Claw Foot (Pes Cavus) VA Disability Rating
Diagnostic Code 5278 · 38 CFR §4.71a
What Is It?
Claw foot, medically called pes cavus, is a condition where the foot has an abnormally high arch that does not flatten during weight bearing. The toes may curl downward into a claw-like position. The high arch concentrates weight on the heel and ball of the foot, causing pain, calluses, and instability. The condition can worsen over time due to nerve damage, muscle imbalance, or the prolonged physical stress of military service. Walking and running become increasingly painful as the arch prevents normal shock absorption.
Rating Criteria
| Rating | Criteria |
|---|---|
| 50% | Bilateral claw foot with marked contraction of the plantar fascia, dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity. |
| 30% | Bilateral claw foot with all toes tending to dorsiflexion, limitation of dorsiflexion at the ankle to a right angle, shortened plantar fascia, and marked tenderness under the metatarsal heads. |
| 20% | Unilateral claw foot with all toes tending to dorsiflexion, limitation of dorsiflexion at the ankle to a right angle, shortened plantar fascia, and marked tenderness under the metatarsal heads. |
| 10% | Bilateral claw foot with the great toe dorsiflexed and some limitation of dorsiflexion at the ankle with definite tenderness under the metatarsal heads. |
Evidence Needed
- Podiatric or orthopedic records documenting the pes cavus diagnosis
- Imaging showing the high arch and any bony deformities
- Examination documenting toe position, ankle motion, and callus formation
- Records of orthotic devices or special footwear prescribed
- Statements describing pain with walking and standing
C&P Exam Tips
- Make sure the examiner documents the toe positions, arch height, and callus locations
- Report all painful areas especially under the ball of the foot
- Show any calluses or skin changes caused by abnormal pressure distribution
- Describe your ankle motion limitations, particularly dorsiflexion
- Mention whether the condition affects one or both feet, as the rating criteria differ
How to File
File under DC 5278 with podiatric examination documenting the specific criteria: toe positions, ankle dorsiflexion limitation, plantar fascia condition, calluses, and whether the condition is unilateral or bilateral. Include photographs of the feet if the deformity is visible.
Common Mistakes
Not having all the specific criteria documented — each rating level has distinct physical findings that must be present Failing to specify whether the condition is unilateral or bilateral, which changes the available ratings Not documenting callus locations and severity which are part of the higher rating criteria Missing secondary conditions like hammer toes that may warrant separate ratings
Frequently Asked Questions
Can pes cavus be caused by military service?
While some cases are inherited, military service can worsen a mild high arch into a symptomatic condition through years of marching, running, and wearing boots. Additionally, nerve damage from service-connected injuries can cause pes cavus to develop. Service connection can be established through aggravation of a pre-existing condition or direct causation.
What is the difference between claw foot and flat foot?
They are opposite conditions. Claw foot has an abnormally high arch, while flat foot has little or no arch. Both cause foot pain but in different areas and through different mechanisms. Claw foot concentrates pressure on the heel and ball, while flat foot distributes too much force through the middle of the foot.