Name of the Procedure:

• Common Name(s): Subtalar Implant Surgery
• Technical Term: Arthroereisis, Subtalar (HCPCS Code: S2117)

Summary

Subtalar arthroereisis is a surgical procedure to correct flatfoot deformity. It involves placing an implant in the subtalar joint to support the arch of the foot and improve alignment. This procedure is generally done to alleviate pain and improve function in patients with flat feet.

Purpose

• Medical Conditions or Problems It Addresses: Flatfoot deformity, excessive pronation, and some types of foot pain.
• Goals or Expected Outcomes: The procedure aims to correct the alignment of the subtalar joint, reduce pain, support the arch of the foot, and improve overall foot function.

Indications

• Specific Symptoms or Conditions: Flatfoot deformity, chronic foot pain, difficulty in walking due to improper foot alignment.
• Patient Criteria: Typically performed on children and adolescents, but can also be indicated for adults with significant flatfoot deformity that has not responded to conservative treatments.

Preparation

• Pre-procedure Instructions: Patients may be advised to fast if general anesthesia is planned. Medication adjustments, such as stopping blood thinners, may be required.
• Diagnostic Tests or Assessments: X-rays, MRI scans, or CT scans of the foot to assess the severity of the deformity.

Procedure Description

1. Anesthesia: The procedure usually requires general anesthesia or regional anesthesia.
2. Incision: A small incision is made near the subtalar joint.
3. Implant Placement: A specially designed implant is inserted into the subtalar joint to limit excessive pronation and support the arch.
4. Closure: The incision is closed with sutures or surgical staples, and a bandage is applied.

• Tools, Equipment, or Technology Used: Surgical implant designed for the subtalar joint, scalpel, sutures, and possibly fluoroscopy for precise placement.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Subtalar arthroereisis is usually performed in an outpatient surgical center or hospital.

Personnel

• Surgeons: An orthopedic surgeon or a podiatric surgeon who specializes in foot and ankle surgery.
• Nurses: Surgical nurses assist during the operation.
• Anesthesiologists: Responsible for administering anesthesia and monitoring the patient.

Risks and Complications

• Common Risks: Infection, pain, swelling, bruising.
• Rare Risks: Implant migration or failure, overcorrection or undercorrection of the deformity, allergic reactions to the implant.
• Management: Postoperative monitoring, antibiotics for infection, and possibly surgical revision for severe complications.

Benefits

• Expected Benefits: Improved foot alignment, reduced pain, and better walking ability.
• How Soon They Might Be Realized: Some benefits may be noticed immediately, with full improvement typically occurring over several weeks to months.

Recovery

• Post-procedure Care and Instructions: Patients may need to wear a cast or boot and use crutches initially. Pain medication and ice may be recommended to manage discomfort.
• Expected Recovery Time: Full recovery can take from a few weeks to several months, depending on the patient’s overall health and adherence to postoperative care guidelines.
• Follow-up Appointments: Regular follow-up visits with the surgeon to monitor healing and implant stability.

Alternatives

• Other Treatment Options: Orthotic devices, physical therapy, other surgical options like tendon transfer or osteotomy.
• Pros and Cons: Non-surgical methods may provide temporary relief but might not address the root cause. Alternatives like tendon transfer have longer recovery times and higher complexity.

Patient Experience

• During the Procedure: The patient will be under anesthesia and should not feel pain.
• After the Procedure: There may be some postoperative pain and swelling, managed with pain medication and rest. Physical therapy might be needed to restore full function.
• Pain Management: Pain is typically managed with prescription pain relievers, ice, and rest.