Subtalar arthroereisis (S2117) using subtalar implants for the treatment of adult or pediatric flatfoot conditions is considered experimental/investigational, as published data are inadequate to permit scientific conclusions regarding the safety and efficacy of this procedure.  Studies have not proven that subtalar arthroereisis is as beneficial as established alternatives.  Subtalar arthroereisis is not covered and is not eligible for payment.  A participating, preferred, or network provider can bill the member for the denied service.

Description 

Flatfoot (hyperpronation and flattening-out of the longitudinal arch; also known as pes planus) is a common deformity among children and adults.  This condition is caused by anterior and medial displacement of the talus.  It may be congenital in nature or acquired in adulthood.  Symptoms of flatfoot include dull aching, throbbing, and cramping foot pain.  There may also be muscle cramps in the calf and ankle, knee discomfort, difficulty standing or walking, and clumsiness.  Conservative treatments to relieve pain from the foot and leg associated with flatfoot include orthotics, stretching exercises, and medication (e.g., non-steroidal anti-inflammatory drugs).  Various surgical techniques have been used in the treatment of patients who have failed conservative approaches for the treatment of flatfoot.  Such treatments include tendon transfer or lengthening, realignment of one or more bones, joint fusion, and the placement of a subtalar implant, or arthroereisis.  Subtalar arthroereisis is a minimally invasive procedure.  It involves the insertion of an implant into the sinus tarsi, a canal that is located above the calcaneus (heel) and below the talus (ankle).  The implant is inserted strategically between the bony structures of the foot to act as an internal orthotic or spacer.  Placement of the implant restores the arch of the foot while preventing excessive pronation.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Needleman RL, A surgical approach for flexible flatfeet in adults including a subtalar arthroereisis with the MBA sinus tarsi implant. Foot and Ankle International.  2006;27:9-18.

Grumbine NA, Talar neck osteotomy for flatfoot reconstruction: a 27-year follow-up study. Foot and Ankle Clinic. 2006;23:41-55.

DePellegrin M, Subtalar screw-arthroereisis for correction of flat foot in children. Orthopade. 2005;34:941-53.