This document discusses various scales used to measure ankle disability. It introduces several scales including the Foot and Ankle Disability Index (FADI), which assesses functional limitations related to foot and ankle conditions. The FADI has two components to address different levels of functioning. Other scales discussed include the Ankle Joint Functional Assessment Tool (AJFAT), Foot and Ankle Ability Measure (FAAM), Foot Function Index (FFI), Chronic Ankle Instability Scale (CAIS), and Manchester Foot Pain and Disability Index (MFPDI). Each scale is designed to measure different dimensions of foot and ankle pain and function, such as impairment, disability, and participation. The document provides details on the development and validation of several

1. Ankle disability scales
Submitted by
Md Saifur Rahman
Mpt(sports )

2. INTRODUCTION
◦ It has been estimated that the prevalence of foot pain in community dwelling adults aged 65
years and over is between 20 and 42% . Foot pain is known to contribute to locomotors
disability1.
◦ Assessment of outcomes from the patient's perspective becomes more recognized in health
care. Also in patients with
◦ chronic ankle instability,
◦ the degree of present impairments,
◦ disabilities and participation problems should be documented from the perspective of the
patient.
◦ There is growing interest in foot health in rheumatology and because of its pivotal role in gait
and posture, researchers and clinicians have developed a number of surveys and assessments
for measuring of foot health and its impact on quality of life.

3. ◦ Most commonly problems of foot arise during our daily living activities.
◦ Their prevalence is higher among older individuals and in chronic rheumatoid
arthritis (RA), gout, and diabetes mellitus with peripheral neuropathy2.
◦ Foot pain and disability can affect workers’ productivity, work absenteeism, and other
issues.
◦ Pain and disability are subjective complaints,
◦ It may causes difficult to quantify without a valid patient report of the degree to which
an individual is experiencing foot pain.

4. SCALES TO MEASURE ANKLE
DISABILITY
FADI- foot and ankle disability index.
Ankle Osteoarthritis scale
AJFAT-Ankle Joint Functional Assessment Tools
FFI-Foot Function Index
FAAM-Foot And Ankle Ability
MFPDI- Manchester Foot Pain and Disability Index

5. Foot and ankle disability index
◦ This is designed to assess functional limitations related to foot and ankle conditions 3.
◦ The FADI is a region-specific self-report of function with 2 components.
FADI Sport is designed to address this need by detecting deficits in higher
functioning subjects ,and it is found more reliable and sensitive and valid to change in
subjects with disability mainly in rheumatoid arthritis.

6. Questionnaire (FADI)
◦ Evidence of content validity is determined by the specific items on the
instrument and what they measure.
◦ The FADI underwent rigorous psychometric analysis, including analysis with
item response theory4.

7. QUESTIONNAIRE5

8. RELIABILITY AND SENSITIVITY
◦ FADI and FADI Sport both are used as a self-report instruments in clinical care and research applications in young
adults with CAI.
◦ These instruments appear to be reliable in detecting functional limitations in subjects with CAI.
◦ Sensitive to differences between healthy subjects and subjects with CAI.
◦ FADI Sport appears to be more sensitive at detecting deficits and may be more practical for use among high-
functioning individuals.
◦ Subjects scored significantly higher on the Foot and Ankle Disability Index after rehabilitation

9. AJFAT
◦ The Ankle Joint Functional Assessment Tool (AJFAT)
It contains 5 impairments
◦ Pain
◦ Stiffness
◦ Stability
◦ strength,
◦ There are , 4 activity related items
◦ walking on uneven ground,
◦ cutting when running,
◦ jogging and descending stairs) and 1 overall quality item.
◦ It has 5 answer options. The best total score of the AJFAT is 40
points, the worst possible 0 points.

10. ◦ The AJFAT is a 12-item tool that asks participants to choose the answers that best describes their dominant limb
ankle using the following scale6.
◦ much less than the other ankle,
◦ slightly less than the other ankle,
◦ equal in amount to the other ankle,
◦ slightly more than the other ankle
◦ much more than the other ankle.
◦ Each answer is assigned a point value between 0 and 4, and the maximum score on this assessment tool is 48.

11. FAAM
◦ An instrument to meet this need: the Foot and Ankle Ability Measure (FAAM).
◦ The FAAM was developed to meet the need for a self-reported evaluative instrument
that comprehensively assesses physical function of individuals with musculoskeletal
disorders of the leg, foot, and ankle7.
◦ FAAM score will be required for applications in other settings or over a different time
frame. These values also may vary depending on the baseline level of function of the
subjects.

12. QUESTIONNAIRE

14. ◦ Validity evidence for this instrument needs to be obtained so that scores can be
meaningfully interpreted.
◦ Interpreting the scores from an evaluative instrument requires evidence .
◦ Scores remain stable when the underlying condition measured by the instrument
remains stable .
◦ Scores are related to other measures of the same or similar construct while not being
unduly related to measures of different constructs evidence of convergent and
divergent validity).

15. FFI- Foot Function Index
◦ The Foot Function Index (FFI) is a self-report, foot-specific instrument measuring pain and disability and has been
widely used to measure foot health for over twenty years8.
◦ It was developed as a self-reporting measure that assesses multiple dimensions of foot function on the basis of
patient-centered values.
◦ FFI and/or FFI-R were used as measures of a variety of foot and ankle problems.
◦ The FFI consists of 23 items divided into 3 subscales that measures pain, disability and activity restriction9

16. ◦ The FFI pioneered measuring outcomes in foot health.
◦ Instrument has been tested through time and adapted in its measures as it was frequently used in full scales or
subscales to measure outcomes in various clinical practice or research studies.
◦ The FFI was recognized as a valid instrument and used as a validation
criterion of other measures.
.

17. Used in:-
◦ It is good scale for patients with foot disorders such as:-
◦ Rheumatoid arthritis
◦ Non-traumatic foot or ankle problems.

18. LIMITATIONS
. During the development of the index, clinicians generated the questionnaire items.
◦ without patient participation therefore,
◦ items might not fully reflect patients’ needs,
◦ might be sex biased , and
◦ might not be applicable to high-functioning individuals.
◦ theoretical model was not part of the design, nor were the items related to footwear which are essential to
support the construct of this instrument.

19. AII(ANKLE INSTABILITY
INSTRUMENT)
The AII was designed specifically for the detection of FAI.
The 16-item questionnaire consists of nine Yes/No questions, six multiple-choice questions, and one open-ended
question.9
Question was designed to fit into one of three categories
◦ severity of initial ankle sprain ,
◦ history of ankle instability
◦ instability during activities of dailylife.
Participants who answer ‘yes’ to five or moreYes/No questions were considered to have FAI

20. CAIS( CHRONIC ANKLE INSTABILITY
SCALE)
◦ The CAIS is a recently developed 14-item patient-assessed instrument.
◦ The CAIS includes items referring to impairment, disability, participation problems, and emotion.
◦ Each item is scored on a five-point scale, ranging from 4 (best
score) to 0 points (worst score).
Lower scores indicate a lower degree of ankle function while higher scores are indicative of a higher degree
of ankle stability.

21. Ankle osteoarthritis scale

23. Manchester foot pain and disability index
◦ Manchester Foot Pain and Disability Index (MFPDI, 19 items) was developed to
measure functional limitations, pain and appearance for patients with foot pain11.
◦ The MFPDI is not merely a descriptive tool (e.g. in cross-sectional studies) but it is also
used as a tool to measure change over time as a result of an intervention.
◦ One to three weeks later the participants were included in the trial and completed a
comprehensive questionnaire with the below mentioned comparator instruments and the
MFPDI as a baseline measure me.11

24. ◦ It is a 19 item tool developed to measure foot pain and foot related function in
patients with foot pain .
◦ intends to measure 3 constructs: functional limitation, pain and personal
appearance .
◦ The MFPDI is not merely a descriptive tool (e.g. in cross-sectional studies) but it
is also used as a tool to measure change over time as a result of an intervention.
◦ To evaluate test-retest reliability
◦ One of the 7a prior stated hypotheses about correlations between different change
scores

25. Judging the pain in your foot now, compared to three months
ago and
Judge the performance of foot
◦related activities now,
◦ compared to three months ago
These questions answered with
◦much
◦worse,
◦ no change, better or much better

26. FAOS
◦ The Foot and Ankle Outcome Score (FAOS) is a 42-item questionnaire divided into 5 subscales12:
◦ Pain other symptoms
◦ activities of daily living
◦ sport and recreation function
◦ foot and ankle related quality of life
◦ subscale pain contains 9 items, the subscale other
◦ symptoms 7 items, the subscale activities of daily living
◦ 17 items, the subscale "sport and recreation function 5 items and the subscale foot and ankle
related quality of life 4 items

27. REFERENCES
◦ 1. Sara Muller and Edward Roddy, A rasch analysis of the Manchester foot pain and disability index,
Journal of Foot and Ankle Research2009.
◦ 2. . Muller* and Edward Roddy, A rasch analysis of the Manchester foot pain and disability index,Sara
Journal of Foot and Ankle Research2009.
◦ 3. Sheri A. Hale, Jay Hertel, Reliability and Sensitivity of the Foot and Ankle Disability Index in Subjects
With Chronic Ankle Instability Reliability and Sensitivity of the Foot and Ankle Disability Index in
Subjects With Chronic Ankle Instability., Journal of Athletic Training 35,Journal of Athletic Training
2005;40(1):35–40.
◦ 4. . Sheri A. Hale*; Jay Hertel†, Reliability and Sensitivity of the Foot and Ankle Disability Index in
Subjects With Chronic Ankle Instability Reliability and Sensitivity of the Foot and Ankle Disability Index
in Subjects With Chronic Ankle Instability., Journal of Athletic Training 35,Journal of Athletic Training
2005;40(1):35–40.
◦ 5. Martin RL, Burdett RG, Irrgang JJ. Development of the Foot and Ankle Disability Index (FADI) J
Orthop Sports Phys Ther. 1999; 29: A32-A33
◦ 6. Matthew Donahue, MS, ATC; Janet Simon, MS, ATC; Carrie L. Docherty, PhD, ATC ,Critical Review of
Self-Reported Functional Ankle Instability Measures, Foot & Ankle International/Vol. 32, No.
12/December 2011

28. ◦ 7. Rob Roy L. Martin, P.T., Ph.D., C.S.C.S.1, James J. Irrgang:, Ray G. Burdett, StephenF.Conti,
Evidence of Validity for the Foot and Ankle Ability Measure (FAAM), Foot & Ankle International/Vol.
26, No. 11/November 2005.
◦ 8. Elly Budiman-Mak Kendon J Conrad Jessica Mazza and Rodney M Stuck, A review of the foot
function index and the foot function index , Budiman-Maket al. Journal of Foot and Ankle Research2013,
◦ 9. Critical Review of Self-Reported Functional Ankle Instability Measures, Foot & Ankle
International/Vol. 32, No. 12/December 2011
◦ 10. Dom sic RT, Saltzman CL. Ankle osteoarthritis scale. Foot Ankle Int. 1998;19:466–471, J Orthop
Trauma Volume 20, Number 8 Supplement, September 2006
◦ 11. Babette C vander zward ,Caroline B Terwee Edward Roddy Berend Terluin Henriette E van der
Horst. Evaluation of the measurement properties of the Manchester foot pain and disability index, van der
Zwaardet al. BMC Musculoskeletal Disorders2014,
◦ 12 . Matthew Donahue, MS, ATC; Janet Simon, MS, ATC; Carrie L. Docherty, PhD, ATC. Critical
Review of Self-Reported Functional Ankle Instability Measures, Foot & Ankle International/Vol. 32, No.
12/December 2011