Current RMA Instruments

Changes from previous Instruments

SOP Bulletin 222

ICD Coding

• ICD-9-CM Codes: 734,754.61
• ICD-10-AM Codes: M21.4, Q66.5

Brief description

Pes planus is flat feet.  Children are born with flexibly flat feet.  The medial longitudinal arch of the foot develops during the first decade of life.  This arch may not develop normally (congenital or developmental pes planus), or it may form and be subsequently lost or partially lost (acquired pes planus - due to disease or injury affecting the anatomical structures that form the arch).  Flat feet may be asymptomatic.  The SOP covers pes planus that manifests with medial foot pain or requires medical treatment.  SOP factors are mostly relevant for acquired forms of pes planus, but the clinical worsening factors may apply to congenital and developmental forms (if worsening of a pre-exisitng condition has occurred).

Confirming the diagnosis

Diagnosis of pes planus is made on clinical grounds, based on the appearance of the foot on weight bearing and the presence of symptoms (pain) or the need for treatment (including orthotics).  Establishing whether the pes planus is congenital/developmental or acquired may be more difficult. 

The relevant medical specialist is an orthopaedic surgeon.

Additional diagnoses covered by SOP

• Flat feet

Conditions excluded from SOP

• Pes cavus^#
• Plantar fasciitis*
• Posterior tibialis tendinopathy* (this condition may coexist with pes planus, but is covered by a separate SOP)

* another SOP applies

^# non-SOP condition

Clinical onset

The longitudinal arch of the foot normally develops in children at around age 3 to 5 years.  Clinical onset may be in childhood, when it becomes apparent that the arch has failed to develop, or may be later in life if due to an acquired cause.  Most cases are developmental.  Some evidence of a normal longitudinal arch having been lost following disease or injury affecting the foot will be required to establish that the condition was acquired and that clinical onset was after the commencement of service.

Clinical worsening

Clinical worsening may be evidenced by progression from flexible to rigid pes planus or an increase in the level of symptoms (pain) attributed to the condition.