Satisfaction (20 points) |
|
I am ... |
|
1. very satisfied with end results |
20 |
2. satisfied with end results |
16 |
3. neither satisfied nor unsatisfied with end results |
12 |
4. unsatisfied with end results |
08 |
5. very unsatisfied with end results |
04 |
|
Function (20 Points) |
|
In my daily living my club foot... |
|
1. Does not limit my activities |
20 |
2. Occasionally limit my strenuous activities |
16 |
3. Usually limits me in strenuous activities |
12 |
4. Limits me occasionally in routine activities |
08 |
5. Limits me in walking |
04 |
|
Pain (30 points) |
|
My club foot... |
|
1. Is never painful |
30 |
2. Occasionally causes mild pain during strenuous activities |
24 |
3. Usually is painful after strenuous activities only |
18 |
4. Is occasionally painful during routine activities |
12 |
5. Is painful during walking |
06 |
|
Position of heel when standing (10 points) |
|
1. Heel varus 0 degree or some heel valgus |
10 |
2. Heel varus 1-5 degree |
5 |
3. Heel varus 6-10 degree |
3 |
4. Heel varus >10 degree |
0 |
|
Passive motion (10 Points) |
|
1. Dorsiflexion |
1 point per 5 degree (up to 5 points) |
2. Total varus-valgus motion of heel |
1 point per 10 degree (up to 3 points) |
3. Total inversion-eversion of foot |
1 point per 50 degree (up to 2 points |
|
Gait (10 Points) |
|
1. Normal |
6 |
2. Can toe walk |
2 |
3. Can heel walk |
2 |
4. Limp |
-2 |
5. No heel strike |
-2 |
6. Abnormal toe off |
-2 |