Boot Fit Survey
Thank you for your participation!
Please wear the test boots and socks for 30 minutes, and then respond to this survey.
Name
First Name
Last Name
Are you experiencing any pressure points, pain, or discomfort inside the shoes? If so, please draw it on the provided diagram, and then rank these areas from most uncomfortable (1) to least uncomfortable (2,3,4+)
Yes
No
If you experienced any pressure points, pain, or discomfort from wearing the shoe where would you say that you felt it?
Rows
Toes
Top
Sole
Inside
Outside
Left
Right
For the most painful or uncomfortable area, how badly would you describe the pain?
Rows
0
1
2
3
4
Choose one
For the pain rating you chose, does it hurt more or less than the pain you felt?
More
Less
Please try the following movements and rate how much the pain, pressure or discomfort affects them:
Rows
No difficulty
at all
Slight
Difficulty
Moderate
Difficulty
Extreme
Difficulty
Unable
to do
Standing
Walking
Climbing Stairs
Pulling up on
the foot bar
Coming up
onto toes
Submit
Should be Empty: