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C&P Exam Prep: Metatarsalgia, Anterior (Morton's Disease)
DBQ Overview
Interview + Physical- Form Name
- Foot_Conditions_Including_Flatfoot_Pes_Planus
- Form Code
- Foot_Conditions_Including_Flatfoot_Pes_Planus
- Page Count
- 16
- Examiner Type
- Physician or Physician Assistant
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity of anterior metatarsalgia (Morton's Disease) including pain under metatarsal heads, functional limitations, and impact on ambulation in order to assign a disability rating under DC 5279.
What the examiner evaluates:
- Location and severity of forefoot pain under metatarsal heads
- Presence of plantar interdigital nerve lesion (Morton's neuroma)
- Tenderness under metatarsal heads (definite vs. marked)
- Painful callosities under metatarsal heads
- Toe deformities associated with metatarsalgia
- Functional loss due to pain during activity and at rest
- Effect of orthotics, arch supports, or built-up shoes on symptoms
- Range of motion of the ankle and toes (active, passive, weight-bearing, non-weight-bearing)
- DeLuca factors: pain with use, fatigue, weakness, incoordination, flare-ups
- Impact on standing, walking, and activities of daily living
- Need for assistive devices or special footwear
- Surgical history including metatarsal head resection or tarsal osteotomy
- Laterality: unilateral or bilateral involvement
Examination will include both interview and physical examination of the foot. You will be asked to stand, walk, and have your feet palpated. Wear comfortable footwear you can easily remove. Bring any orthotics, special insoles, or metatarsal pads you use. Note that DC 5279 provides a single 10% rating regardless of whether the condition is unilateral or bilateral, so accurate documentation of severity and functional impact is critical.
Typical duration: 30-45 minutes
Palpation of Metatarsal Heads
Tenderness under metatarsal heads (2nd-4th most common for Morton's neuroma between 3rd and 4th)
What to expect:
The examiner will press firmly under the ball of your foot on each metatarsal head. They will assess whether tenderness is definite or marked. They may apply lateral compression of the forefoot (Mulder's test) to elicit a click or pain from a Morton's neuroma.
Key thresholds:
- Definite tenderness under metatarsal heads — Supports 10% rating under DC 5279
- Marked tenderness under metatarsal heads — Supports 10% rating and documents severity; may support analogous rating under DC 5284 if more advantageous
Tips:
- Do not brace yourself or suppress a pain reaction - allow your natural response to be observed
- Point out exactly which metatarsal spaces or heads are most tender
- Tell the examiner if the tenderness worsens when pressed versus when walking
- Mention if you feel electric, shooting, or burning sensations radiating to toes when pressed
Pain considerations: Pain under metatarsal heads is the cardinal feature of this condition. Clearly communicate whether pain is sharp, burning, or aching, and whether it radiates to the toes or the plantar surface. Inform the examiner if palpation recreates your typical daily pain.
Callosity Assessment
Presence and severity of painful callosities beneath metatarsal heads, which are a rated symptom under the foot conditions DBQ
What to expect:
The examiner will visually inspect the plantar surface of your foot for calluses under the metatarsal heads. They will ask whether these are painful.
Key thresholds:
- Very painful callosities under metatarsal heads — Documented as a specific symptom in the DBQ (field: PUBLICDBQMUSCFOOTCONDITIONSINCLUDINGFLATFOOTPESPLA_594_VERYPAINFULCALLOSITIES); supports severity documentation
Tips:
- Point out any visible calluses before the exam if they are not immediately apparent
- Describe how painful the calluses are on a 0-10 scale
- Explain whether calluses bleed, crack, or require regular podiatric care
Pain considerations: Painful callosities beneath metatarsal heads compound the disability of metatarsalgia. Describe how callus pain differs from or adds to your nerve-type pain.
Ankle and Toe Range of Motion (ROM)
Active and passive ROM of the ankle (dorsiflexion/plantarflexion) and toe joints, weight-bearing and non-weight-bearing, per Correia requirements
What to expect:
The examiner will measure how far you can bend your ankle and toes both actively (you move them) and passively (examiner moves them), while standing (weight-bearing) and seated (non-weight-bearing). Goniometer measurements are expected.
Key thresholds:
- Limitation of dorsiflexion at ankle to right angle — Documented separately in DBQ; may support more severe rating under pes planus or foot injury codes if applicable
- Pain at end range of motion — Must be documented under DeLuca factors as pain-limited ROM
Tips:
- Perform each motion to your honest pain limit - do not push through severe pain
- Verbally report pain onset and pain severity at each stage of movement
- If symptoms worsen after repetitive motion, ask the examiner to note that fatigue effect
- Report any differences between how far you can move without weight on the foot versus while standing
Pain considerations: Per DeLuca v. Brown, the examiner must consider pain, fatigue, weakness, and incoordination with both initial and repetitive use. Proactively describe how your forefoot pain changes with prolonged standing or walking.
Functional Gait Observation
How metatarsalgia affects your walking pattern, weight distribution, and ability to ambulate
What to expect:
The examiner may observe you walk across the room and note any antalgic gait, toe-off avoidance, or altered weight-bearing patterns.
Key thresholds:
- Antalgic gait with forefoot avoidance — Supports functional loss documentation under disturbance of locomotion field
- Inability to heel-to-toe walk or stand on tiptoe without pain — Supports documentation of interference with standing and disturbance of locomotion
Tips:
- Walk at your natural pace - do not overperform or underperform
- If you normally use a metatarsal pad or orthotic, mention whether you are currently wearing it
- Describe how far you can walk before pain forces you to stop or sit down
Pain considerations: Your worst-day walking ability is what matters for rating purposes. Describe your most limited days, not just average days.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 10% | Anterior metatarsalgia (Morton's Disease), unilateral or bilateral. DC 5279 provides a single flat rating of 10% regardless of laterality or specific severity level. The 10% rating is the only available rating under this code. Severity documentation is important for (1) establishing entitlement to the 10% rating, (2) supporting potential analogous ratings under DC 5284 if a more advantageous evaluation is warranted, and (3) documenting functional loss for overall combined rating purposes. |
CFR: 38 CFR 4.71a DC 5279: 'Metatarsalgia, anterior (Morton's disease), unilateral, or bilateral - 10 percent.' Per M21-1 V.iii.1.B.5.g, anterior metatarsalgia of any type, including Morton's Disease, is evaluated under DC 5279. The code provides for a 10% evaluation regardless of unilateral or bilateral involvement. |
10% Anterior metatarsalgia (Morton's Disease), unilateral or bil ...
Anterior metatarsalgia (Morton's Disease), unilateral or bilateral. DC 5279 provides a single flat rating of 10% regardless of laterality or specific severity level. The 10% rating is the only available rating under this code. Severity documentation is important for (1) establishing entitlement to the 10% rating, (2) supporting potential analogous ratings under DC 5284 if a more advantageous evaluation is warranted, and (3) documenting functional loss for overall combined rating purposes.
Key Symptoms
- Pain in the forefoot under metatarsal heads
- Burning, shooting, or electric pain radiating to toes (Morton's neuroma pattern)
- Tenderness on palpation of metatarsal heads
- Painful callosities under metatarsal heads
- Pain with prolonged standing or walking
- Antalgic gait or altered weight distribution
- Need for metatarsal pads, orthotics, or special footwear
- Flare-ups with activity that limit ambulation
CFR: 38 CFR 4.71a DC 5279: 'Metatarsalgia, anterior (Morton's disease), unilateral, or bilateral - 10 percent.' Per M21-1 V.iii.1.B.5.g, anterior metatarsalgia of any type, including Morton's Disease, is evaluated under DC 5279. The code provides for a 10% evaluation regardless of unilateral or bilateral involvement.
How to Describe Your Symptoms
Forefoot Pain and Tenderness
How to describe:
Describe the pain as located specifically under the ball of your foot, typically between the 3rd and 4th toes (for Morton's neuroma) or under multiple metatarsal heads. Characterize the pain type: burning, sharp, shooting, electric, or aching. Describe onset with activity versus at rest.
Worst-day example:
“'On my worst days, the burning pain under the ball of my foot starts within 5 minutes of walking. It feels like I'm walking on a sharp pebble or a hot coal. I have to stop and sit down, remove my shoe, and rub my foot before I can continue. The pain sometimes shoots into my 3rd and 4th toes like an electric shock.'”
What the examiner listens for:
Specific location (which metatarsal space), quality of pain (burning/electric favors neuroma), provocative factors (tight shoes, prolonged standing, walking), and relieving factors (removing shoes, orthotics, rest).
Understatements to avoid:
Saying 'my foot hurts sometimes' without specifying location, intensity, or functional impact. Avoid saying 'it's not that bad' when pain consistently limits your activity.
Functional Limitations - Standing and Walking
How to describe:
Quantify how long you can stand or walk before pain forces a change. Describe the impact on your job, household tasks, and recreation. Mention how the condition has changed your ability to perform activities you could previously do.
Worst-day example:
“'On bad days I cannot stand at the kitchen counter for more than 10 minutes without excruciating pain under my foot. I have stopped going to the grocery store on my own because I cannot walk the aisles. I used to walk my dog for 30 minutes but now I can manage only 5 minutes before I have to turn back.'”
What the examiner listens for:
Specific time and distance limitations, changes from pre-service baseline, compensatory behaviors (sitting more, avoiding standing on hard surfaces), and whether limitations are consistent or fluctuating.
Understatements to avoid:
Avoid saying 'I can still walk OK' if you have substantially reduced your activity to accommodate your pain. Report your actual worst-day functional capacity, not your adapted routine.
Flare-Ups
How to describe:
Describe frequency, duration, triggers, and severity of flare-ups. Note what makes them worse (prolonged standing, dress shoes, going barefoot on hard floors, weather changes) and how long recovery takes.
Worst-day example:
“'I have flare-ups 3-4 times per week, often triggered by wearing any shoe with a firm sole or standing more than 30 minutes. During a flare, the pain is 8-9 out of 10 and I cannot bear weight on the forefoot at all. I have to elevate my foot and apply ice for 1-2 hours before the pain subsides enough to walk again.'”
What the examiner listens for:
Frequency and predictability of flare-ups, functional loss during flare-ups, whether flare-ups require any medical intervention or missed work or activities, and description of pain level during flares versus baseline.
Understatements to avoid:
Do not downplay flare-ups as 'just occasional bad days.' The DBQ has a specific field for flare-up functional loss (field: PUBLICDBQMUSCFOOTCONDITIONSINCLUDINGFLATFOOTPESPLA_770_IFYESTHEREISAFUNCTIONALLOSSDUETOPAINDURINGFLAREUPS). Flare-up severity directly informs the examiner's functional loss assessment.
DeLuca Factors - Pain, Fatigue, Weakness, Incoordination with Use
How to describe:
Specifically address how your foot performs with repetitive use. Describe whether pain, fatigue, or weakness increases after prolonged use. Note if you have difficulty with balance or coordination on the affected foot.
Worst-day example:
“'After walking for more than 10 minutes, the pain under my foot worsens significantly and I notice my foot feeling weak and unsteady. I have difficulty pushing off with my forefoot when climbing stairs because the pain is so severe. By afternoon most days, I am limping noticeably because the forefoot pain makes me alter my gait.'”
What the examiner listens for:
Whether functional loss worsens with repetitive use beyond the single-motion assessment, presence of fatigue, weakness, or incoordination as distinct from pain alone, and whether condition is stable or worsens throughout the day.
Understatements to avoid:
Do not assume the examiner will infer DeLuca factors. Explicitly state that your foot function declines with use and that your range of motion or strength decreases after activity.
Impact of Assistive Devices and Orthotics
How to describe:
Describe any metatarsal pads, custom orthotics, arch supports, special footwear, or assistive devices you use. Explain whether they provide relief and how limited you are without them.
Worst-day example:
“'I wear custom orthotics with a metatarsal pad every day. Without them I cannot walk more than 2-3 minutes on any surface. Even with orthotics I have significant pain after 20-30 minutes of walking. I cannot wear dress shoes, heels, or any shoe without extra depth, which has affected my professional life.'”
What the examiner listens for:
Type and frequency of assistive device use, degree of relief provided, and level of disability even with devices in use. The DBQ documents arch supports, built-up shoes, cane, crutches, walker, brace, and wheelchair use.
Understatements to avoid:
Do not present your orthotics as fully resolving the condition. The examiner should understand the residual disability that persists even with optimal accommodations.
Common Mistakes to Avoid
Failing to distinguish forefoot pain from heel pain
The examiner must correctly categorize metatarsalgia (forefoot/ball of foot) versus plantar fasciitis (heel). Conflating the two can result in misdiagnosis or rating under the wrong DC.
Instead: Clearly point to the ball of your foot and the area under the metatarsal heads as your primary pain location. Separately describe any heel pain if present, as plantar fasciitis may be rated separately.
Impact: 10%
Minimizing symptoms because only one rating level exists under DC 5279
Veterans sometimes assume that since DC 5279 only has a 10% rating, symptom documentation does not matter. However, thorough documentation matters for establishing entitlement, supporting potential analogous ratings, and overall combined rating calculations.
Instead: Document your full symptom picture accurately. A thorough record also ensures that if the condition worsens and analogous rating under DC 5284 becomes appropriate, or if metatarsal bone changes develop (DC 5283), the record supports re-evaluation.
Impact: 10%
Not mentioning bilateral involvement
DC 5279 provides the same 10% rating for unilateral or bilateral. However, bilateral involvement is factored into overall combined rating calculations and may support separate bilateral factor adjustments.
Instead: Clearly state whether both feet are affected and which is more severe if bilateral. The examiner will document laterality in the DBQ (RG_1B_Metatarsalgia_Side_affected).
Impact: 10%
Performing ROM testing beyond your actual pain-limited range
Pushing through pain to demonstrate maximum ROM underrepresents your true functional limitation. The examiner is required to note pain-limited ROM under DeLuca, but only if you report or visibly demonstrate it.
Instead: Stop at the point where pain becomes limiting and verbally tell the examiner 'this is where pain limits my movement.' Ask that pain-limited ROM be documented separately from anatomical ROM.
Impact: 10%
Not mentioning the functional loss during flare-ups
The DBQ has a specific field asking whether there is functional loss due to pain during flare-ups. If you do not mention flare-up severity, the examiner may leave this field blank, underrepresenting your disability.
Instead: Proactively describe flare-up frequency, duration, triggers, and the functional loss during those episodes. Reference that your condition is not static and varies significantly from baseline.
Impact: 10%
Failing to bring or mention orthotics and special footwear
The DBQ documents whether arch supports, built-up shoes, or other accommodations are used and whether they relieve symptoms. Omitting this information means the examiner cannot capture the full picture of your adaptive needs.
Instead: Bring your orthotics, metatarsal pads, and any prescription footwear to the exam. Show them to the examiner. Describe your baseline disability even when using these devices.
Impact: 10%
Not mentioning that metatarsalgia and plantar fasciitis can be rated separately
Per M21-1 V.iii.1.B.5.h, since metatarsalgia is forefoot pain and plantar fasciitis is heel pain, they generally do not overlap and separate evaluations may be assigned. Veterans who have both conditions may fail to claim plantar fasciitis separately.
Instead: If you also have heel pain, report it separately and ensure both conditions are evaluated. However, note that metatarsalgia and pes planus cannot be rated separately under M21-1 V.iii.1.B.5.i.
Impact: 10%
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to receive a copy of your completed DBQ and C&P examination report. Request it from the VA Regional Office or examining contractor.
- You have the right to record your C&P examination in most states - check applicable state law and facility policy before doing so. Notify the examiner before recording begins.
- You have the right to submit additional evidence (buddy statements, private medical opinions, personal statements) after the exam but before the rating decision is issued.
- You have the right to request a new or corrected examination if the VA examination was inadequate, the examiner lacked sufficient expertise, the examination report contains a factual error, or if new and relevant evidence is submitted.
- You have the right to a fully reasoned rating decision explaining how the examiner's findings were applied to the rating criteria. If the decision does not explain how DC 5279 was applied, you may appeal.
- You have the right to be examined by an examiner appropriate to your condition. If you believe the examiner lacked knowledge of metatarsalgia or Morton's neuroma, you may raise this concern during an appeal.
- Per 38 CFR 3.102 (benefit of the doubt), when evidence is in approximate balance, the benefit of the doubt is given to the veteran. If your symptoms are documented but the examiner is uncertain about severity, the rating decision should favor you.
- You have the right to claim metatarsalgia and plantar fasciitis as separate disabilities if both are present, per M21-1 V.iii.1.B.5.h, as their symptoms (forefoot pain vs. heel pain) generally do not overlap.
- You have the right to be evaluated for an analogous rating under DC 5284 (foot injury) if your metatarsalgia resulted from a service-connected foot injury and such a rating would be more advantageous than DC 5279.
- You have the right to appoint a Veterans Service Organization (VSO), accredited claims agent, or attorney to assist you in preparing and prosecuting your claim at no cost during the initial claims process.
Related Conditions
- Plantar Fasciitis May be rated separately from metatarsalgia per M21 1 V.iii.1.B.5.h because plantar fasciitis causes heel pain while metatarsalgia causes forefoot pain symptoms generally do not overlap. If you have both conditions, claim both.
- Pes Planus (Flat Foot) Per M21 1 V.iii.1.B.5.i, separate evaluations for pes planus and metatarsalgia are NOT permitted due to pyramiding (both involve foot pain). If you have both, a single evaluation under the predominant DC applies, unless both resulted from a foot injury (DC 5284 may then apply).
- Tarsal or Metatarsal Bones, Malunion or Nonunion (DC 5283) If metatarsalgia is accompanied by malunion or nonunion of metatarsal bones, DC 5283 may be applicable and provides ratings of 10 30%. This may be more advantageous than DC 5279 in certain cases.
- Foot Injury, Other (DC 5284) If metatarsalgia resulted from a service connected injury to the foot, rating by analogy under DC 5284 may be more advantageous and should be explored, per M21 1 V.iii.1.B.5.g. DC 5284 provides ratings of 10 30% with a 40% rating for actual loss of use.
- Hammer Toes Hammer toes frequently co occur with metatarsalgia and can be rated separately as a distinct foot condition. Document any toe deformities associated with your metatarsalgia.
- Hallux Valgus (Bunion) Hallux valgus can alter weight distribution and contribute to or exacerbate metatarsalgia. If service connected, hallux valgus can be rated separately from metatarsalgia.
- Peripheral Neuropathy The burning, shooting nerve pain of Morton's neuroma must be distinguished from peripheral neuropathy. If peripheral neuropathy is also present (e.g., from diabetes or other service connected conditions), it should be evaluated and rated separately under neurological DCs.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.