Visual Function - Sports and Recreational Activities Scale
Function - Sports and Recreational Activities : 0.0
Visual Quality of Life Scale
Quality of Life : 0.0
Symptoms
Answer these questions thinking of your foot/ankle symptoms during the last week
1. Do you have swelling in your foot/ankle?
2. Do you feel grinding, hear clicking, or any other type of noise when your foot/ankle moves?
3. Does your foot/ankle catch or hang up when moving?
4. Can you straighten your foot/ankle fully?
5. Can you bend your foot/ankle fully?
Stiffness - The following questions concerns the amount of joint stiffness you have experience during the last week in your foot/ankle. Stiffness is a sensation of restriction or slowness in the ease with which you move your foot/ankle joint.
6. How severe is your foot/ankle stiffness after first wakening in the morning?
7. How severe is your foot/ankle stiffness after sitting, lying, or resting later in the day?
Pain
8. How often do you experience foot/ankle pain?
What amount of foot/ankle pain have you experienced the last week during the following activities?
9. Twisting/pivoting on your foot/ankle
10. Straightening foot/ankle fully
11. Bending foot/ankle fully
12. Walking on a flat surface
13. Going up or down stairs
14. At night while in bed
15. Sitting or lying
16. Standing upright
Function - Daily Living
This section describes your ability to move around and to look after yourself. For each of the following activities, please indicate the degree of difficulty you have experienced in the last week due to your foot/ankle
17. Descending stairs
18. Ascending stairs
19. Rising from sitting
20. Standing
21. Bending to the floor/pick up an object
22. Walking on a flat surface
23. Getting in/out of a car
24. Going shopping
25. Putting on socks/stockings
26. Rising from bed
27. Taking off socks/stockings
28. Lying in bed (turning over, maintaining foot/ankle position)
29. Getting in/out of bath
30. Sitting
31. Getting on/off toilet
32. Heavy domestic duties (moving heavy boxes, scrubbing floors, etc)
33. Light domestic duties (cooking, dusting, etc)
Function - Sports and Recreational Activities
This section describes your ability to be active on a higher level. For each of the following activities, please indicate the degree of the difficulty you have experienced in the last week due to your foot/ankle
34. Squatting
35. Running
36. Jumping
37. Twisting/pivoting on your injured foot/ankle
38. Kneeling
Quality of Life
39. How often are you aware of your foot/ankle problem?
40. Have you modified your life style to avoid activities potentially damaging to your foot/ankle?
41. How much are you troubled with lack of confidence in your foot/ankle?
42. In general, how much difficulty do you have with your foot/ankle?
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