Flat Feet and Military Service: What Article 68 Actually Says

The short answer: grades I and II of flat feet do not prevent conscription in Russia, while an exemption comes with grade III — and even then not on its own, but when the degree is confirmed on an X-ray and accompanied by impaired foot function. The line between "unfit" and "fit with restrictions" runs not through the diagnosis in your chart but through a specific clause of article 68 of the Schedule of Diseases. Below is what that article says verbatim, how the degree is measured and what your records must contain for the board to see what your doctor sees.

The answer by degree

The Schedule of Diseases is the annex to the Regulation on military medical assessment (Russian Government Decree No. 565 of 4 July 2013). Flat feet and other foot deformities are covered by article 68, and it is built around functional impairment, not around degrees. The degree of flat foot is merely the way that impairment is measured.

Note that clauses «b» and «v» both yield the same category V in column I. The argument over which clause applies rarely changes the outcome for a conscript — it matters for those assessed under column III (contract service, officers), where the two diverge.

What article 68 says verbatim

The article is titled "Flat feet and other foot deformities". Fitness categories are distributed across three columns: I — registration and conscription, II — those serving as conscripts, III — contract servicemen and officers.

And here is the sentence from the explanatory notes that dismantles half of all expectations:

Longitudinal or transverse flat foot of grade I is not grounds for applying this article, does not prevent military service and does not prevent admission to military educational institutions.

Together with the one that defines clause «g»:

Clause «g» covers longitudinal or transverse flat foot of grade II.

In other words, grade II is not "almost an exemption" — it is a category B-3 named explicitly in the document.

How the degree is measured

The degree of flat foot is a measurement, not an opinion. The regulation describes the method in detail, and that is the method the board applies.

Longitudinal flat foot is assessed on an X-ray in lateral projection, standing, under full static load on the foot being examined. A triangle is constructed from three points — the lowest point of the head of the first metatarsal, the lowest point where the navicular and cuneiform bones meet, and the lowest point of the calcaneal tuberosity — and the arch angle is measured:

• normal — 125–130°;
• grade I — 131–140°;
• grade II — 141–155°;
• grade III — above 155°.

An image taken lying down or without load is unsuitable: under body weight the arch behaves differently, and the angle comes out "better" than it is. This is the single most common reason images get repeated at the board.

Transverse flat foot: different numbers

Transverse flat foot is assessed on X-rays of the forefoot and midfoot in direct projection, standing on both feet under body weight. Two angles are measured at once: between the first and second metatarsals, and the deviation of the great toe from the axis of the first metatarsal.

For article 68 what matters is transverse flat foot of grades III–IV — and only in combination with the findings listed in clause «b».

Why grade III alone does not settle it

Clause «b» is not simply "grade III". The regulation lists a combination of findings:

Clause «b» covers: longitudinal flat foot of grade III or transverse flat foot of grades III–IV with pronounced pain, exostoses, toe contracture and the presence of arthrosis in the midfoot joints.

Clause «v» is milder and covers precisely the "degree present, complications absent" case:

Clause «v» covers: moderately pronounced foot deformities with minor pain and impaired statics, in which regulation military footwear can be adapted for wear; longitudinal flat foot of grade III without valgus positioning of the calcaneus and without deforming arthrosis in the midfoot joints.

Arthrosis in these formulations is also a measurable quantity, and its stages are described in the same place: stage I — joint space narrowing of less than 50 % with marginal outgrowths up to 1 mm; stage II — narrowing of more than 50 %, outgrowths above 1 mm, deformity and subchondral osteosclerosis; stage III — the joint space is no longer visible radiologically. If the imaging report says nothing about arthrosis, the board proceeds on the basis that there is none.

The regulation separately describes decompensated longitudinal flat foot: pain in the feet when standing, worsening towards evening as swelling and pastosity of the feet appear, a pronated foot widened in its middle part, a lowered arch and a valgus heel. These are the exact phrases that should appear in an orthopaedist's report, not only in your account of it.

What your records must contain

The board works with paperwork. Under article 68 it looks for:

• Weight-bearing X-rays of both feet — lateral projection for longitudinal flat foot, direct for transverse — with a current report stating the measured angles in degrees.
• A description of arthrosis in the midfoot joints with its stage, if present.
• An orthopaedist's or traumatologist's conclusion describing functional impairment in the regulation's own terms: pain, impaired statics, toe contracture, valgus positioning of the calcaneus.
• A history: repeat visits recorded over time, not a single appointment the day before the board.
• Sometimes computed tomography of the subtalar joint: the regulation itself calls it the most informative way to assess that joint.

In an outpatient chart the diagnosis is recorded under code M21.4 — which on its own confirms only the fact of the diagnosis, not the degree and not any functional impairment.

What is usually missing

The same gaps recur when records are reviewed:

• images taken lying down or without load — the degree cannot be established from them;
• the imaging report contains no degrees, only the word "flat feet";
• nothing is said about arthrosis or its stage, although it is visible on the image;
• pain is mentioned at the appointment but never reaches the chart;
• the images are more than a year old while the board wants a current picture;
• body weight is well above normal, which increases the load on the arch and is worth documenting — your body mass index takes a minute to calculate;
• the minimum set of tests separating arthrosis from an inflammatory process has not been done — which tests are taken for joint pain is covered separately.

Questions for your doctor

• What is the arch angle on my most recent image, and in which projection was it taken?
• Are there signs of arthrosis in the midfoot joints, and at what stage?
• Is there valgus positioning of the calcaneus?
• How would you rate the functional impairment — minor, moderate or significant?
• Which of my complaints are recorded in the chart, and which exist only verbally?

These questions are not about "obtaining a category". They are about making your records describe your own picture fully and consistently with what your doctor sees.

Departmental boards have their own schedules

Everything above concerns military medical assessment under Decree No. 565. The boards of the Ministry of Internal Affairs, the National Guard, the Federal Security Service and the Emergencies Ministry use their own schedules of diseases, approved by their own orders, with different requirements. A review under article 68 will tell you where your records and measurements stand, but it is not their regulation — worth planning for in advance if you are applying to those services.

The short version

Grade I flat foot has nothing to do with article 68 at all; grade II gives category B-3 and does not prevent conscription; category V comes with grade III longitudinal flat foot, provided it is measured on a weight-bearing image and described together with the state of the joints. Only the military medical board decides the fitness category, and no one can guarantee a category in advance. What is within your control is arriving with a complete, coherent set of records in which the degree is measured correctly and function is described in the regulation's own language.