Plantar Fasciitis Secondary to Pes Planus

The biomechanical pathway

Pes planus (flat feet) flattens the medial longitudinal arch, shifting load distribution across the foot and increasing tensile stress on the plantar fascia, particularly at its calcaneal insertion. Over time this can produce the inflammatory and degenerative changes characteristic of plantar fasciitis (sometimes more precisely termed plantar fasciopathy).

Podiatry and orthopedic literature recognize this association. A secondary claim under 38 CFR § 3.310 is typically framed as: pes planus altered foot mechanics → chronic plantar fascial overload → plantar fasciitis.

Rating criteria — DC 5269

Diagnostic Code 5269 was added in 2021 to provide a dedicated rating for plantar fasciitis. Ratings turn on whether symptoms respond to treatment, whether surgery has been required, and whether the condition is unilateral or bilateral.

• 10% (unilateral) / 10% (bilateral) — pain on use, relieved by non-surgical treatment.
• 20% (unilateral) / 30% (bilateral) — pain on use, not relieved by non-surgical treatment.
• 30% (unilateral) / 30% (bilateral) — pain on use, status post surgery without relief.

The bilateral factor (§ 4.26)

If both feet are affected and both receive compensable ratings, the bilateral factor adds 10% to the combined value of the paired ratings before combining with the rest of the body. On two 10% plantar-fasciitis ratings (combined value 19), the bilateral factor adds roughly 2, pushing the paired value to 21 — which can cross a rounding threshold when combined with other ratings.

Evidence that strengthens the claim

• Existing service connection for pes planus, bilateral or unilateral.
• Podiatry or orthopedic diagnosis of plantar fasciitis with imaging (ultrasound or MRI) when available.
• Records of conservative treatment attempts — orthotics, stretching, night splints, NSAIDs, steroid injections, physical therapy — and the response.
• Surgical records (plantar fasciotomy, gastrocnemius recession) if applicable, supporting the 30% tier.
• A nexus opinion explicitly tying the plantar fasciitis to pes planus-driven gait mechanics.
• Custom-orthotic prescriptions or VA-issued footwear/diabetic-shoe documentation.

Pyramiding considerations (§ 4.14)

Plantar fasciitis and pes planus are rated under different diagnostic codes and capture different functional impairments (arch collapse vs. fascial pain). Separate ratings are appropriate as long as the same pain symptom is not being counted twice. A well-drafted DBQ that distinguishes arch deformity from fascial pain reduces the pyramiding objection.

Where these claims break down

• ×Letting a C&P examiner lump 'foot pain' into the pes planus rating instead of evaluating plantar fasciitis separately.
• ×Failing to document the response (or non-response) to conservative treatment — it drives the rating tier.
• ×Not claiming bilateral when both feet are affected, missing the bilateral factor.
• ×Skipping the nexus opinion on the assumption the secondary link is obvious — it isn't to a rater without medical training.

Frequently Asked Questions