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Many surgical procedures have been described for the treatment of congenital and acquired conditions of the big toe. Conservative treatments include exercise, physiotherapy, supportive shoes worn alone or worn with soft/semi-rigid orthoses, non-steroidal anti-inflammatory drugs, and steroid injections. Although the literature addressing treatments of conditions that affect the hallux often focuses on surgical interventions, the use of conservative therapies is emphasized before surgery is considered. Disease/disorder of the MPJ affects shoe wear, ambulation, and other activities of daily living. Hallux valgus is classified as an abnormal deviation of the great toe towards the midline of the foot. Hallux rigidus is characterized by pain as well as a reduction in the range of motion (ROM), especially dorsiflexion, at the first MPJ. The MPJ may become stiff (hallux rigidus), or deformed (hallux valgus). Both types of arthritis often affect the first MPJ located at the base of the big toe.
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The underlying causes of disease/disorder of the MPJ include osteoarthritis, rheumatoid arthritis, disease of the hallucal sesamoids and post-traumatic degeneration. Most clinical presentations of the hallux (big toe) concern the metatarsal phalangeal joint (MPJ). total prosthetic replacement arthroplasty with silastic implants (e.g., the In2Bones Reference Toe System (RTS) Implant) andĪetna considers metatarsal phalangeal joint replacement for other indications, and for joints other than the first metatarsal phalangeal joint (e.g., tarsal metatarsal joint) experimental and investigational because its value is unproven.Īetna considers ceramic prostheses (e.g., the Moje implant) experimental and investigational for replacement of the first metatarsal phalangeal joint and for other indications because their long-term effectiveness has not been established.Īetna considers modular implants (e.g., the Arthrex metatarsal phalangeal joint implant, the Cartiva Synthetic Cartilage Implant, the METIS prosthesis, the OsteoMed ReFlexion 1st MTP Implant System, and the ToeFit-Plus prosthesis) experimental and investigational for replacement of the first metatarsal phalangeal joint and for other indications because their long-term effectiveness has not been established.Īetna considers interpositional arthroplasty with biologic spacers (e.g., the InterPhlex interdigital implant) and total prosthetic replacement arthroplasty using total metallic implants experimental and investigational for hallux rigidus, degenerative arthritis, and other indications involving the metatarsal phalangeal joints because their effectiveness has not been established.Īetna considers the bioabsorbable poly-L-D-lactic acid RegJoint inter-positional implant experimental and investigational for the treatment of hallux rigidus and arthritic hallux valgus because its effectiveness has not been established.
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Policy Aetna considers the following procedures medically necessary for persons with disabling arthritis of the first metatarsal phalangeal joint (hallux rigidus):