• The Lower Extremity Functional Scale

    For Knee, Ankle, Foot Conditions
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • 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.

  • Today, do you or would you have any difficulty at all with: any of your usual work, housework, or school activities?*
  • Today, do you or would you have any difficulty at all with: Your usual hobbies, recreational, or sporting activities.*
  • Today, do you or would you have any difficulty at all with: Getting into or out of the bath/shower.*
  • Today, do you or would you have any difficulty at all with: Walking between rooms*
  • Today, do you or would you have any difficulty at all with: Putting on your shoes or socks.*
  • Today, do you or would you have any difficulty at all with: Squatting.*
  • Today, do you or would you have any difficulty at all with: Lifting an object, like a bag of groceries from the floor.*
  • Today, do you or would you have any difficulty at all with: Performing light activities around your home.*
  • Today, do you or would you have any difficulty at all with: Performing heavy activities around your home.*
  • Today, do you or would you have any difficulty at all with: Getting into or out of a car.*
  • Today, do you or would you have any difficulty at all with: Walking 2 blocks.*
  • Today, do you or would you have any difficulty at all with: Walking 1 mile*
  • Today, do you or would you have any difficulty at all with: Going up or down 10 stairs (about 1 flight of stairs).*
  • Today, do you or would you have any difficulty at all with: Standing for 1 hour.*
  • Today, do you or would you have any difficulty at all with: Sitting for 1 hour*
  • Today, do you or would you have any difficulty at all with: Running on even ground.*
  • Today, do you or would you have any difficulty at all with: Running on uneven ground.*
  • Today, do you or would you have any difficulty at all with: Making sharp turns while running fast.*
  • Today, do you or would you have any difficulty at all with: Hopping.*
  • Today, do you or would you have any difficulty at all with: Rolling over in bed.*
  • Should be Empty: