Segment Reporting [Abstract]
Segment and Geographic Information	NOTE 14. SEGMENT AND GEOGRAPHIC INFORMATION The following table represents total net revenue by geographic area, based on the location of the customer for the three and nine months ended September 30, 2022 and 2021, respectively. Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 United States $ 39,960 $ 31,882 $ 112,781 $ 92,014 International 6,046 3,969 17,094 12,675 Total net revenue $ 46,006 $ 35,851 $ 129,875 $ 104,689 No individual country with net revenue originating outside of the United States accounted for more than 10% of consolidated net revenue for three and nine months ended September 30, 2022 and 2021. The following table represents total non-current assets, excluding deferred taxes, by geographic area as of September 30, 2022 and December 31, 2021, respectively. September 30, 2022 December 31, 2021 United States $ 76,346 $ 51,809 International 30,070 3,206 Total assets $ 106,416 $ 55,015 With the acquisition of Disior, total non-current assets within both the United States and Finland exceed 10% of consolidated total assets as of September 30, 2022. No individual country with total non-current assets outside the United States accounted for more than 10% of the consolidated total assets as of December 31, 2021 .

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2022
Subsequent Events [Abstract]
Subsequent Events	NOTE 15. SUBSEQUENT EVENTS On October 21, 2022, the Company granted certain officers and management of the Company an aggregate of 852,556 Restricted Stock Units (RSUs) at a price of $ 17.77 based on the thirty day trailing average price under the 2021 Plan. All RSUs granted were time-based awards and vest over a four-year period. On November 1, 2022, the Company filed a Registration Statement on Form S-3 (the “Shelf Registration Statement”). The Shelf Registration Statement covers the offering and sale of up to $ 100,000 of the Company’s securities, including common stock, preferred stock, debt securities, warrants, purchase contracts and units, as well as up to 10,000 shares of common stock by certain selling securityholders, in one or more transactions from time to time, including an “at-the-market” offering under the Securities Act of 1933. The SEC declared the Shelf Registration Statement effective on November 7, 2022. On November 9, 2022, the Company entered into an amendment to the MidCap Revolving Loan with MidCap Funding IV Trust (the "Revolving Loan Agreement") and an amendment t o the MidCap Term Loan with MidCap Financial Trust (the “Term Loan Agreement” and together with the "Revolving Loan Agreement", “MidCap Credit Agreements”). The amendment to the Midcap Revolving Loan provides up to $ 50,000 in total borrowing capacity compared to up to $ 30,000 available previously. The MidCap amendments modified the MidCap Credit Agreements to include provisions related to the transition from the LIBOR Interest Rate plus Applicable Margin to the SOFR Interest Rate plus Applicable Margin, maintaining the Applicable Margin of 6 % under the MidCap Term Loan and increasing the Applicable Margin from 3 % to 3.75 % under the Midcap Revolving Loan. In addition, the MidCap amendments amended certain covenants, terms and provisions in the Midcap Credit Agreements to, among other things, modify the covenant levels for the Minimum Net Product Sales financial covenant and to remove the Minimum Consolidated EBITDA financial covenant. On November 10, 2022, the Company entered into the First Amendment to the Zions Facility with Zions Bancorporation, N.A. dba Vectra Bank Colorado. The amendment to the Zions Facility amends the financial covenants to require the Company to maintain (i) the Liquidity Ratio, if the Cash Flow as of the last day of any quarter measured on a trailing three month basis is less than or equal to $ 0 , and (ii) the Fixed Charge Coverage Ratio which will be calculated as of the last day of each quarter on a trailing four quarter basis, as well as a certain level of Liquidity, if the Cash Flow is greater than $ 0 . In addition, a Net Revenue Growth covenant was added which will be calculated as of the last day of each quarter on a year-over-year basis.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2022
Accounting Policies [Abstract]
Basis of Presentation and Consolidation	Basis of Presentation and Consolidation The accompanying Condensed Consolidated Financial Statements include the accounts of Paragon 28, Inc. and its subsidiaries, all of which are wholly-owned. The accompanying Condensed Consolidated Financial Statements have been prepared in conformity with accounting principles generally accepted in the U.S. (“U.S. GAAP”) and pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) for interim financial information. Accordingly, they do not include all of the information required by U.S. GAAP for complete financial statements. The interim Condensed Consolidated Financial Statements reflect all adjustments that are of a normal recurring nature and that are considered necessary for a fair representation of the results for the periods presented and should be read in conjunction with the audited Consolidated Financial Statements and notes thereto for the year ended December 31, 2021, which include a complete set of footnote disclosures, including our significant accounting policies. The audited Consolidated Financial Statements and notes thereto for the year ended December 31, 2021 are included in the Company’s Annual filing on Form 10-K filed with the SEC on March 8, 2022. The results for interim periods are not necessarily indicative of the results that may be expected for a full fiscal year or for any other future period. All intercompany balances and transactions have been eliminated in consolidation.
Use of Estimates	Use of Estimates The preparation of the financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Because future events and their effects cannot be determined with precision, actual results could differ significantly from these estimates. Any changes in these estimates will be reflected in the Company’s Condensed Consolidated Financial Statements. Significant items subject to such estimates and assumptions include the determination of the collectability of trade receivables, inventory obsolescence, impairment of long-lived assets, recoverability of goodwill and intangible assets, contingent earn-out liabilities, income taxes and stock-based compensation.
Foreign Currency Translation	Foreign Currency Translation The Condensed Consolidated Financial Statements are presented in U.S. dollars. The Company’s non-U.S. subsidiaries have a functional currency (i.e., the currency in which operational activities are primarily conducted) that is other than the U.S. dollar, generally the currency of the country in which such subsidiaries are domiciled. Such subsidiaries’ assets and liabilities are translated into U.S. dollars at quarter-end exchange rates, while revenue and expenses are translated at average exchange rates during the quarter based on the daily closing exchange rates. Adjustments that result from translating amounts from a subsidiary’s functional currency to U.S. dollars are reported in Accumulated Other Comprehensive (Loss) Income, net of tax.
Business Combinations	Business Combinations We allocate the purchase consideration to the identifiable net assets acquired, including intangible assets and liabilities assumed, based on estimated fair values at the date of the acquisition. The excess of the fair value of the purchase consideration over the fair value of the identifiable assets and liabilities, if any, is recorded as goodwill. During the measurement period, which is up to one year from the acquisition date, we may adjust provisional amounts that were recognized at the acquisition date to reflect new information obtained about facts and circumstances that existed as of the acquisition date. Determining the fair value of assets acquired and liabilities assumed requires significant judgment, including the selection of valuation methodologies including the income approach, the cost approach, and the market approach. Significant assumptions used in those methodologies include, but are not limited to, the expected values of the underlying metric, the systematic risk embedded in the underlying metric, the volatility of the underlying metric, the risk-free rate, and the counterparty risk. The use of different valuation methodologies and assumptions is highly subjective and inherently uncertain and, as a result, actual results may differ materially from estimates.
Trade Receivables, Less Allowance for Doubtful Accounts	Trade Receivables, Less Allowance for Doubtful Accounts The Company estimates an allowance for doubtful accounts based upon an evaluation of the current status of receivables, historical experience, and other factors as necessary. It is reasonably possible that the Company’s estimate of the allowance for doubtful accounts will change. As of September 30, 2022 and December 31, 2021 the balance for allowance for doubtful accounts was not material.
Inventories, Net	Inventories, Net The Company estimates a reserve for obsolete and slow-moving inventory based on current inventory levels, historical sales and future projected demand. Charges (benefit) for excess and obsolete inventory are included in Cost of goods sold and were $ 366 and $ 1,004 for the three months ended September 30, 2022 and 2021, respectively and were $( 62 ) and $ 2,229 for the nine months ended September 30, 2022 and 2021, respectively . The inventory reserve was $ 16,218 and $ 19,374 as of September 30, 2022 and December 31, 2021 , respectively.
Intangibles	Intangibles The costs associated with applying for patents and trademarks are capitalized. Patents are amortized on a straight-line basis over the lesser of the patent’s economic or legal life, which is seventeen years . Costs associated with capitalized patents include third-party attorney fees and other third-party fees as well as costs related to the following: the preparation of patent applications, government filings and registration fees, drawings, computer searches, and translations related to specific patents. Trademarks that are anticipated to be renewed every ten years have an indefinite life and are not amortized but tested for impairment annually. Once it is determined a trademark will no longer be renewed, the trademark is amortized over the remainder of the trademark’s registration period. Customer relationships are amortized over an estimated useful life of three to seven years on a straight-line basis. Other intangibles, which mainly consist of noncompete arrangements, are amortized over an estimated useful life of three years on a straight-line basis. Developed technology is amortized over an estimated useful life of twelve years on a straight-line basis. Amortizable intangible assets are assessed for impairment upon triggering events that indicate that the carrying value of an asset may not be recoverable. Recoverability is measured by a comparison of the carrying amount to future net undiscounted cash flows expected to be generated by the associated asset. If the asset’s carrying value is determined to not be recoverable, the impairment to be recognized is measured by the amount by which the carrying amount exceeds the fair market value of the intangible assets. No impairment charges were recorded in any of the periods presented. Indefinite-lived trademark assets are reviewed for impairment annually or whenever events or changes in circumstances indicate that the carrying value of an asset may not be recoverable. The Company can elect to first apply the optional qualitative impairment assessment to determine whether the indefinite-lived intangible asset is more-likely-than-not impaired. If, on the basis of the qualitative impairment assessment, an entity asserts that it is more likely than not that the indefinite-lived intangible asset is impaired, the Company would be required to calculate the fair value of the asset for an impairment test. Impairment loss is recognized if the carrying amount of the asset exceeds its fair value. A qualitative assessment considers macroeconomic and other industry-specific factors, such as trends in short-term and long-term interest rates and the ability to access capital, and company specific factors such as trends in revenue generating activities, and merger or acquisition activity. If the Company elects to bypass qualitatively assessing its indefinite-lived intangible assets, or it is not more likely than not that the fair value of the intangible asset exceeds its carrying value, management estimates the fair value of the intangible asset and compares it to the carrying value. The estimated fair value of the intangible asset is established using an income approach based on a discounted cash flow model that includes significant assumptions about the future operating results and cash flows of the intangible asset or assets.
Goodwill	Goodwill Goodwill represents the excess of the purchase price as compared to the fair value of net assets acquired and liabilities assumed. Goodwill is not amortized, but is tested for impairment annually or when indications of impairment exist. We can elect to qualitatively assess goodwill for impairment if it is more likely than not that the fair value of a reporting unit exceeds its carrying value. Impairment exists when the carrying amount, including goodwill, of the reporting unit exceeds its fair value, resulting in an impairment charge for this excess (not to exceed the carrying amount of the goodwill). Our annual impairment testing date is October 1. The impairment, if determined, is recorded within Operating expenses in the Condensed Consolidated Statements of Operations and Comprehensive Income (Loss) in the period the determination is made. There were no impairments recorded during the periods presented.
Contingent Earn-Out Consideration	Contingent Earn-out Consideration Business combinations may include contingent earn-out consideration as part of the purchase price under which the Company will make future payments to the seller upon the achievement of certain milestones. The fair value of the contingent earn-out consideration is estimated as of the acquisition date at the present value of the expected contingent payments and is subsequently remeasured at each balance sheet date. Two methodologies may be considered in the valuation: the scenario-based model (“SBM”) and Monte Carlo simulation. The SBM relies on multiple outcomes to estimate the likelihood of future payoff of the contingent consideration. The resulting earnout payoff is then probability-weighted and discounted at an appropriate risk adjusted rate in order to arrive at the present value of the expected earnout payment. The Monte Carlo simulation is used to value the non-linear contingent considerations based on projected financial metrics. Each trial of the Monte Carlo simulation draws a value from the assumed distribution for the underlying metric. The earnout payoff for each simulation trial is calculated based on that particular simulated path for the underlying metrics and then discounted to present value using the risk-free rate, adjusted for counterparty credit risk. The value of the earnout is estimated as the average value from all simulation trials. The fair value estimates use unobservable inputs that reflect our own assumptions as to the ability of the acquired business to meet the targeted benchmarks and discount rates used in the calculations. The unobservable inputs are defined in ASC Topic 820, “Fair Value Measurements and Disclosures,” as Level 3 inputs. We review the probabilities of achievement of the earnout milestones to determine impact on the fair value of the earnout consideration on a quarterly basis over the earn-out period. Actual results are compared to the estimates and probabilities of achievement used in our forecasts. Should actual results of the acquired business increase or decrease as compared to our estimates and assumptions, the estimated fair value of the contingent earn-out consideration liability will increase or decrease, up to the contractual limit, as applicable. Changes in the estimated fair value of the contingent earn-out consideration are recorded in other (expense) income in the Consolidated Statements of Operations and Comprehensive (Loss) Income and are reflected in the period in which they are identified. Changes in the estimated fair value of the contingent earn-out consideration may materially impact or cause volatility in our operating results.
Revenue Recognition	Revenue Recognition Revenue is recorded, net of estimated losses for bad debts, when our performance obligation is satisfied which is when our customers take title of the product, and typically when the product is used in surgery. As such, the timing of revenue recognition may differ from the timing of invoicing to our customers. We have recorded unbilled accounts receivable related to this timing difference of $ 3,987 and $ 3,637 as of September 30, 2022 and December 31, 2021 , respectively.
Accounting Pronouncements Issued Not Yet Adopted	Accounting Pronouncements Issued Not Yet Adopted In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842) (“ASU 2016-02”), which sets out the principles for the recognition, measurement, presentation and disclosure of leases for both parties to a contract (i.e., lessees and lessors). The new standard requires lessees to apply a dual approach, classifying leases as either finance or operating leases based on the principle of whether or not the lease is effectively a financed purchase by the lessee. This classification will determine whether lease expense is recognized based on an effective interest method or on a straight-line basis over the term of the lease, respectively. A lessee is also required to record a right-of-use asset and a lease liability for all leases with a term of greater than 12 months regardless of their classification. Leases with a term of 12 months or less will be accounted for similar to existing guidance for operating leases today. ASU 2016-02 supersedes the previous leases standard, ASC 840, Leases. ASU 2016-02, as subsequently amended for various technical issues, is effective for emerging growth companies following private company adoption dates in fiscal years beginning after December 15, 2021, and interim periods with fiscal years beginning after December 15, 2022. The Company is currently evaluating the new guidance, but does not believe it will have a material impact on the Consolidated Financial Statements. In June 2016, the FASB issued ASU 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments (“ASU 2016-13”), which requires entities to estimate all expected credit losses for certain types of financial instruments, including trade receivables, held at the reporting date based on historical experience, current conditions, and reasonable and supportable forecasts. The updated guidance also expands the disclosure requirements to enable users of financial statements to understand the entity’s assumptions, models and methods for estimating expected credit losses over the entire contractual term of the instrument from the date of initial recognition of that instrument. ASU 2016-13, as subsequently amended for various technical issues, is effective for emerging growth companies following private company adoption dates for fiscal years, and for interim periods within those fiscal years, beginning after December 15, 2022, with early adoption permitted. The Company is currently evaluating the new guidance to determine the impact it will have on the Consolidated Financial Statements. In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) (“ASU 2019-12”), which is part of the FASB’s overall simplification initiative to reduce the costs and complexity of applying accounting standards while maintaining or improving the usefulness of the information provided to users of financial statements. ASU 2019-12 simplifies accounting guidance for intra-period allocations, deferred tax liabilities, year-to-date losses in interim periods, franchise taxes, step-up in tax basis of goodwill, separate entity financial statements, and interim recognition of tax laws or rate changes. ASU 2019-12 is effective for emerging growth companies following private company adoption dates in fiscal years beginning after December 15, 2021, and interim periods within fiscal years beginning after December 15, 2022, with early adoption permitted. The adoption of this guidance is not expected to have a significant impact on the Company's Consolidated Financial Statements and related disclosures.

Business Combinations (Tables)

Business Combinations (Tables)	9 Months Ended
	Sep. 30, 2022
Disior LTD.
Business Acquisition [Line Items]
Summary of Purchase Consideration Transferred	The following table summarizes the purchase price: Consideration Paid Cash consideration $ 19,696 Contingent consideration 6,550 Total consideration $ 26,246
Summary of Fair Values of Assets Acquired and Liabilities Assumed	The following table summarizes the fair values of the assets acquired and liabilities assumed as of the Disior Acquisition Date: Measurement Preliminary allocation period adjustments Adjusted allocation Assets acquired: Cash and cash equivalents $ 1,192 $ — $ 1,192 Other current assets 410 — 410 Intangible assets 4,900 — 4,900 Goodwill 20,343 303 20,646 Total assets acquired $ 26,845 $ 303 $ 27,148 Liabilities assumed: Accruals and other current liabilities $ 615 $ — $ 615 Deferred tax liabilities, net 287 — 287 Total liabilities assumed $ 902 — $ 902 Net assets acquired $ 25,943 $ 303 $ 26,246
Useful Life Determination of Assets	The useful life on intangible assets was determined by management to be in line with the Company’s policy on intangible assets. Both determinations are outlined in the table below: Fair Value Estimated Useful Life Developed Technology $ 4,500 12 Tradenames 400 Indefinite $ 4,900
Additive Orthopaedics, LLC
Business Acquisition [Line Items]
Summary of Purchase Consideration Transferred	The following table summarizes the purchase consideration transferred in connection with the acquisition of Additive and consists of the following: Consideration Paid Cash consideration $ 15,000 Contingent consideration 2,870 Total consideration $ 17,870
Summary of Fair Values of Assets Acquired and Liabilities Assumed	The following table summarizes the fair values of the assets acquired and liabilities assumed as of the Closing Date: Assets acquired: Accounts receivable $ 761 Inventory 113 Intangible assets 11,560 Goodwill 6,329 Total Assets Acquired 18,763 Liabilities assumed: Accounts payable 796 Accrued expenses $ 97 Total Liabilities Assumed 893 Net assets acquired $ 17,870
Useful Life Determination of Assets	The useful life determination was made by management in line with the Company’s policy on assets. Both determinations are outlined in the table below: Fair Value Estimated Useful Life Noncompete arrangements $ 30 3 Customer relationships 240 3 Developed technology 11,290 12 $ 11,560

Goodwill And Intangible Assets

Goodwill And Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	As of September 30, 2022 and December 31, 2021, goodwill was $ 26,975 and $ 6,329 , respectively; the activity is as follows: Balance, December 31, 2021 $ 6,329 Acquisitions 20,646 Balance, September 30, 2022 $ 26,975
Indefinite lived and Finite Lived Intangible Assets	Intangible assets as of September 30, 2022 are as follows: Estimated Useful Life Gross Carrying Amount Accumulated Amortization Net Carrying Amount Trademarks and tradenames, indefinite-lived Indefinite $ 853 $ — $ 853 Patents, definite-lived 15.1 6,466 2,301 4,165 Customer relationships 3 - 7 1,733 201 1,532 Developed technology 12 15,790 1,507 14,283 Other intangibles 3 30 13 17 Total intangible assets, net $ 24,872 $ 4,022 $ 20,850 Intangible assets as of December 31, 2021 , are as follows: Estimated Useful Life Gross Carrying Amount Accumulated Amortization Net Carrying Amount Trademarks, indefinite-lived Indefinite $ 413 $ — $ 413 Patents, definite-lived 13.2 5,335 1,133 4,202 Customer relationships 3 - 7 1,167 47 1,120 Developed technology 12 11,290 549 10,741 Other intangibles 3 35 6 29 Total intangible assets, net $ 18,240 $ 1,735 $ 16,505
Schedule of Expected Future Amortization Expense	Expected future amortization expense is as follows: 2022 (Remaining) $ 424 2023 1,695 2024 1,643 2025 1,604 2026 1,604 2027 1,603

Contingent Earn-Out Considera_2

Contingent Earn-Out Consideration (Tables)	9 Months Ended
	Sep. 30, 2022
Business Combinations [Abstract]
Schedule of Reconciliation Level 3 Earn-out Liabilities	The following table provides a reconciliation of our Level 3 earn-out liabilities for the nine months ended September 30, 2022: Balance, December 31, 2021 $ 2,310 Acquisition date fair value of earn-out liabilities 6,550 Achieved milestone paid ( 500 ) Change in fair value of earn-out liabilities ( 575 ) Balance, September 30, 2022 $ 7,785

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2022
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	Long-term debt as of September 30, 2022 and December 31, 2021 consists of the following: September 30, 2022 December 31, 2021 MidCap Term Loan $ 30,000 $ 10,000 Bank of Ireland Note Payable 112 245 Vectra Term Loan Facility 15,733 — $ 45,845 $ 10,245 Less: deferred issuance costs ( 2,618 ) ( 2,616 ) Total debt, net of issuance costs 43,227 7,629 Less: current portion ( 735 ) ( 153 ) Long-term debt, net, less current maturities $ 42,492 $ 7,476

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	9 Months Ended
	Sep. 30, 2022
Earnings Per Share [Abstract]
Summary of Computation of Net Loss Per Share	The computation of net loss per share for the three and nine months ended September 30, 2022 and 2021, respectively was as follows: Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Net loss attributable to common stockholders Net loss attributable to Paragon 28, Inc. $ ( 9,724 ) $ ( 5,107 ) $ ( 28,563 ) $ ( 7,518 ) Less: Dividends on Series B convertible preferred stock — ( 574 ) — ( 1,516 ) Net loss attributable to common stockholders $ ( 9,724 ) $ ( 5,681 ) $ ( 28,563 ) $ ( 9,034 ) Weighted-average common stock outstanding: Basic 76,850,949 47,005,334 76,595,118 46,926,344 Diluted 76,850,949 47,005,334 76,595,118 46,926,344 Loss per share: Basic $ ( 0.13 ) $ ( 0.12 ) $ ( 0.37 ) $ ( 0.19 ) Diluted $ ( 0.13 ) $ ( 0.12 ) $ ( 0.37 ) $ ( 0.19 )
Summary of Potentially Dilutive Securities Excluded from Calculation of Diluted Net Loss Per Share Attributable to Common Stockholders	The following outstanding potentially dilutive securities were excluded from the calculation of diluted net loss per share attributable to common stockholders because their impact would have been antidilutive for the period presented: As of September 30, 2022 2022 2021 Stock options 7,304,770 5,307,200 Restricted stock units 144,547 — Series A convertible preferred stock — 13,812,500 Series B convertible preferred stock — 6,608,700

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2022
Share-Based Payment Arrangement [Abstract]
Assumptions used in Determining Fair Value of Employee Stock Purchase Plan	Below are the assumptions used for the nine months ended September 30, 2022 in determining the fair value of shares under the ESPP. No shares were issued duri ng the nine months ended September 30, 2021. Nine Months Ended September 30, 2022 Expected volatility 70.3 % Expected dividends — Expected term (in years) 0.50 Discount rate 10.0 % Risk-free rate 2.79 %
Assumptions used in Determining Fair Value of Stock Options	Below are the assumptions used for the nine months ended September 30, 2022 and 2021 in determining the fair value of each option award: Nine Months Ended September 30, 2022 2021 Expected volatility 52.0 % 52 % - 54 % Expected dividends — — Expected term (in years) 5.60 5.75 - 6.25 Risk-free rate 2.01 % 0.47 % - 0.93 %
Summary of Stock Option Activity	The following summarizes the Company’s stock option plan and the activity for the nine months ended September 30, 2022: Shares Weighted-Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Outstanding, December 31, 2021 7,953,018 $ 9.02 8.16 Granted 359,054 16.08 Exercised or released ( 617,578 ) 3.89 Forfeited or expired ( 389,724 ) 11.84 Outstanding, September 30, 2022 7,304,770 $ 9.66 7.64 Exercisable, September 30, 2022 3,324,831 $ 4.80 6.17 Vested and expected to vest at September 30, 2022 7,304,770 $ 9.66 7.64
Summary of Restricted Stock Units Activity	The following summarizes the Company’s restricted stock units activity for the nine months ended September 30, 2022. Restricted Stock Units Weighted-Average Fair Value Outstanding, December 31, 2021 79,886 $ 17.84 Granted 87,641 17.12 Vested ( 14,062 ) 16.00 Forfeited or expired ( 8,918 ) 16.82 Outstanding, September 30, 2022 144,547 $ 17.64 Vested and expected to vest at September 30, 2022 144,547 $ 17.64

Income Taxes (Tables)

Income Taxes (Tables)	9 Months Ended
	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Schedule of Effective Tax Rates	The effective tax rates for the nine months ended September 30, 2022 and 2021 are as follows: Nine Months Ended September 30, 2022 2021 Effective tax rate ( 1.057 %) ( 6.300 %)

Segment and Geographic Inform_2

Segment and Geographic Information (Tables)	9 Months Ended
	Sep. 30, 2022
Segment Reporting [Abstract]
Schedule of Total Net Revenue by Geographic Area	The following table represents total net revenue by geographic area, based on the location of the customer for the three and nine months ended September 30, 2022 and 2021, respectively. Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 United States $ 39,960 $ 31,882 $ 112,781 $ 92,014 International 6,046 3,969 17,094 12,675 Total net revenue $ 46,006 $ 35,851 $ 129,875 $ 104,689
Schedule of Total Non-current Assets, Excluding Deferred Taxes, by Geographic Area	The following table represents total non-current assets, excluding deferred taxes, by geographic area as of September 30, 2022 and December 31, 2021, respectively. September 30, 2022 December 31, 2021 United States $ 76,346 $ 51,809 International 30,070 3,206 Total assets $ 106,416 $ 55,015

Business and Basis of Present_2

Business and Basis of Presentation - Additional Information (Details) - Common Stock $ / shares in Units, $ in Thousands	Oct. 19, 2021 USD ($) $ / shares shares
Initial Public Offering
Subsidiary, Sale of Stock [Line Items]
Number of shares issued and sold	8,984,375
Public offering price per share | $ / shares	$ 16
Net proceeds after deducting underwriting discounts and commissions | $	$ 129,118
Number of shares issued upon conversion of convertible securities	20,421,200
Underwriters Option to Purchase Additional Shares
Subsidiary, Sale of Stock [Line Items]
Number of shares issued and sold	1,171,875

Summary of Significant Accoun_3

Summary of Significant Accounting Policies - Additional Information (Details) - USD ($)	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Impairment of intangible asset, finite-lived	$ 0	$ 0	$ 0	$ 0
Impairment of goodwill	0	0	0	0
Charges (benefit) for excess and obsolete inventory			(91,000)	2,226,000
Inventory reserve	16,218,000		16,218,000		$ 19,374,000
Unbilled accounts receivable	3,987,000		$ 3,987,000		$ 3,637,000
Patents
Finite-Lived Intangible Assets [Line Items]
Amortization period			17 years
Estimated useful life			15 years 1 month 6 days		13 years 2 months 12 days
Developed Technology
Finite-Lived Intangible Assets [Line Items]
Estimated useful life			12 years		12 years
Customer Relationships | Minimum
Finite-Lived Intangible Assets [Line Items]
Estimated useful life			3 years		3 years
Customer Relationships | Maximum
Finite-Lived Intangible Assets [Line Items]
Estimated useful life			7 years		7 years
Other Intangibles
Finite-Lived Intangible Assets [Line Items]
Estimated useful life			3 years		3 years
Cost of Goods Sold
Finite-Lived Intangible Assets [Line Items]
Charges (benefit) for excess and obsolete inventory	$ 366,000	$ 1,004,000	$ (62,000)	$ 2,229,000

Business Combinations - Additio

Business Combinations - Additional Information (Details) - USD ($)			3 Months Ended		9 Months Ended
	Jan. 10, 2022	May 28, 2021	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Business Acquisition [Line Items]
Cash consideration					$ 18,504,000	$ 15,000,000
Proceeds from revolving credit facility					20,000,000	0
Disior LTD.
Business Acquisition [Line Items]
Acquired percentage	100%
Aggregate purchase price of acquisition	$ 26,246,000
Contingent earn-out consideration, estimated fair value	6,550,000				$ 6,550,000
Net working capital adjustments and deferred payments, net payable	222,000
Cash consideration	19,696,000
Maximum earn out payment	8,000,000
Acquisition related costs				$ 0		0
Business acquisition, pro forma information, description					There is no supplemental proforma presentation of operating results of the acquisition of Disior due to the immaterial impact on the Company’s Consolidated operations for the three and nine months ended September 30, 2021.
Measurement period adjustment					$ 303,000
Disior LTD. | Term Loan
Business Acquisition [Line Items]
Proceeds from revolving credit facility	$ 20,000,000
Disior LTD. | Selling, General, and Administrative Expenses
Business Acquisition [Line Items]
Acquisition related costs			$ 0		761,000
Additive Orthopaedics, LLC
Business Acquisition [Line Items]
Aggregate purchase price of acquisition		$ 17,870,000
Contingent earn-out consideration, estimated fair value		2,870,000
Cash consideration		15,000,000
Maximum earn out payment		$ 9,500,000
Acquisition related costs			$ 0		$ 0
Business acquisition, pro forma information, description					There is no supplemental proforma presentation of operating results of the acquisition of Additive due to the immaterial impact on the Company’s Consolidated operations for the three and nine months ended September 30, 2021.
Additive Orthopaedics, LLC | Selling, General, and Administrative Expenses
Business Acquisition [Line Items]
Acquisition related costs						$ 524,000

Business Combinations - Summary

Business Combinations - Summary of Purchase Consideration Transferred (Details) - USD ($) $ in Thousands			9 Months Ended
	Jan. 10, 2022	May 28, 2021	Sep. 30, 2022	Sep. 30, 2021
Consideration Paid
Cash consideration			$ 18,504	$ 15,000
Disior LTD.
Consideration Paid
Cash consideration	$ 19,696
Contingent consideration	6,550		$ 6,550
Total consideration	$ 26,246
Additive Orthopaedics, LLC
Consideration Paid
Cash consideration		$ 15,000
Contingent consideration		2,870
Total consideration		$ 17,870

Business Combinations - Summa_2

Business Combinations - Summary of Fair Values of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Jan. 10, 2022	Dec. 31, 2021	May 28, 2021
Assets acquired:
Goodwill	$ 26,975		$ 6,329
Additive Orthopaedics, LLC
Assets acquired:
Accounts receivable				$ 761
Inventory				113
Intangible assets				11,560
Goodwill				6,329
Total assets acquired				18,763
Liabilities assumed:
Accounts payable				796
Accrued expenses				97
Total liabilities assumed				893
Net assets acquired				$ 17,870
Disior LTD.
Assets acquired:
Cash and cash equivalents		$ 1,192
Other current assets		410
Intangible assets		4,900
Goodwill		20,646
Total assets acquired		27,148
Liabilities assumed:
Accruals and other current liabilities		615
Deferred tax liabilities, net		287
Total liabilities assumed		902
Net assets acquired		26,246
Preliminary Allocation | Disior LTD.
Assets acquired:
Cash and cash equivalents		1,192
Other current assets		410
Intangible assets		4,900
Goodwill		20,343
Total assets acquired		26,845
Liabilities assumed:
Accruals and other current liabilities		615
Deferred tax liabilities, net		287
Total liabilities assumed		902
Net assets acquired		25,943
Measurement Period Adjustments | Disior LTD.
Assets acquired:
Goodwill		303
Total assets acquired		303
Liabilities assumed:
Net assets acquired		$ 303

Business Combinations - Useful

Business Combinations - Useful Life Determination of Assets (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2022 USD ($)
Disior LTD.
Business Acquisition [Line Items]
Fair Value	$ 4,900
Additive Orthopaedics, LLC
Business Acquisition [Line Items]
Fair Value	11,560
Noncompete Arrangements | Additive Orthopaedics, LLC
Business Acquisition [Line Items]
Fair Value	$ 30
Estimated Useful Life (in years)	3 years
Customer Relationships | Additive Orthopaedics, LLC
Business Acquisition [Line Items]
Fair Value	$ 240
Estimated Useful Life (in years)	3 years
Developed Technology | Disior LTD.
Business Acquisition [Line Items]
Fair Value	$ 4,500
Estimated Useful Life (in years)	12 years
Developed Technology | Additive Orthopaedics, LLC
Business Acquisition [Line Items]
Fair Value	$ 11,290
Estimated Useful Life (in years)	12 years
Tradenames | Disior LTD.
Business Acquisition [Line Items]
Fair Value	$ 400

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Additional Information (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Goodwill	$ 26,975,000		$ 26,975,000		$ 6,329,000
Impairment charges related to intangibles	0	$ 0	0	$ 0
Impairment charges related to goodwill	0	0	0	0
Patents and Trademarks
Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired excluding Disior intangible assets			1,720,000
Selling, General, and Administrative Expenses
Finite-Lived Intangible Assets [Line Items]
Amortization expense	$ 440,000	$ 494,000	$ 2,290,000	$ 635,000

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Schedule of Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2022 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Balance, December 31, 2021	$ 6,329
Acquisitions	20,646
Balance, September 30, 2022	$ 26,975

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Intangible Assets (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2022	Dec. 31, 2021
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Amount	$ 24,872	$ 18,240
Accumulated Amortization	4,022	1,735
Net Carrying Amount	20,850	16,505
Trademarks and tradenames, Indefinite-Lived
Indefinite Lived Intangible Assets By Major Class [Line Items]
Net Carrying Amount	$ 853	$ 413
Patents, Definite-Lived
Indefinite Lived Intangible Assets By Major Class [Line Items]
Estimated Useful Life (in years)	15 years 1 month 6 days	13 years 2 months 12 days
Gross Carrying Amount	$ 6,466	$ 5,335
Accumulated Amortization	2,301	1,133
Net Carrying Amount	4,165	4,202
Customer Relationships
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Amount	1,733	1,167
Accumulated Amortization	201	47
Net Carrying Amount	$ 1,532	$ 1,120
Customer Relationships | Minimum
Indefinite Lived Intangible Assets By Major Class [Line Items]
Estimated Useful Life (in years)	3 years	3 years
Customer Relationships | Maximum
Indefinite Lived Intangible Assets By Major Class [Line Items]
Estimated Useful Life (in years)	7 years	7 years
Developed Technology
Indefinite Lived Intangible Assets By Major Class [Line Items]
Estimated Useful Life (in years)	12 years	12 years
Gross Carrying Amount	$ 15,790	$ 11,290
Accumulated Amortization	1,507	549
Net Carrying Amount	$ 14,283	$ 10,741
Other Intangibles
Indefinite Lived Intangible Assets By Major Class [Line Items]
Estimated Useful Life (in years)	3 years	3 years
Gross Carrying Amount	$ 30	$ 35
Accumulated Amortization	13	6
Net Carrying Amount	$ 17	$ 29

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Schedule of Expected Future Amortization Expense (Details) $ in Thousands	Sep. 30, 2022 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2022 (Remaining)	$ 424
2023	1,695
2024	1,643
2025	1,604
2026	1,604
2027	$ 1,603

Contingent Earn-Out Considera_3

Contingent Earn-Out Consideration - Schedule of Reconciliation of Level 3 Earn-Out Liabilities (Details) - USD ($) $ in Thousands		9 Months Ended
	Jan. 10, 2022	Sep. 30, 2022
Business Acquisition [Line Items]
Beginning Balance		$ 2,310
Achieved milestone paid		(500)
Change in fair value of earn-out liabilities		(575)
Ending Balance		7,785
Disior LTD.
Business Acquisition [Line Items]
Acquisition date fair value of earn-out liabilities	$ 6,550	$ 6,550

Contingent Earn-Out Considera_4

Contingent Earn-Out Consideration - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2022	Sep. 30, 2021
Business Acquisition, Contingent Consideration [Line Items]
Contingent earn-out liability, current	$ 6,878	$ 6,878
Decrease in estimate of earn-out liabilities		575	$ (60)
Other Income [Member]
Business Acquisition, Contingent Consideration [Line Items]
Decrease in estimate of earn-out liabilities	$ (35)	$ (575)

Debt - Schedule of Long-term De

Debt - Schedule of Long-term Debt Instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Debt, gross amount	$ 45,845	$ 10,245
Less: deferred issuance costs	(2,618)	(2,616)
Total debt, net of issuance costs	43,227	7,629
Less: current portion	(735)	(153)
Long-term debt net, less current maturities	42,492	7,476
MidCap Term Loan
Debt Instrument [Line Items]
Debt, gross amount	30,000	10,000
Bank of Ireland Note Payable
Debt Instrument [Line Items]
Debt, gross amount	112	245
Vectra Term Loan Facility
Debt Instrument [Line Items]
Debt, gross amount	$ 15,733	$ 0

Debt - MidCap Credit Agreements

Debt - MidCap Credit Agreements - Additional Information (Details) - USD ($)		3 Months Ended		9 Months Ended
	May 06, 2021	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Debt Instrument [Line Items]
Amortization expense				$ 417,000	$ 372,000
MidCap Credit Agreements
Debt Instrument [Line Items]
Total borrowing capacity	$ 70,000,000
Debt issuance cost before amortization		$ 3,288,000		3,288,000
MidCap Credit Agreements | Interest Expense
Debt Instrument [Line Items]
Amortization expense		$ 165,000	$ 192,000	$ 409,000	$ 318,000
MidCap Credit Agreements | Term Loan
Debt Instrument [Line Items]
Total borrowing capacity	$ 40,000,000
Expiration date	May 01, 2026
MidCap Credit Agreements | Term Loan | LIBOR
Debt Instrument [Line Items]
Variable interest rate	6%
MidCap Credit Agreements | Term Loan, First Commitment
Debt Instrument [Line Items]
Total borrowing capacity	$ 10,000,000
MidCap Credit Agreements | Term Loan, Second Commitment
Debt Instrument [Line Items]
Total borrowing capacity	30,000,000
MidCap Credit Agreements | Revolving Loan
Debt Instrument [Line Items]
Total borrowing capacity	$ 30,000,000
Expiration date	May 01, 2026
MidCap Credit Agreements | Revolving Loan | LIBOR
Debt Instrument [Line Items]
Variable interest rate	3%

Debt - Vectra Bank Colorado Loa

Debt - Vectra Bank Colorado Loan Agreements - Additional Information (Details) - USD ($)			3 Months Ended	9 Months Ended
	Mar. 24, 2022	Mar. 27, 2020	Sep. 30, 2022	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Line Of Credit Facility [Line Items]
Total debt issuance costs			$ 2,618,000	$ 2,618,000		$ 2,616,000
Amortization of debt issuance costs				417,000	$ 372,000
Vectra Loan Agreement
Line Of Credit Facility [Line Items]
Maturity date		Sep. 30, 2020
Maturity extended date		Oct. 05, 2023
Interest rate		3%
Vectra Loan Agreement | 2020 Term Loan
Line Of Credit Facility [Line Items]
Principal amount		$ 6,802,000
Secured Term Loan Facility
Line Of Credit Facility [Line Items]
Principal amount	$ 16,000,000
Maturity date	Mar. 24, 2037
Debt, frequency of payment	monthly
Total debt issuance costs			271,000	271,000
Amortization of debt issuance costs			$ 4,000	$ 9,000
Secured Term Loan Facility | SOFR
Line Of Credit Facility [Line Items]
Variable interest rate	1.75%
New 2020 Revolving Loan | 2020 Term Loan
Line Of Credit Facility [Line Items]
Total borrowing capacity		$ 15,000,000

Debt - Bank of Ireland Note Pay

Debt - Bank of Ireland Note Payable - Additional Information (Details) - Bank of Ireland Note Payable	Jun. 12, 2020 USD ($)
Debt Instrument [Line Items]
Principal amount	$ 474,000
Interest rate	4%
Debt, frequency of payment	monthly
Debt instrument term	36 months

Convertible Preferred Series _2

Convertible Preferred Series Equity and Stockholders Equity - Additional Information (Details) $ / shares in Units, $ in Thousands			1 Months Ended				3 Months Ended		9 Months Ended
	Oct. 19, 2021 USD ($) $ / shares shares	Oct. 08, 2021 $ / shares shares	Jul. 31, 2020 USD ($) $ / shares shares	Nov. 30, 2012 USD ($) $ / shares shares	Feb. 29, 2012 USD ($) $ / shares shares	Dec. 31, 2011 USD ($) $ / shares shares	Sep. 30, 2022 $ / shares shares	Sep. 30, 2021 shares	Sep. 30, 2022 USD ($) $ / shares shares	Sep. 30, 2021 USD ($) shares	Dec. 31, 2021 $ / shares shares
Class of Stock [Line Items]
Forward stock split		5
Shares of capital stock authorized for issuance		310,000,000
Common stock share authorized		300,000,000					300,000,000		300,000,000		300,000,000
Common stock par value | $ / shares		$ 0.01					$ 0.01		$ 0.01		$ 0.01
Convertible preferred stock, authorized		10,000,000
Convertible preferred stock, par value | $ / shares		$ 0.0001
Treasury stock repurchase shares							0	0	0	85,050
Treasury stock repurchase value | $									$ 0	$ 561
Common Stock
Class of Stock [Line Items]
Number of aggregate issued										151,515
Initial Public Offering | Common Stock
Class of Stock [Line Items]
Public offering price per share | $ / shares	$ 16
Number of shares issued and sold	8,984,375
Conversion of shares	20,421,200
Underwriters Option to Purchase Additional Shares | Common Stock
Class of Stock [Line Items]
Number of shares issued and sold	1,171,875
Series A Convertible Preferred Stock
Class of Stock [Line Items]
Number of aggregate issued				10,562,495	10,562,495	3,250,005
Proceeds from issuance of convertible preferred stock | $				$ 3,250	$ 3,250	$ 1,000
Price per share | $ / shares				$ 0.30769	$ 0.30769	$ 0.30769
Series A Convertible Preferred Stock | Initial Public Offering | Common Stock
Class of Stock [Line Items]
Conversion of shares	13,812,500
Series B Convertible Preferred Stock
Class of Stock [Line Items]
Number of aggregate issued			6,608,700
Cash dividends accrued | $	$ 2,328
Proceeds from issuance of convertible preferred stock | $			$ 36,030
Issuance costs | $			$ 1,970
Price per share | $ / shares			$ 5.75
Series B Convertible Preferred Stock | Initial Public Offering | Common Stock
Class of Stock [Line Items]
Conversion of shares	6,608,700

Earnings (Loss) Per Share - Sum

Earnings (Loss) Per Share - Summary of Computation of Net Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Net loss attributable to common stockholders
Net loss attributable to Paragon 28, Inc.	$ (9,724)	$ (5,107)	$ (28,563)	$ (7,518)
Less: Dividends on Series B convertible preferred stock	0	(574)	0	(1,516)
Net loss attributable to common stockholders	$ (9,724)	$ (5,681)	$ (28,563)	$ (9,034)
Weighted-average common stock outstanding:
Basic	76,850,949	47,005,334	76,595,118	46,926,344
Diluted	76,850,949	47,005,334	76,595,118	46,926,344
Loss per share, Basic:
Basic	$ (0.13)	$ (0.12)	$ (0.37)	$ (0.19)
Loss per share, Diluted:
Diluted	$ (0.13)	$ (0.12)	$ (0.37)	$ (0.19)

Earnings (Loss) Per Share - S_2

Earnings (Loss) Per Share - Summary of Potentially Dilutive Securities Excluded from Calculation of Diluted Net Loss Per Share Attributable to Common Stockholders (Details) - shares	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Stock Options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of dilutive net loss per share	7,304,770	5,307,200
Restricted Stock Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of dilutive net loss per share	144,547	0
Series A Convertible Preferred Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of dilutive net loss per share	0	13,812,500
Series B Convertible Preferred Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of dilutive net loss per share	0	6,608,700

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands			3 Months Ended		9 Months Ended
	Jan. 01, 2022	Oct. 19, 2021	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Employee contribution percentage					100%
Options granted					359,054
Cash received from exercise of stock options					$ 2,224	$ 442
Weighted average strike price			$ 9.66		$ 9.66		$ 9.02
Time-based Stock Options | Certain Officers and Contractors
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted					311,840	816,250
Weighted average strike price			$ 16.08	$ 6.60	$ 16.08	$ 6.60
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted					359,054	816,250
Compensation expense			$ 2,254	$ 1,032	$ 6,351	$ 2,747
Cash received from exercise of stock options			1,923	91	2,224	442
Tax benefit from equity options exercised			436	19	504	$ 93
Aggregate intrinsic value of options outstanding			59,651		59,651
Aggregate intrinsic value of vested and exercisable options			43,280		$ 43,280
Weighted average fair value of options granted					$ 9.26	$ 5.04
Total unrecognized compensation cost related to non-vested stock awards			21,662		$ 21,662
Total unrecognized compensation cost related to non-vested stock awards, weighted average recognition period					3 years 10 days
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation expense			332	0	$ 701	$ 0
Total unrecognized compensation cost related to non-vested stock awards			1,997		$ 1,997
Total unrecognized compensation cost related to non-vested stock awards, weighted average recognition period					1 year 10 months 24 days
Fair value of RSU vested			$ 0	$ 0	$ 225	$ 0
Number of shares granted				0	87,641	0
Number of shares vested				0	14,062	0
Number of shares forfeited				0	8,918	0
Outstanding			144,547		144,547		79,886
Employee Stock Purchase Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options permitted to grant		1,329,040
Market price of shares authorized percentage		85%
Employee contribution percentage					15%
Maximum purchase value of shares available for each employee					$ 25,000
Shares issued					17,060	0
Shares available for issuance			2,076,453		2,076,453
Percentage of shares issued from outstanding number of shares		1%
Number of shares reserved and available for issuance increase (decrease)	764,473
Compensation expense			$ 100	$ 0	$ 100	$ 0
2021 Incentive Award Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options permitted to grant		7,641,979
Options reserved for future grants			10,760,114		10,760,114
Percentage of shares issued from outstanding number of shares		5%
Number of shares reserved and available for issuance increase (decrease)	3,822,364

Stock Based Compensation - Assu

Stock Based Compensation - Assumptions used in Determining Fair Value (Details)	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Stock Options
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Expected volatility	52%
Expected dividends	0%	0%
Expected term (in years)	5 years 7 months 6 days
Risk-free rate	2.01%
Stock Options | Minimum
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Expected volatility		52%
Expected term (in years)		5 years 9 months
Risk-free rate		0.47%
Stock Options | Maximum
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Expected volatility		54%
Expected term (in years)		6 years 3 months
Risk-free rate		0.93%
Employee Stock Purchase Plan
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Expected volatility	70.30%
Expected dividends	0%
Expected term (in years)	6 months
Discount rate	10%
Risk-free rate	2.79%

Stock-Based Compensation - Summ

Stock-Based Compensation - Summary of Stock Option Activity (Details)	9 Months Ended	12 Months Ended
	Sep. 30, 2022 $ / shares shares	Dec. 31, 2021 $ / shares shares
Share-Based Payment Arrangement [Abstract]
Shares Outstanding, Beginning Balance | shares	7,953,018
Shares, Granted | shares	359,054
Shares, Exercised or released | shares	(617,578)
Shares, Forfeited or Expired | shares	(389,724)
Shares Outstanding, Ending Balance | shares	7,304,770	7,953,018
Shares, Exercisable | shares	3,324,831
Shares, Vested and Expected To Vest | shares	7,304,770
Weighted-Average Exercise Price, Beginning Balance | $ / shares	$ 9.02
Weighted-Average Exercise Price, Granted | $ / shares	16.08
Weighted-Average Exercise Price, Exercised | $ / shares	3.89
Weighted-Average Exercise Price, Forfeited or Expired | $ / shares	11.84
Weighted-Average Exercise Price, Ending Balance | $ / shares	9.66	$ 9.02
Weighted-Average Exercise Price, Exercisable | $ / shares	4.80
Weighted-Average Exercise Price, Vested and Expected To Vest | $ / shares	$ 9.66
Weighted-Average Remaining Contractual Term (Years)	7 years 7 months 20 days	8 years 1 month 28 days
Weighted-Average Remaining Contractual Term (Years), Exercisable	6 years 2 months 1 day
Weighted-Average Remaining Contractual Term (Years), Vested and expected to vest	7 years 7 months 20 days

Stock Based Compensation - Summ

Stock Based Compensation - Summary of Restricted Stock Units (Details) - Restricted Stock Units - $ / shares	3 Months Ended	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Outstanding, Beginning balance		79,886
Granted	0	87,641	0
Vested	0	(14,062)	0
Forfeited or expired	0	(8,918)	0
Outstanding, Ending balance		144,547
Vested and expected to vest		144,547
Weighted Average Fair Value, Beginning Balance		$ 17.84
Weighted Average Fair Value, Granted		17.12
Weighted Average Fair Value, Vested		16
Weighted Average Fair Value, Forfeited or expired		16.82
Weighted Average Fair Value, Ending Balance		17.64
Weighted Average Fair Value, Vested and expected to vest		$ 17.64

Employee Benefit Plan - Additio

Employee Benefit Plan - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Retirement Benefits [Abstract]
Defined contribution plan, description			The Company sponsors a defined contribution plan for eligible employees who are 21 years of age with three months of service can voluntarily contribute up to 100% of their eligible compensation.
Defined contribution plan minimum annual contributions per employee percent			3%
Defined benefit plan, plan assets, contributions by employer	$ 266	$ 129	$ 734	$ 425
Defined contribution plan, maximum percentage of eligible compensation for voluntary contribution			100%

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Tax Rates (Details)	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Income Tax Disclosure [Abstract]
Effective tax rate	(1.057%)	(6.30%)

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Income Tax Disclosure [Abstract]
Income tax expense	$ 201	$ 105	$ 306	$ 437

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Related Party Transaction [Line Items]
Due to related parties	$ 184		$ 184		$ 66
Selling, general and administrative expenses from transactions with related party	0	$ 148	$ 266	$ 485
Director | License Agreement
Related Party Transaction [Line Items]
Percentage of revenue paid as royalty			4%
Royalty estimated useful life			15 years
Related party transaction term of agreement			20 years
Related party transaction, agreement renewal term			5 years
Due to related parties	129		$ 129		$ 163
Payments to related party	28	$ 29	221	$ 236
Annual Payment Threshold | Minimum | Director | License Agreement
Related Party Transaction [Line Items]
Due to related parties	$ 250		$ 250

Segment and Geographic Inform_3

Segment and Geographic Information - Schedule of Total Net Revenue by Geographic Area (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Segment Reporting Information [Line Items]
Total net revenue	$ 46,006	$ 35,851	$ 129,875	$ 104,689
United States
Segment Reporting Information [Line Items]
Total net revenue	39,960	31,882	112,781	92,014
International
Segment Reporting Information [Line Items]
Total net revenue	$ 6,046	$ 3,969	$ 17,094	$ 12,675

Segment and Geographic Inform_4

Segment and Geographic Information - Schedule of Total Non-current Assets, Excluding Deferred Taxes, by Geographic Area (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Total assets	$ 106,416	$ 55,015
United States
Segment Reporting Information [Line Items]
Total assets	76,346	51,809
International
Segment Reporting Information [Line Items]
Total assets	$ 30,070	$ 3,206

Subsequent Events - Additional

Subsequent Events - Additional Information (Details) - USD ($)					3 Months Ended	9 Months Ended
	Nov. 09, 2022	Nov. 07, 2022	Oct. 21, 2022	May 06, 2021	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Restricted Stock Units
Subsequent Event [Line Items]
Number of shares granted					0	87,641	0
Weighted average grant price						$ 17.12
MidCap Credit Agreements
Subsequent Event [Line Items]
Total borrowing capacity				$ 70,000,000
Revolving Loan | MidCap Credit Agreements
Subsequent Event [Line Items]
Total borrowing capacity				$ 30,000,000
Revolving Loan | MidCap Credit Agreements | LIBOR
Subsequent Event [Line Items]
Variable interest rate				3%
Subsequent Event | 2021 Plan | Restricted Stock Units
Subsequent Event [Line Items]
Number of shares granted			852,556
Weighted average grant price			$ 17.77
Vesting period			4 years
Subsequent Event | MidCap Credit Agreements | LIBOR
Subsequent Event [Line Items]
Variable interest rate	6%
Subsequent Event | Secured Term Loan Facility
Subsequent Event [Line Items]
Threshold amount of operating cash flow to calculate liquidity ratio	$ 0
Threshold Amount of Operating Cash Flow to Calculate Fixed Charge Coverage Ratio	0
Subsequent Event | Revolving Loan | MidCap Credit Agreements
Subsequent Event [Line Items]
Total borrowing capacity	$ 50,000,000
Subsequent Event | Revolving Loan | MidCap Credit Agreements | LIBOR
Subsequent Event [Line Items]
Variable interest rate	3.75%
Subsequent Event | Maximum
Subsequent Event [Line Items]
Equity offering, value of securities to be issued		$ 100,000,000
Equity offering, number of common shares to be issued		10,000