Date of completion
Clinical rating system for the ankle and hindfoot
Clinician's name (or ref)
Patient's name (or ref)
Please answer the following questions.  
During the past 4 weeks......  
Section 1 - Pain   Section 2 - Function-activity limitations/support requirements
None   No limitations, no support
Mild Occasional   No limitation of daily activities, limitation of recreational activities, no support
Moderate, daily   Limited daily and recreational activities, cane
Severe, almost always present   Severe limitation of daily and recreational activities, walker, crutches, wheelchair, brace
Section 3 - Maximum walking distance ( blocks)   Section 4 - Walking surfaces
Greater than 6   No difficulty on any surface
4-6   Some difficulty on uneven terrain, stairs, inclines, ladders
1-3   Severe difficulty on uneven terrain, stairs, inclines, ladders
Less than 1      
Section 5 - Gait abnormality   Section 6 - Sagittal motion (flexion plus extension)
None, slight   Normal or mild restriction (30° or more)
Obvious   Moderate restriction (15°-29°)
Marked   Severe restriction (less than 15°)
Section 7 - Hindfoot motion (inversion plus eversion)   Section 8- Alignment
Normal or mild restriction (75%-100% normal)   Good, plantigrade foot, ankle-hindfoot well aligned
Moderate restriction (25%-74% normal)   Fair, plantigrade foot, some degree of ankle- hindfoot malalignment observed, no symptoms
Marked restriction (less than 25% normal)   Poor, nonplantigrade foot, severe malalignment, symptoms
Section 9 - Ankle-hindfoot stability (anteroposterior, varus-valgus)  

The Clinical rating system for the ankle and hindfoot is

Definitely unstable  

To save this data please print or


AMERICAN FOOT AND ANKLE - Reference for Score: Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994 Jul;15(7):349-53. link to pubmed