Date of completion

The Foot & Ankle Disability Index (FADI) Score
Clinician's name (or ref)
Patient's name (or ref
Patient's d.o.b
 

Please answer every question with one response that most closely describes your condition within the past week. If the activity in question is limited by something other than your foot or ankle, mark N/A
No difficulty at all Slight difficulty Moderate difficulty Extreme difficulty Unable to do
1.
Standing
2.
Walking on even ground
3.
Walking on even ground without shoes
4.
Walking up hills
5.
Walking down hills
6.
Going up stairs

7.

Going down stairs
8.
Walking on uneven ground
9.
Stepping up and down curves
10.
Squatting
11.
Sleeping
12.
Coming up to your toes
13.
Walking initially
14.
Walking 5 minutes or less
15.
Walking approximately 10 minutes
16.
Walking 15 minutes or greater

17.

Home responsibilities

18.

Activities of daily living

19.

Personal care

20.

Light to moderate work (standing, walking)
21.
Heavy work (push/pulling, climbing, carrying)
22.
Recreational activities
 
NO PAIN MILD MODERATE SEVERE UNBEARABLE
23.
General level of pain
24.
Pain at rest
25.
Pain during your normal activity
26.
Pain first thing in the morning

Thank you very much for completing all the questions in this questionnaire.

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Foot & Ankle Disability Index (FADI) Score is  

( NB. A FADI score may not be calculated if there are greater than 3 missing items.)

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Reference:
Waddell C, Newton M, Henderson I, et al. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993; 52:157-168.

Fritz JM, George S. Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs. Phys Ther. 2002; 82(10): 973-983.

Lethem J, Slade PD, Troup JDG, Bendey G. Outline of a fear avoidance model of exaggerated pain perceptions, Behav Res Ther. 1983;21:401-408.

Williamson E. Fear Avoidance Behavior Questionnaire. Austrailian Journal of Physiotherapy. 2006; 52: 149.

Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eck H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62: 36, 272.