SEFAS Self-Reported Foot and Ankle Score

SEFAS

Self-Reported Foot and Ankle Score
Name*

First NameLast Name
Email*
example@example.com
Today's Date*

MonthDayYear
Date
If you are completing this form regarding a different date, enter it here (Month, Day, Year)

MonthDayYear
Date
Please indicate which side foot or ankle this survey is about:*

LeftRight
Please indicate which part of your foot/ankle this is about:

AnkleMid-FootToe(s)Other
If "other", please specify here which part of your foot/ankle:
VAS: Overall, how bad is your pain (0=no pain, 100 =maximum imaginable pain)*
1. How much pain do you have in your foot/ankle?*

Severe painModerate painMild painVery mild painNo pain
2. How much swelling do you have in your foot/ankle?*

Severe swellingModerate swellingMild swellingVery mild swellingNo swelling
3. How much stiffness do you have in your foot/ankle?*

Severe stiffnessModerate stiffnessMild stiffnessVery mild stiffnessNo stiffness
4. How much difficulty do you have walking on uneven ground?*

Severe difficultyModerate difficultyMild difficultyVery mild difficultyNo difficulty
5. How much difficulty do you have walking on flat ground?*

Severe difficultyModerate difficultyMild difficultyVery mild difficultyNo difficulty
6. How much difficulty do you have climbing stairs?*

Severe difficultyModerate difficultyMild difficultyVery mild difficultyNo difficulty
7. How much difficulty do you have going down stairs?*

Severe difficultyModerate difficultyMild difficultyVery mild difficultyNo difficulty
8. How much difficulty do you have standing on tiptoe?*

Severe difficultyModerate difficultyMild difficultyVery mild difficultyNo difficulty
9. How much difficulty do you have standing on your heels?*

Severe difficultyModerate difficultyMild difficultyVery mild difficultyNo difficulty
10. How much difficulty do you have running?*

Severe difficultyModerate difficultyMild difficultyVery mild difficultyNo difficulty
11. How much difficulty do you have jumping?*

Severe difficultyModerate difficultyMild difficultyVery mild difficultyNo difficulty
12. What is your overall function of your foot/ankle?*

Very poorPoorFairGoodExcellent
Total score out of 48
Total score in percentage
The SEFAS has been validated and shown to have good reliability and validity for assessing foot and ankle conditions, including toe arthritis.[1-2]

References
1.Comparison of the Self-Reported Foot and Ankle Score (SEFAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS).Cöster MC, Rosengren BE, Bremander A, Brudin L, Karlsson MK.

Foot & Ankle International. 2014;35(10):1031-6. doi:10.1177/1071100714543647.

2.Reliability, Validity and Responsiveness of the German Self-Reported Foot and Ankle Score (SEFAS) in Patients With Foot or Ankle Surgery.Arbab D, Kuhlmann K, Schnurr C, et al.

BMC Musculoskeletal Disorders. 2017;18(1):409. doi:10.1186/s12891-017-1772-1.
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