CPT® Code 28737

The procedure described by CPT® Code 28737 refers to an arthrodesis, specifically involving tendon lengthening and advancement at the midtarsal region, targeting the tarsal navicular-cuneiform joint. This surgical intervention is primarily indicated for addressing malalignment or sagging of the navicular-cuneiform joint, conditions that are frequently associated with flatfoot deformity or severe pronation. The arthrodesis aims to fuse the affected bones, thereby stabilizing the joint and alleviating pain or dysfunction. The procedure involves a careful surgical approach, beginning with an incision over the midfoot, followed by meticulous dissection of soft tissues to safeguard surrounding nerves and blood vessels. The surgical team exposes the midtarsal and tarsal navicular-cuneiform joints, excising cartilage and scaling bone to reveal the underlying cancellous bone. A key component of this procedure is the lengthening and advancement of the tibialis anterior tendon, which is achieved through a specific technique known as the Miller type procedure. This involves creating a Z-shaped incision in the tendon, allowing for its elongation and subsequent advancement to improve foot alignment. The surgical process also includes the repositioning of the midtarsal, navicular, and cuneiform bones to their anatomical positions, stabilization of the joints with pins or screws, and closure of the incisions in layers. Postoperatively, a bulky dressing is applied, and the foot is immobilized in a cast, splint, or boot to facilitate healing.