Edmund OLeary Scoring Questionnaire

Pain *

NeverRarelySometimesOftenAlways

P1. How often do you experience foot/ankle/toes pain?

NeverRarelySometimesOftenAlways

What amount of foot/ankle pain have you experienced the last week during the following activities? *

NoneMildModerateSevereExtreme

P2. Twisting/pivoting on your foot/ankle/toes

NoneMildModerateSevereExtreme

P3. Straightening foot/ankle/toes fully

NoneMildModerateSevereExtreme

P4. Bending foot/ankle/toes fully

NoneMildModerateSevereExtreme

P5. Walking on flat surface

NoneMildModerateSevereExtreme

P6. Going up or down stairs

NoneMildModerateSevereExtreme

P7. At night while in bed

NoneMildModerateSevereExtreme

P8. Sitting or lying

NoneMildModerateSevereExtreme

P9. Standing upright

NoneMildModerateSevereExtreme

Function & Daily Living- For each of the following activities please indicate the degree of difficulty you have experienced in the last week due to your foot/ankle. *

NoneMildModerateSevereExtreme

A1. Descending stairs

NoneMildModerateSevereExtreme

A2. Ascending stairs

NoneMildModerateSevereExtreme

A3. Rising from sitting

NoneMildModerateSevereExtreme

A4. Standing

NoneMildModerateSevereExtreme

A5. Bending to floor/picking up object

NoneMildModerateSevereExtreme

A6. Walking on flat surface

NoneMildModerateSevereExtreme

A7. Getting in/out of car

NoneMildModerateSevereExtreme

A8. Going shopping

NoneMildModerateSevereExtreme

A9. Putting on socks/stockings

NoneMildModerateSevereExtreme

A10. Rising from bed

NoneMildModerateSevereExtreme

A11. Taking off socks/stockings

NoneMildModerateSevereExtreme

A12. Lying in bed

NoneMildModerateSevereExtreme

A13. Getting in /out bath

NoneMildModerateSevereExtreme

A14. Sitting

NoneMildModerateSevereExtreme

A15. Getting on/off toilet

NoneMildModerateSevereExtreme

A16. Heavy domestic duties (move heavy boxes, scrub floors)

NoneMildModerateSevereExtreme

A17. Light domestic duties (cooking, dusting)

NoneMildModerateSevereExtreme

Quality of Life *

NeverMonthlyWeeklyDailyAlways

Q1. How often are you aware of your foot/ankle/toes problem?

NeverMonthlyWeeklyDailyAlways

Not at allMildlyModeratelySeverelyExtremely

Q2. Have you modified your life style to avoid potentially damaging activities to your foot/ankle/toes?

Not at allMildlyModeratelySeverelyExtremely

Q3. How much are you troubled with lack of confidence in your foot/ankle/toes?

Not at allMildlyModeratelySeverelyExtremely

NoneMildModerateSevereExtreme

Q4. In general, how much difficulty do you have with your foot/ankle/toes?

NoneMildModerateSevereExtreme

The numbers next to each item represents the amount of pain you typically had in each situation. On the far left 1 = “No pain” and on the far right 10 = “The worst pain imaginable.”

Please indicate how bad your ankle pain was in each of the following situations during the past week. If you were not involved in one or more of these situations, mark that item N/A.

How severe was your foot/ankle/toe pain: 1 = NO PAIN, 10 = WORST PAIN IMAGINABLE *

12345678910N/A

1. At its worst?

12345678910N/A

2. Before you get up in the morning?

12345678910N/A

3. When you walked barefoot?

12345678910N/A

4. When you stood barefoot?

12345678910N/A

5. When you walked wearing shoes?

12345678910N/A

6. When you stood wearing shoes?

12345678910N/A

7. When you walked wearing shoe inserts or braces?

12345678910N/A

8. When you stood wearing shoe inserts or braces?

12345678910N/A

9. At the end of the day?

12345678910N/A

The numbers next to each item represents the amount of difficulty you had performing an activity. On the far left is “No difficulty” and on the far right is “So difficult unable.”

Please indicate how much difficulty you had performing each activity because of your foot/ankle/toes during the past week. If you did not perform an activity during the past week, mark that item N/A.

How much difficulty did you have: 1 = NO DIFFICULTY 10 = SO DIFFICULT UNABLE *

12345678910N/A

1. Walking around the house?

12345678910N/A

2. Walking outside on uneven ground?

12345678910N/A

3. Walking four blocks or more?

12345678910N/A

4. Climbing stairs?

12345678910N/A

5. Descending stairs?

12345678910N/A

6. Standing on tip toes?

12345678910N/A

7. Getting out of a chair?

12345678910N/A

8. Climbing up or down curbs?

12345678910N/A

9. Walking fast or running?

12345678910N/A

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

SCORING QUESTIONNAIRE

EQ-5D

FAOS