Description

Subtalar arthroereisis is a surgical procedure that involves placing an implant that has the appearance of a threaded cylinder into the sinus tarsi between the talus bone and calcaneus (heel) to stabilize the foot. It may be performed on both children and adults for congenital and adult-onset flatfoot (eg, pes planus, pes planovalgus, and pes valgus) deformities.

Examples of US Food & Drug Administration (FDA) approved implants utilized during subtalar arthroereisis include, but may not be limited to:

• Arthrex ProStop arthroereisis subtalar implant
• Gaitway implant system
• HyProCure subtalar implant systems
• OsteoMed Talar-Fit subtalar implant
• SubFix arthroereisis implant
• SubTalar Lok implant
• Subtalar Maxwell-Brancheau arthroereisis (MBA) system
• Trilliant Twist surgical subtalar implant

Talotarsal joint subluxation/hypermobility occurs when the ankle bones have become displaced from their correct position on the hindfoot bones creating an imbalance or malalignment. Purportedly, this malalignment is a primary contributing cause to many foot and ankle problems including flatfoot. A subtalar joint implant (HyProCure) is used to correct subluxation during the extraosseous subtalar joint implantation or extraosseous talotarsal stabilization (EOTTS) surgical procedure.

Coverage Determination

Most Plans do not cover the treatment of weak, strained, flat, unstable or unbalanced feet. Please consult the member's individual certificate regarding Plan coverage.

Humana members may NOT be eligible under the Plan for subtalar arthroereisis or extraosseous subtalar joint implantation for the treatment of any condition including, but may not be limited to:

• Congenital and adult-onset flatfoot deformities (eg, pes planus, pes planovalgus, pes valgus); OR
• Posterior tibial tendon dysfunction; OR
• Talotarsal joint subluxation/hypermobility

This is considered experimental/investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature published in the English language.

Background

Additional information about flatfeet in children and adults and other disorders of the feet may be found from the following websites:

• American Academy of Orthopaedic Surgeons
• American College of Foot and Ankle Surgeons
• National Library of Medicine

Medical Alternatives

Alternatives to subtalar arthroereisis/talotarsal joint subluxation include, but may not be limited to, the following:

• Orthotics (please refer to Orthotics Medical Coverage Policy)
• Physical therapy (please refer to Physical Therapy and Occupational Therapy Medical Coverage Policy)
• Prescription drug therapy
• Short leg walking cast or brace
• Surgical procedures including, but may not be limited to, the following:
  • Arthrodesis
  • Osteotomy
  • Tendon transfer

Physician consultation is advised to make an informed decision based on an individual's health needs.