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Foot Function Index (Ffi)

Foot Function Index (FFI)

Form

Foot Function Index (FFI)
Form

Outstanding Tasks0

Complete Tasks Below
Click on the items below to complete.

Foot Function Index (Ffi)

Foot Function Index (FFI)

Form

Foot Function Index (FFI)
Form

Foot Function Index (FFI)


During the past week, how severe was your foot pain:

Before you get up in the morning?*

When you first stand barefoot?*

When you first walk barefoot?*

When you stand wearing shoes?*

When you walk wearing shoes?*

When you stand wearing custom shoe inserts?*

When you walk wearing custom shoe inserts?*

At the end of a typical day?*

When you had foot cramps?*

Before you went to sleep?*

At its worst?*

None
Mild
Moderate
Severe
Very Severe
Worst Imaginable
Not Applicable
Before you get up in the morning?
When you first stand barefoot?
When you first walk barefoot?
When you stand wearing shoes?
When you walk wearing shoes?
When you stand wearing custom shoe inserts?
When you walk wearing custom shoe inserts?
At the end of a typical day?
When you had foot cramps?
Before you went to sleep?
At its worst?
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During the past week, how severe was your foot stiffness:

Before you get up in the morning?*

When you first stand barefoot?*

When you first walk barefoot?*

When you stand wearing shoes?*

When you walk wearing shoes?*

When you walk wearing custom shoe inserts?*

Before you went to sleep?*

At its worst?*

None
Mild
Moderate
Severe
Very Severe
Worst Imaginable
Not Applicable
Before you get up in the morning?
When you first stand barefoot?
When you first walk barefoot?
When you stand wearing shoes?
When you walk wearing shoes?
When you walk wearing custom shoe inserts?
Before you went to sleep?
At its worst?
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During the past week how much of the time did your foot problems cause you to:

Use a cane, crutches or walker inside?*

Use a cane, crutches or walker outside?*

Stay indoors most of the day?*

Stay in bed most of the day?*

Take extra precautions in crowds?*

Limit outdoor activities?*

Limit leisure/sport activities?*

Choose not to use public transportation?*

Choose not to drive?*

None
A little of the time
Some of the time
Much of the time
Most of the time
All of the time
Not applicable
Use a cane, crutches or walker inside?
Use a cane, crutches or walker outside?
Stay indoors most of the day?
Stay in bed most of the day?
Take extra precautions in crowds?
Limit outdoor activities?
Limit leisure/sport activities?
Choose not to use public transportation?
Choose not to drive?
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During the past week, how much difficulty did your foot problems cause you:

Walking around the house?*

Walking on uneven surfaces?*

Going up stairs?*

Going down stairs?*

Standing on tip toes?*

Standing normally?*

Carrying or lifting objects over 5 lbs.?*

Getting out of a chair?*

Walking fast?*

Running?*

Walking down a hill?*

Walking at your normal pace?*

Walking your regular distance?*

Walking 4 or more blocks?*

Keeping your balance?*

Keeping your foot clean?*

Walking with assistive devices?*

Because of hazards around the house?*

Operating a vehicle requiring the use of your foot?*

Performing your daily activities?*

None
Mild
Moderate
Severe
Very Severe
Too difficult to do
Not applicable
Walking around the house?
Walking on uneven surfaces?
Going up stairs?
Going down stairs?
Standing on tip toes?
Standing normally?
Carrying or lifting objects over 5 lbs.?
Getting out of a chair?
Walking fast?
Running?
Walking down a hill?
Walking at your normal pace?
Walking your regular distance?
Walking 4 or more blocks?
Keeping your balance?
Keeping your foot clean?
Walking with assistive devices?
Because of hazards around the house?
Operating a vehicle requiring the use of your foot?
Performing your daily activities?
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During the past week, how much of the time did you experience:

Fear of falling?*

Embarrassment due to limp?*

Difficulty finding fashionable footwear?*

Difficulty finding dress shoes?*

Embarrassment due to footwear?*

Depression due to foot problems?*

Difficulty finding suitable footwear?*

Feeling awful because of foot problems?*

Limit social activities?*

Constant aggravation due to management of foot pain?*

Limiting social activities due to footwear?*

Frustration in performing daily activities?*

Poor sleep due to pain?*

Burden of taking medication to control pain?*

Difficulty finding comfortable footwear?*

Difficulty finding employment due to foot problems?*

Concern over appearance of feet?*

Concern about limited work around home?*

Concern about possible amputation of foot, leg or toes?*

None
A little of the time
Some of the time
Much of the time
Most of the time
All of the time
Not applicable
Fear of falling?
Embarrassment due to limp?
Difficulty finding fashionable footwear?
Difficulty finding dress shoes?
Embarrassment due to footwear?
Depression due to foot problems?
Difficulty finding suitable footwear?
Feeling awful because of foot problems?
Limit social activities?
Constant aggravation due to management of foot pain?
Limiting social activities due to footwear?
Frustration in performing daily activities?
Poor sleep due to pain?
Burden of taking medication to control pain?
Difficulty finding comfortable footwear?
Difficulty finding employment due to foot problems?
Concern over appearance of feet?
Concern about limited work around home?
Concern about possible amputation of foot, leg or toes?
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