| Diagnostic Code + Condition | Rating |
|---|---|
| 5269 Plantar Fasciitis: | |
| not responsive to treatment and is so severe that the foot cannot be used at all | |
| (DC 5167 - loss of use of foot) | 40% |
| no relief from both non-surgical and surgical treatment, bilateral | 30% |
| no relief from both non-surgical and surgical treatment, unilateral | 20% |
| otherwise, unilateral or bilateral | 10% |
| *90% of plantar fasciitis cases resolve without surgical treatment | |
| 5276 Flatfoot, acquired: | |
| Pronounced | |
| • marked pronation | |
| • extreme tenderness of plantar surfaces of the feet | |
| • marked inward displacement and severe spasm of the tendo achillis on manipulation | |
| • not improved by orthopedic shoes or appliances | |
| Bilateral | 50% |
| Unilateral | 30% |
| Severe | |
| • objective evidence of marked deformity (pronation, abduction, etc.) | |
| • pain on manipulation and use accentuated | |
| • indication of swelling on use | |
| • characteristic callosities | |
| Bilateral | 30% |
| Unilateral | 20% |
| Moderate | |
| • weight-bearing line over or medial to great toe | |
| • inward bowing of the tendo achillis | |
| • pain on manipulation and use of the feet | |
| • bilateral or unilateral | 10% |
| Mild | |
| • symptoms relieved by built-up shoe or arch support | |
| • bilateral or unilateral | 0% |
| 5277 Weak foot, bilateral: | |
| A symptomatic condition secondary to many constitutional conditions, characterized by atrophy of the musculature, disturbed circulation, and weakness: | |
| Rate the underlying condition, minimum rating | 10% |
| 5278 Claw foot (pes cavus), acquired: | |
| Marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity: | |
| Bilateral | 50% |
| Unilateral | 30% |
| All toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads: | |
| Bilateral | 30% |
| Unilateral | 20% |
| Great toe dorsiflexed, some limitation of dorsiflexion at ankle, definite tenderness under metatarsal heads: | |
| Bilateral | 10% |
| Unilateral | 10% |
| Slight | 0% |
| 5279 Metatarsalgia, anterior (Morton's disease), unilateral, or bilateral | 10% |
| 5280 Hallux valgus, unilateral: | |
| Operated with resection of metatarsal head | 10% |
| Severe, if equivalent to amputation of great toe | 10% |
| 5281 Hallux rigidus, unilateral, severe: | |
| Rate as hallux valgus, severe. | |
| Note: Not to be combined with claw foot ratings. | |
| 5282 Hammer toe: | |
| All toes, unilateral without claw foot | 10% |
| Single toes | 0% |
| 5283 Tarsal, or metatarsal bones, malunion of, or nonunion of: | |
| Severe | 30% |
| Moderately severe | 20% |
| Moderate | 10% |
| Note: With actual loss of use of the foot, rate 40 percent. | |
| 5284 Foot injuries, other: | |
| All other foot conditions and injuries are rated based on their severity and on how much the foot can be used. This coding is only used if none of the other codes can satisfactorily describe the symptoms of the condition. For example, if there is a bone condition in the foot, but it isn’t a break, then it most likely will still be rated under code 5283 as a broken bone since it still affects the same kind of things a broken bone would. Similarly if the condition is a disease, then it should be rated under the code for a similar disease. If it doesn’t fit into any of those other options, then it can be rated under 5284. | |
| With actual loss of use of the foot | 40% |
| Severe | 30% |
| Moderately severe | 20% |
| Moderate | 10% |
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