38 CFR Part 4 — 38 CFR § 4.71a
Claw foot (pes cavus), acquired — VA Diagnostic Code 5278
Musculoskeletal
Diagnostic code
5278
38 CFR § 4.71a lists Diagnostic Code 5278 under “The Foot” as “Claw foot (pes cavus), acquired:”. Appendix B to Part 4 uses the same words, with a period instead of the colon. The marked-contraction description has no percentage of its own. Bilateral under that description is 50. Unilateral is 30. Two further descriptions have their own bilateral and unilateral numbers. “Slight” is 0.
Reviewed 2026-10-05. Text checked against the eCFR versioner full-text XML for 2026-10-01 on 2026-10-05. Title 38 was up to date as of 2026-10-01 and last amended on 2026-08-27. The § 4.71a source note prints 29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 40 FR 42536, Sept. 15, 1975; 41 FR 11294, Mar. 18, 1976; 43 FR 45350, Oct. 2, 1978; 51 FR 6411, Feb. 24, 1986; 61 FR 20439, May 7, 1996; 67 FR 48785, July 26, 2002; 67 FR 54349, Aug. 22, 2002; 68 FR 51456, Aug. 27, 2003; 69 FR 32450, June 10, 2004; 80 FR 42041, July 16, 2015; 85 FR 76460, Nov. 30, 2020, 85 FR 85523, Dec. 29, 2020, 86 FR 8142, Feb. 4, 2021. The source note uses a comma, not a semicolon, before 85 FR 85523 and before 86 FR 8142. The § 4.69 source note prints 62 FR 30239, June 3, 1997. The § 4.71 source note prints 29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978; 67 FR 48785, July 26, 2002. The § 4.68 XML for this date does not print a Federal Register source note.
The rating criteria at each level
5278 Marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity:
Rating %: 50
Criteria (verbatim). Bilateral
Rating %: 30
Criteria (verbatim). Unilateral
| Rating % | Criteria (verbatim) |
|---|---|
| 50 | Bilateral |
| 30 | Unilateral |
5278 All toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads:
Rating %: 30
Criteria (verbatim). Bilateral
Rating %: 20
Criteria (verbatim). Unilateral
| Rating % | Criteria (verbatim) |
|---|---|
| 30 | Bilateral |
| 20 | Unilateral |
5278 Great toe dorsiflexed, some limitation of dorsiflexion at ankle, definite tenderness under metatarsal heads:
Rating %: 10
Criteria (verbatim). Bilateral
Rating %: 10
Criteria (verbatim). Unilateral
| Rating % | Criteria (verbatim) |
|---|---|
| 10 | Bilateral |
| 10 | Unilateral |
5278 Slight
Rating %: 0
Criteria (verbatim). Slight
| Rating % | Criteria (verbatim) |
|---|---|
| 0 | Slight |
The three description lines end with a colon and do not themselves print a percentage. Bilateral and unilateral are the next cells.
The marked-contraction line says “all toes hammer toes.” It does not insert “are” or a hyphen.
Marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity is 50 bilateral and 30 unilateral. All toes tending to dorsiflexion, limitation of dorsiflexion at ankle to right angle, shortened plantar fascia, and marked tenderness under metatarsal heads is 30 bilateral and 20 unilateral. Great toe dorsiflexed, some limitation of dorsiflexion at ankle, and definite tenderness under metatarsal heads is 10 bilateral and 10 unilateral. Slight is 0. The ankle words are inside those DC 5278 lines. The lines do not say “rate as DC 5271.” 38 CFR § 4.7 assigns the higher rating when the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 CFR § 4.6 requires each element affecting the evidence to be studied so that decisions will be equitable and just.
DC 5281 is hallux rigidus, unilateral, severe. It says “Rate as hallux valgus, severe.” Its note is “Note: Not to be combined with claw foot ratings.” DC 5282 is hammer toe. “All toes, unilateral without claw foot” is 10. “Single toes” is 0. DC 5279 is “Metatarsalgia, anterior (Morton's disease), unilateral, or bilateral,” at 10. The apostrophe in “Morton's” is the character the cell prints.
DC 5276 is acquired flatfoot. The public page is flat feet. DC 5269 is plantar fasciitis. The public page is plantar fasciitis. Note (1) under DC 5269 says “With actual loss of use of the foot, rate 40 percent.” That sentence is not printed on DC 5278. DC 5277 is weak foot, bilateral. It says “Rate the underlying condition, minimum rating,” 10.
Source: 38 CFR § 4.71a, Diagnostic Code 5278, eCFR full-text XML for 2026-10-01.
What the words mean in your records
The description and the side are different cells
“Marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity:” is one cell. “Bilateral” 50 and “Unilateral” 30 are the next cells. The same pattern is used for the other two descriptions.
Slight is the 0 line
“Slight” is 0. It does not say bilateral or unilateral. It does not end with a colon.
Claw foot ratings and hallux rigidus
The DC 5281 note says hallux rigidus is not to be combined with claw foot ratings. That note is printed under DC 5281. It names claw foot. It does not assign a second percentage to DC 5278.
Evidence that speaks to each level
50 bilateral or 30 unilateral
What the rater needs to see. Marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, and marked varus deformity, and whether the findings are bilateral or unilateral.
Where that usually lives. The foot examination.
30 bilateral or 20 unilateral
What the rater needs to see. 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.
Where that usually lives. The same examination.
10 and 10, or 0
What the rater needs to see. Great toe dorsiflexed, some limitation of dorsiflexion at the ankle, and definite tenderness under the metatarsal heads, bilateral or unilateral, at 10. Slight is 0.
Where that usually lives. The same examination.
VA’s public DBQ list, checked October 5, 2026, names “Foot Conditions Including Flatfoot (Pes Planus)” under Musculoskeletal. The file is Foot Conditions Including Flatfoot (Pes Planus).
The exam form
DC 5278 prints the bilateral and unilateral lines and the word “Slight.” This page does not say the form replaces those lines.
Related codes and how they interact
Hammer toe and hallux rigidus name claw foot in their own rows.
DC 5282’s 10 percent line is all toes, unilateral, without claw foot. DC 5281’s note says not to combine hallux rigidus with claw foot ratings. Acquired flatfoot is DC 5276.
Secondary conditions and presumptions
The 2026-10-01 text of 38 CFR § 3.309 does not contain “claw” or “pes cavus.” DC 5278 is a rating-schedule line.
A separate question, when a presumption does not decide it, is a medical question on the facts under 38 CFR § 3.310. Paragraph (a) covers disability proximately due to or the result of a service-connected disease or injury. Paragraph (b) covers increase in severity and requires a medical baseline.
Short answers
What is the VA rating for acquired claw foot?
Under 38 CFR § 4.71a, Diagnostic Code 5278 is claw foot (pes cavus), acquired. The highest printed line is 50 percent bilateral, under the marked-contraction description. Unilateral under that description is 30. Slight is 0. Education only. VA decides on the evidence.
Is the ankle limitation a separate code inside this row?
The second and third descriptions name limitation of dorsiflexion at the ankle as part of the claw-foot picture. They do not say to rate that finding under DC 5271.
FAQ
What percentages does DC 5278 print?
The marked-contraction description is 50 bilateral and 30 unilateral. The all-toes description is 30 bilateral and 20 unilateral. The great-toe description is 10 bilateral and 10 unilateral. Slight is 0. Education only.
Does the marked line say the toes are hammer toes?
The cell says “all toes hammer toes.” It does not print “are” between those words, and it does not hyphenate “hammer toes.”
Can hallux rigidus be combined with this code?
The note under DC 5281 says: “Not to be combined with claw foot ratings.” That note is on the hallux rigidus row. DC 5278 does not reprint it as a percentage.
Next steps
- Read the decision for DC 5278, which description it used, and whether the finding was bilateral, unilateral, or slight.
- The free worksheet is a place to write the code, the findings, and the records you already have. It does not file a claim or protect a filing date. An accredited representative is at find a VSO.
- Other foot codes are on the musculoskeletal diagnostic-code index. The category page is musculoskeletal conditions. The foot page is foot conditions.
Education only. Not legal or medical advice. My Claim Packet is not a VA-accredited representative and does not file claims. VA decides every claim on its own evidence.
Other codes in this body system
Nearby catalog entries in Musculoskeletal, ordered by diagnostic code number. All Musculoskeletal codes
- DC 5270Ankle, ankylosis
- DC 5271Ankle, limited motion
- DC 5272Subastragalar or tarsal joint, ankylosis
- DC 5273Os calcis or astragalus, malunion
- DC 5274Astragalectomy
- DC 5275Lower extremity bones, shortening
- DC 5276Flatfoot, acquired
- DC 5277Weak foot, bilateral
- DC 5279Metatarsalgia, anterior (Morton's disease)
- DC 5280Hallux valgus
- DC 5281Hallux rigidus
- DC 5282Hammer toe
- DC 5283Tarsal or metatarsal bones, malunion or nonunion
- DC 5284Foot injuries, other
- DC 5295Lumbosacral strain (legacy — pre-9/26/2003 schedule)
- DC 5296Skull, loss of part of both inner and outer tables
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 5278 • va.gov
⚠️ Important Disclaimer
This page provides general educational information based on public VA regulations and VA.gov resources. It is not legal or medical advice, and My Claim Packet is not a VA-accredited representative. Any worksheets or draft documents produced by the tools must be reviewed for accuracy and are not filed with VA for you. Ratings and service connection are decided case-by-case from the individual record. Consult a VA-accredited VSO, claims agent, attorney, or qualified clinician for help with your situation, and verify current rules using the linked official source.