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. 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) andР”Р„etna 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.Р”Р„etna considers ceramic prostheses (e.g., the Moje implant) experimental and investigational for replacement of the first metatarsal phalangeal joint and for other indications becauseР’В their long-term effectiveness has not been established.Р”Р„etna 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.Р”Р„etna 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.Р”Р„etna considers the bioabsorbable poly-L-D-lactic acid RegJoint inter-positional implant experimental and investigational for the treatment of hallux rigidus and arthritic hallux valgusР’В becauseР’В its effectiveness has not been established.Policy Aetna considers the following proceduresР’В medically necessary for persons with disabling arthritis of the first metatarsal phalangeal joint (hallux rigidus):

First mtp