The military is hard on feet and ankles. Thousands of miles of running, rucking, jumping, and standing in boots that prioritize durability over biomechanical support — all of it takes a toll. Ankle sprains, stress fractures, plantar fasciitis, flat feet, and degenerative joint disease of the ankle and foot are among the most common musculoskeletal conditions in veteran populations. Yet many veterans don't connect their chronic foot pain to their years of military service.
Common Foot and Ankle Conditions in Veterans
- Plantar fasciitis. Inflammation of the plantar fascia — the thick band of tissue connecting the heel to the toes. Running, marching, and prolonged standing in military boots are well-established causes.
- Pes planus (flat feet). Loss of the longitudinal arch, which may develop or worsen during service due to the demands placed on the feet. If the entrance physical shows normal arches and separation shows flat feet, the claim is straightforward.
- Ankle instability. Chronic instability following in-service ankle sprains. Military training creates high risk for ankle sprains, and repeated sprains cause ligament laxity and chronic instability.
- Degenerative joint disease (ankle arthritis). Post-traumatic arthritis developing years after in-service ankle injuries, fractures, or the cumulative impact of airborne operations.
- Stress fractures. Repetitive stress injuries to the metatarsals, calcaneus, or tibia from running, marching, and high-impact training. Initial stress fractures may heal but can lead to chronic pain and structural changes.
- Hallux valgus (bunions). Lateral deviation of the great toe, often aggravated by narrow military footwear and prolonged standing.
- Morton's neuroma. Thickening of nerve tissue between the metatarsal heads, associated with repetitive pressure from running and tight footwear.
- Achilles tendinopathy. Chronic degeneration of the Achilles tendon from repetitive running, jumping, and ruck marching.
Why Military Service Causes Foot Problems
- High-impact training. Running, rucking with heavy loads, airborne operations (parachute landing falls), and obstacle courses subject the feet and ankles to repetitive trauma.
- Military footwear. Standard-issue boots are designed for durability and environmental protection, not biomechanical support. Years of service in boots that don't accommodate individual foot anatomy contributes to structural changes.
- Surface conditions. Running and marching on hard surfaces (concrete, asphalt, packed earth) increases impact forces compared to athletic training surfaces.
- Load carriage. Infantry, combat engineers, and other MOSs regularly carry 60-100+ pounds of equipment, dramatically increasing stress on the feet and ankles.
- Limited recovery. Military training schedules often don't allow adequate recovery between high-impact activities, promoting overuse injuries.
What the Nexus Letter Should Address
- In-service documentation of foot or ankle complaints, injuries, profiles, or treatment.
- The veteran's MOS and the physical demands it placed on the lower extremities.
- The current diagnosis with supporting clinical evidence (imaging, physical exam findings).
- The biomechanical mechanism connecting military service to the current condition.
- The progressive and degenerative nature of musculoskeletal conditions — explaining why a condition that began during service worsens over decades.
The Key Point
Foot and ankle conditions are cumulative injuries. They develop from years of high-impact activity, not single dramatic events. The nexus opinion should connect the veteran's specific duty requirements — the running, the rucking, the airborne operations, the years in military boots — to the current condition, and explain the progressive nature of musculoskeletal degeneration.
Continue Reading: Foot and Ankle Claims in Detail
Plantar Fasciitis: The Most Common Foot Condition
Plantar fasciitis is one of the most frequently claimed foot conditions among veterans. The connection to military service is well-supported:
- Mechanism. The plantar fascia is subjected to repetitive microtrauma with each step, especially during running and marching. Military boots typically provide less arch support than athletic shoes, increasing strain on the plantar fascia. Heavy load carriage increases ground reaction forces and further stresses the tissue.
- In-service onset. Many veterans first develop heel pain during service — particularly during basic training or deployments with high foot-marching demands. If this is documented in STRs, the direct service connection argument is strong.
- Chronic nature. Plantar fasciitis often becomes chronic, with periods of improvement and exacerbation. The fact that symptoms may have improved at some point during or after service doesn't mean the condition resolved.
- Secondary connections. Plantar fasciitis can develop secondary to service-connected conditions that alter gait — knee injuries, hip conditions, or back conditions that cause compensatory changes in how the veteran walks and distributes weight.
The VA rates plantar fasciitis under Diagnostic Code 5276 (flatfoot) or 5284 (other foot injuries), depending on the specific presentation and whether it's associated with pes planus.
Pes Planus (Flat Feet): The Aggravation Argument
Flat feet claims have a unique aspect: many veterans enter service with some degree of pes planus noted on their entrance physical. This doesn't bar the claim — it changes the argument to aggravation:
- Pre-existing condition aggravated by service. If mild pes planus was noted at entry but became symptomatic or structurally worse during service, the claim is for aggravation of a pre-existing condition under 38 C.F.R. § 3.306.
- The presumption of soundness. Under 38 U.S.C. § 1111, a veteran is presumed to have been in sound condition when entering service, unless a condition was noted on the entrance examination. If pes planus was noted at entry, the presumption doesn't apply and the question becomes whether service aggravated the condition beyond its natural progression.
- Normal arches at entry. If the entrance physical shows normal arches and the separation physical or subsequent records show pes planus, direct service connection (not aggravation) is the appropriate argument.
The VA rates bilateral pes planus under Diagnostic Code 5276:
- 0%: Mild; symptoms relieved by built-up shoe or arch support.
- 10%: Moderate; weight-bearing line over or medial to the great toe, inward bowing of the Achilles tendon, pain on manipulation and use.
- 30%: Severe; objective evidence of marked deformity, pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities.
- 50%: Pronounced; marked pronation, extreme tenderness of plantar surfaces, marked inward displacement and severe spasm of the Achilles tendon on manipulation, not improved by orthopedic shoes or appliances.
Ankle Instability and Post-Traumatic Arthritis
Ankle sprains are among the most common acute injuries in military populations. While individual sprains may heal, repeated sprains cause cumulative ligament damage leading to chronic ankle instability. Over years, this instability causes abnormal joint mechanics and accelerated cartilage degeneration:
- The progression. In-service ankle sprain(s) → ligament laxity → chronic instability → abnormal joint mechanics → cartilage degradation → post-traumatic osteoarthritis. This progression can take 10-20 years, creating a gap between service and diagnosis that the nexus letter must address.
- Imaging evidence. X-rays showing joint space narrowing, osteophytes, or subchondral sclerosis confirm degenerative changes. MRI can demonstrate ligament damage and cartilage loss. Comparing current imaging to any in-service imaging demonstrates progression.
- The nexus argument. The medical literature on post-traumatic ankle arthritis is well-established. The nexus letter should cite the documented in-service sprains, explain the pathophysiology of post-traumatic degeneration, and connect it to the current findings.
Airborne and Special Operations: Unique Considerations
Veterans with airborne, air assault, or special operations service have specific foot and ankle risk factors:
- Parachute landing falls (PLFs). Even properly executed PLFs transmit significant impact forces through the feet, ankles, and knees. Hundreds of jumps over a career cause cumulative damage. Jump logs document the number of jumps.
- Fast-roping and rappelling. High-speed descent techniques subject feet and ankles to sudden impact loads.
- Extended foot patrols with heavy loads. Special operations and infantry units conduct patrols carrying extreme loads (100+ pounds) over rough terrain for extended periods.
- The "warrior mentality" underreporting problem. In elite units, service members are less likely to report foot and ankle complaints due to unit culture. The absence of STR documentation doesn't mean the injuries didn't occur — the nexus letter should address this.
Secondary Connections from Foot and Ankle Conditions
Foot and ankle conditions frequently cause secondary conditions through altered biomechanics:
- Knee conditions. Flat feet, ankle instability, and altered gait change the load distribution through the knee joint, accelerating degenerative changes.
- Hip conditions. Chronic limping or compensatory gait from ankle pain alters hip mechanics.
- Back conditions. Altered gait mechanics from foot and ankle conditions change spinal loading and alignment, contributing to lumbar disc disease and degenerative changes.
- Contralateral limb overuse. Favoring one side due to a painful foot or ankle overloads the opposite leg, causing secondary conditions in the contralateral knee, hip, or ankle.
These secondary connections should be identified in the nexus letter, either to support additional claims or to document the full scope of impairment for rating purposes.
Rating Foot and Ankle Conditions
The VA rates foot and ankle conditions under several diagnostic codes:
- DC 5270: Ankle ankylosis (20-40% based on angle of fixation).
- DC 5271: Ankle limited motion (10% moderate, 20% marked).
- DC 5276: Flatfoot (0-50% as described above).
- DC 5277: Bilateral weak foot (10%).
- DC 5278: Claw foot/pes cavus (0-50%).
- DC 5279: Anterior metatarsalgia/Morton's disease (10%).
- DC 5280: Hallux valgus (0-10%).
- DC 5284: Other foot injuries (10% moderate, 20% moderately severe, 30% severe).
The nexus letter should document the specific functional limitations — walking distance, standing tolerance, impact on daily activities and employment — in language that maps to the appropriate rating criteria.