Foot and Ankle Disability Score
Please answer every question with one response that most closely describes your condition within the past week.

On a scale of 0-4:

0 = unable to do
1 = extreme difficulty
2 = moderate difficulty
3 = slight difficulty
4 = no difficulty at all
First and Last Name *
Standing
unable to do
no difficulty at all
Clear selection
Walking on even ground
unable to do
no difficulty at all
Clear selection
Walking on even ground without shoes
unable to do
no difficulty at all
Clear selection
Walking up hills
unable to do
no difficulty at all
Clear selection
Walking down hills
unable to do
no difficulty at all
Clear selection
Going up stairs
unable to do
no difficulty at all
Clear selection
Going down stairs
unable to do
no difficulty at all
Clear selection
Walking on uneven ground
unable to do
no difficulty at all
Clear selection
Stepping up and down curves
unable to do
no difficulty at all
Clear selection
Squatting
unable to do
no difficulty at all
Clear selection
Sleeping
unable to do
no difficulty at all
Clear selection
Coming up onto your toes
unable to do
no difficulty at all
Clear selection
Walking initially
unable to do
no difficulty at all
Clear selection
Walking for 5 min or less
unable to do
no difficulty at all
Clear selection
Walking for aprox 10 min
unable to do
no difficulty at all
Clear selection
Walking 15 minutes or greater
unable to do
no difficulty at all
Clear selection
Home responsibilities
unable to do
no difficulty at all
Clear selection
Light to moderate work (standing, walking)
unable to do
no difficulty at all
Clear selection
Heavy work (push/pulling, climbing, walking)
unable to do
no difficulty at all
Clear selection
Pain Score
On a scale of 0-4:

0 = unbearable pain
1 = severe pain
2 = moderate pain
3 = mild pain
4 = no pain at all
General level of pain
unbreable pain
no pain at all
Clear selection
Pain at rest
unbearable pain
no pain at all
Clear selection
Pain during normal activity
unbearable pain
no pain at all
Clear selection
Pain first thing in the morning
unbearable pain
no pain at all
Clear selection
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