Lower Extremity (Knee, Ankle, Foot) Pain Index

The Lower Extremity Functional Scale

For Knee, Ankle, Foot Conditions
Name*

First NameLast Name
Date*

MonthDayYear
Date
We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity.
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Extreme difficulty or unable to perform activityQuite a bit of difficultyModerate difficultyA little bit of difficultyNo difficulty
Should be Empty:

The Lower Extremity Functional Scale