Scribd
Upload
2K views1 page

Foot Function Index: Pain Subscale: How Severe Is Your Foot Pain

Uploaded by

mekar retnoningsih

This document appears to be a foot function index questionnaire used to assess foot pain and disability. It contains 3 subscales to evaluate pain, disability, and activity limitation related to foot function. For each item, the patient rates their level of pain or difficulty on a 10-point scale. The physical therapist then scores and signs the questionnaire.

Copyright:

© All Rights Reserved
Download as PDF, TXT or read online from Scribd
Download as pdf or txt

Foot Function Index: Pain Subscale: How Severe Is Your Foot Pain

Uploaded by

mekar retnoningsih
2K views1 page
This document appears to be a foot function index questionnaire used to assess foot pain and disability. It contains 3 subscales to evaluate pain, disability, and activity limitation related to foot function. For each item, the patient rates their level of pain or difficulty on a 10-point scale. The physical therapist then scores and signs the questionnaire.

Original Description:

Indeks

Original Title

Index

Copyright

© © All Rights Reserved

Available Formats

PDF, TXT or read online from Scribd

Did you find this document useful?

Is this content inappropriate?

This document appears to be a foot function index questionnaire used to assess foot pain and disability. It contains 3 subscales to evaluate pain, disability, and activity limitation related to foot function. For each item, the patient rates their level of pain or difficulty on a 10-point scale. The physical therapist then scores and signs the questionnaire.

Copyright:

© All Rights Reserved
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
2K views1 page

Foot Function Index: Pain Subscale: How Severe Is Your Foot Pain

Uploaded by

mekar retnoningsih
This document appears to be a foot function index questionnaire used to assess foot pain and disability. It contains 3 subscales to evaluate pain, disability, and activity limitation related to foot function. For each item, the patient rates their level of pain or difficulty on a 10-point scale. The physical therapist then scores and signs the questionnaire.

Copyright:

© All Rights Reserved
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
You are on page 1/ 1

Foot Function Index

Name:____________________________________


































Date:__________________

Pain
subscale:

How
severe
is
your
foot
pain:
worst
pain

no
pain imaginable
1.

Foot
pain
at
it's
worse? 1 2 3 4 5 6 7 8 9 10
2.

Foot
pain
in
the
morning? 1 2 3 4 5 6 7 8 9 10
3.

Pain
walking
barefoot? 1 2 3 4 5 6 7 8 9 10
4.

Pain
standing
barefoot? 1 2 3 4 5 6 7 8 9 10
5.

Pain
walking
with
shoes? 1 2 3 4 5 6 7 8 9 10
6.

Pain
standing
with
shoes? 1 2 3 4 5 6 7 8 9 10
7.

Pain
walking
with
orthoCcs? 1 2 3 4 5 6 7 8 9 10
8.

Pain
standing
with
orthoCcs? 1 2 3 4 5 6 7 8 9 10
9.

Foot
pain
at
end
of
day? 1 2 3 4 5 6 7 8 9 10

Disability
Subscale:

How
much
difficulty
did
you
have:
no
difficulty unable
10.

Difficulty
walking
in
the
house? 1 2 3 4 5 6 7 8 9 10
11.

Difficulty
walking
outside? 1 2 3 4 5 6 7 8 9 10
12.

Difficulty
walking
4
blocks? 1 2 3 4 5 6 7 8 9 10
13.

Difficulty
climbing
stairs? 1 2 3 4 5 6 7 8 9 10
14.

Difficulty
descending
stairs? 1 2 3 4 5 6 7 8 9 10
15.

Difficulty
standing
Cp
toe? 1 2 3 4 5 6 7 8 9 10
16.

Difficulty
geIng
up
from
chair? 1 2 3 4 5 6 7 8 9 10
17.

Difficulty
climbing
curbs? 1 2 3 4 5 6 7 8 9 10
18.

Difficulty
walking
fast? 1 2 3 4 5 6 7 8 9 10

Ac<vity
Limita<on
Subscale:

How
much
of
the
<me
do
you:
none
of
the
 all
of
the

<me <me
19.

Stay
inside
all
day
because
of
feet? 1 2 3 4 5 6 7 8 9 10
20.

Stay
in
bed
all
day
because
of
feet? 1 2 3 4 5 6 7 8 9 10
21.

Limit
acCviCes
because
of
feet? 1 2 3 4 5 6 7 8 9 10
22.

Use
assisCve
device
indoors? 1 2 3 4 5 6 7 8 9 10
23.

Use
assisCve
device
outdoors? 1 2 3 4 5 6 7 8 9 10

To
be
completed
by
physical
therapist/provider















Score____________/170
x
100%

____________________________________________________________________________________________________
Signature
of
provider













































































































Date

Adapted
from
Budiman‐Mak,
E.,
Conrad,

K.,
&
Roach
K.

(1991).

The
foot
funcCon
index:
A
measure
of
foot
pain
and
disability.
J
Clin

Epidemiology,
44(6).

You might also like