The Foot & Ankle Disability Index
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Patient Information
*
Please provide your full legal name as it appears on your driver's license, state identification card, or government issued identification card.
Birth Month
January
February
March
April
May
June
July
August
September
October
November
December
Birth Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Birth Year
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Gender
Male
Female
The Foot & Ankle Disability Index
* Required Information
Please answer every question with one response that most closely describes your condition within the past week.
*
Standing
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Walking on even ground
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Walking on even ground without shoes
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Walking up hills
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Walking down hills
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Going up stairs
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Going down stairs
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Walking on uneven ground
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Stepping up and down curves
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Squatting
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Sleeping
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Coming up to your toes
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Walking initially
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Walking 5 minutes or less
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Walking approximately 10 minutes
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Walking 15 minutes or greater
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Home responsibilities
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Activities of daily living
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Personal care
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Light to moderate work (standing, walking)
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Heavy work (push/pulling, climbing, carrying)
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
Recreational activities
No difficulty at all
Slight difficulty
Moderate difficulty
Extreme difficulty
Unable to do
*
General level of pain
No Pain
Mild
Moderate
Severe
Unbearable
*
Pain at rest
No Pain
Mild
Moderate
Severe
Unbearable
*
Pain during your normal activity
No Pain
Mild
Moderate
Severe
Unbearable
*
Pain first thing in the morning
No Pain
Mild
Moderate
Severe
Unbearable
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