BlueCross BlueShield of Tennessee Medical Policy Manual

Subtalar Arthroereisis

DESCRIPTION

Flexible flatfoot is a common disorder, anatomically described as excessive pronation during weight bearing due to anterior and medial displacement of the talus. It may be congenital in nature or it may be acquired in adulthood due to posterior tibial tendon dysfunction, which in turn may be caused by trauma, overuse, inflammatory disorders and other factors. Symptoms include dull, aching and throbbing, cramping pain, which in children may be described as growing pains. Conservative treatments include orthotics or shoe modifications.

Surgical options include arthrodesis (joint fusion), osteotomy, and subtalar arthroereisis. Subtalar arthroereisis (STA) is performed by placing an implant in the sinus tarsi, which is a canal located between the talus and the calcaneus.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

The evidence for subtalar arthroereisis includes mainly single-arm case series and one small nonrandomized controlled trial.  Some studies report high rates of complications and implant removal.  The evidence is insufficient to determine the effects of the technology on health outcomes.

SOURCES 

BlueCross BlueShield Association. Medical Policy Reference Manual. (8:2017). Subtalar arthroereisis (7.01.104). Retrieved January 12, 2018 from BlueWeb. (18 articles and/or guidelines reviewed)

Chong, D. Y., Macwilliams, B. A., Hennessey, T. A., Teske, N., & Stevens, P. M. (2015). Prospective comparison of subtalar arthroereisis with lateral column lengthening for painful flatfeet. Journal of Pediatric Orthopaedics, Part B, 24 (4), 345-353. Abstract retrieved January 27, 2017 from PubMed database.

Metcalfe, S., Bowling, F., & Reeves, N. (2011). Subtalar joint arthroereisis in the management of pediatric flexible flatfoot: a critical review of the literature. Foot & Ankle International, 32 (12), 1127-1139. Abstract retrieved March 2, 2016 from PubMed database.

National Institute for Health and Clinical Excellence. (2009, July). Sinus tarsi implant insertion for mobile flatfoot. Retrieved January 13, 2011 from http://www.nice.org.uk.

Saxena, A., Via, A., Maffulli, N., and Chiu, H. (2016, May)  Subtalar arthroereisis implant removal in adults: a prospective study of 100 patients. Journal of Foot & Ankle Surgery, 55(3), 500-503. Abstract retrieved January 12, 2018 from PubMed database.

Shah, N., Needleman, R., Bokhari, O., & Buzas, D. (2015). 2013 subtalar arthroereisis survey: the current practice patterns of members of the AOFAS. Foot & Ankle Specialist, 8 (3), 180-185. Abstract retrieved March 2, 2016 from PubMed database.

U. S. Food and Drug Administration. (2006, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K053543. Retrieved January 14, 2010 from http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2006, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K061765. Retrieved August 30, 2013 from http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2009, May). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K081755. Retrieved August 30, 2013 from http://www.accessdata.fda.gov.

Winifred S. Hayes, Inc. Medical technology Directory. (2012, November; last update search September 2016). Subtalar arthroereisis for the treatment of flatfoot. Retrieved January 27, 2017 from www.Hayesinc.com/subscribers (52 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  4/13/2006

MOST RECENT REVIEW DATE:  2/8/2018

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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