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, physical therapy/stretching exercises, and medication (e.g., non-steroidal anti-inflammatory drugs).  Surgical management is a consideration if non-surgical treatment options fail to provide adequate relief from pain, if there is a progression of deformity or instability, or if there is failure to return to acceptable function. 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, calcaneal osteotomy, joint fusion, and the placement of a subtalar implant, or arthroereisis.  

Subtalar arthroereisis 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.  Subtalar arthroereisis has been suggested as a stand-alone procedure or as a component of a more comprehensive bone or soft tissue procedure.  When performed as an isolated procedure, subtalar arthroereisis is considered to be a simple, minimally invasive procedure that can be performed through a small incision, with little postoperative immobilization, and rapid recovery.

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.

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