Highmark Commercial Medical Policy in West Virginia

Section:	Surgery
Number:	S-194
Topic:	Subtalar Arthroereisis
Effective Date:	November 3, 2008
Issued Date:	April 18, 2011
Date Last Reviewed:	03/2011

General Policy Guidelines

Indications and Limitations of Coverage

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.

Procedure Codes

S2117

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

Harris EJ, Vanore JV, Thomas JL, et al. Diagnosis and treatment of pediatric flatfoot. J Foot Ankle Surg. 2004;43(6):341-73.

Lee MS, Vanore JV, Thomas JL, et al. Diagnosis and treatment of adult flatfoot. J Foot Ankle Surg. 2005;44(2):78-113.

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

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

Labovitz JM. The algorithmic approach to pediatric flexible pes planovalgus. Clin Podiatric Med Surg. 2006;23(1):57-76.

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.

Soomekh DJ, Baravarian B. Pediatric and adult flatfoot reconstruction: subtalar arthroereisis versus realignment osteotomy surgical options. Clin Podiatr Med Surg. 2006;23(4):695-708.

Chang TJ, Lee J. Subtalar joint arthroereisis in adult-acquired flatfoot and posterior tibial tendon dysfunction. Clin Podiatr Med Surg. 2007;24(4):687-97.

Jacobs AM. Soft tissue procedures for the stabilization of medial arch pathology in the management of flexible flatfoot deformity. Clin Podiatr Med Surg. 2007;24(4):657-65.

Schon LC. Subtalar arthroereisis: A new exploration of an old concept. Foot Ankle Clin. 2007;12(2):329-39.

Giza E, Cush G, Schon LC. The flexible flatfoot in the adult. Foot Ankle Clin. 2007;12(2):251-271.

Scher DM, Bansal M, Handler-Matasar S, et al. Extensive implant reaction in failed subtalar arthroereisis: report of two cases. HSS J. 2007;3(2):177-81.

Adelman VR, Szczepanski JA, Adelman RP. Radiographic evaluation of endoscopic gastrocnemius recession, subtalar joint arthroereisis, and flexor tendon transfer for surgical correction of stage II posterior tibial tendon dysfunction: a pilot study. J Foot Ankle Surg.2008;47(5):400-8.

Cicchinelli LD, Pascual Huerta J, Garcia Carmona FJ, et al. Analysis of gastrocnemius recession and medial column procedures as adjuncts in arthroereisis for the correction of pediatric pes planovalgus: a radiographic retrospective study. J Foot Ankle Surg. 2008;47(5):385-91.

Stapleton JJ, BelczykR, Zgonis T, Polyzois VD. Combined medial displacement calcaneal osteotomy, subtalar joint arthrodesis, and ankle arthrodiastasis for end-stage posterior tibial tendon dysfunction. Clin Podiatr Med Surg. 2009;26(2): 325-333.

Arangio GA, Salathe EP. A biomechanical analysis of posterior tibial tendon dysfunction, medial displacement calcaneal osteotomy and flexor digitorum longus transfer in adult acquired flat foot. Clin Biochem. 2009;24(4):385-390.

Hockenbury RT. Acquired flatfoot. eMedicine Specialties. 2009. www.emedicine.medscpae.com/article/1235600-overview. Website accessed March 9, 2011.

Medline Plus. Pes Planus. 2009. www.nlm.nih.gov/medlineplus/ency/article/001262.htm. Website accessed March 7, 2011.

Molayem I, Persiani P, Marcovici LL, et al. Complications following correction of the planovalgus foot in cerebral palsy by arthroereisis. Acta Orthop Belg. 2009;75(3):374-379.

Koning PM, Heesterbeek PJ, De Visser E. Subtalar arthroereisis for pediatric flexible pes planovalgus: fifteen years experience with the cone-shaped implant. J Am Podiatr Med Assoc. 2009;99(5):447-453.

National Institue for Health and Clinical Excellence (NICE). Sinus tarsi implant insertion for mobile flatfoot. Issue date July 2009.

Jerosch J, Schunck J, Abdel-Aziz H. The stop screw technique—as simple and reliable method in treating flexible flatfoot in children. Foot Ankle Surg. 2009;15(4):174-178.

Scharer BM, Black BE, Sockrider N. Treatment of painful pediatric flatfoot with Maxwell-Brancheau subtalar arthroereisis implant a retrospective radiographic review. Foot Ankle Spec. 2010;3(2):67-72.

Graham ME. Hyperpronation-The role of subtalar arthroereisis. European Musculoskeletal Review. 2010;5(1):65-69.

De Retana PF. Subtalar arthroereisis in pediatric flatfoot reconstruction. Foot Ankle Clin. 2010;15(2):323-335.

Kirby K. Biomechanics of subtalar arthroereisis. Podiatry Arena. 2010. www.podiatry-arena.com/podiatry-forum/showthread.php?t=42481. Website accessed March 7, 2011.

Podiatry Today Staff. Device offers unique solution for subtalar joint instability. Podiatry Today. 2010;12(8):80. www.podiatrytoday.com/device-offers-unique-solution-subtalar-joint-instability.htm. Website accessed March 7, 2011.

Graham ME. Dispelling the misconceptions about subtalar arthroereisis. Podiatry Today. 2010;23(5):26-32. www.podiatrytoday.com/dispelling-the-misconceptions-about-subtalar-arthrereisis.htm. Website accessed March 7, 2011.

Yeagerman SE, Cross MB, Positano R, Doyle SM. Evaluation and treatment of symptomatic pes planus. Curr Opin Pediatr. 2011;23(1):60-67.

Iaquinto JM, Wayne JS. Effects of surgical correction for the treatment of adult acquired flatfoot deformity: A computational investigation. J Orthop Res. 2011 [Epub ahead of print].

Evans AM, Rome K. A review of the evidence for non-surgical interventions for flexible pediatric flat foot. Eur J Phys Rehabil Med. 2011;[Epub ahead of print].

Jordan TH, Rush SM, Hamilton GA, Ford LA. Radiographic outcomes of adult acquired flatfoot corrected by medial column arthrodesis with or without a medializing calcaneal osteotomy. J Foot Ankle Surg. 2011;50(2):176-181.

Medline Plus. Flat feet tied to knee pain in older adults. 2011. www.nlm.nih.gov/medlineplus/news/fullstory_108053.htm. Website accessed March 7, 2011.

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Procedure Code Attachments

Diagnosis Codes

ICD-9 Diagnosis Codes

ICD-10 Diagnosis Codes

Glossary

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.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Highmark West Virginia plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Highmark West Virginia retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark West Virginia. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.