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Foot Function Index Questionnaire

This document contains a foot function index questionnaire to assess how foot pain has impacted a patient's daily activities over the past week. It consists of 17 questions asking the patient to rate pain levels and difficulty with various activities like walking, standing, climbing stairs, and running on a scale of 0 to 10. The scores are totaled and converted to a percentage to evaluate the patient's current foot function and pain levels.

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VALEN
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5K views1 page

Foot Function Index Questionnaire

This document contains a foot function index questionnaire to assess how foot pain has impacted a patient's daily activities over the past week. It consists of 17 questions asking the patient to rate pain levels and difficulty with various activities like walking, standing, climbing stairs, and running on a scale of 0 to 10. The scores are totaled and converted to a percentage to evaluate the patient's current foot function and pain levels.

Uploaded by

VALEN
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Foot Function Index

Name:_______________________________________ Date:_____________

This questionnaire has been designed to give your therapist information as to how your foot pain has
affected your ability to manage in every day life. For the following questions, we would like you to score
each question on a scale from 0 (no pain) to 10 (worst pain imaginable) that best describes your foot
over the past WEEK. Please read each question and place a number from 0-10 in the corresponding box.

No Pain 0 1 2 3 4 5 6 7 8 9 10 Worst Pain Imaginable


1. In the morning upon taking your first step? 0 1 2 3 4 5 6 7 8 9 10
2. When walking? 0 1 2 3 4 5 6 7 8 9 10
3. When standing? 0 1 2 3 4 5 6 7 8 9 10
4. How is your pain at the end of the day? 0 1 2 3 4 5 6 7 8 9 10
5. How severe is your pain at its worst? 0 1 2 3 4 5 6 7 8 9 10

Answer all of the following questions related to your pain and activities over the past WEEK, how much
difficulty did you have? No Difficulty 0 1 2 3 4 5 6 7 8 9 10 So Difficult unable to do
6. When walking in the house? 0 1 2 3 4 5 6 7 8 9 10
7. When walking outside? 0 1 2 3 4 5 6 7 8 9 10
8. When walking four blocks? 0 1 2 3 4 5 6 7 8 9 10
9. When climbing stairs? 0 1 2 3 4 5 6 7 8 9 10
10. When descending stairs? 0 1 2 3 4 5 6 7 8 9 10
11. When standing tip toe? 0 1 2 3 4 5 6 7 8 9 10
12. When getting up from a chair? 0 1 2 3 4 5 6 7 8 9 10
13. When climbing curbs? 0 1 2 3 4 5 6 7 8 9 10
14. When running or fast walking? 0 1 2 3 4 5 6 7 8 9 10

Answer all the following questions related to your pain and activities over the past WEEK. How much of
the time did you: None of the time 0 1 2 3 4 5 6 7 8 9 10 All of the time
15. Use an assistive device (cane, walker,
0 1 2 3 4 5 6 7 8 9 10
crutches, etc) indoors?
16. Use an assistive device (cane, walker,
0 1 2 3 4 5 6 7 8 9 10
crutches, etc) outdoors?
17. Limit physical activities? 0 1 2 3 4 5 6 7 8 9 10

Score: (Total:_____/170)100 = ______%

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