Left	Right	Score
1. I have pain in my ankle
Never	□	□	5
During sport	□	□	4
Running on uneven surfaces	□	□	3
Running on level surfaces	□	□	2
Walking on uneven surfaces	□	□	1
Walking on level surfaces	□	□	0
2. My ankle feels UNSTABLE
Never	□	□	4
Sometimes during sport (not every time)	□	□	3
Frequently during sport (every time)	□	□	2
Sometimes during daily activity	□	□	1
Frequently during daily activity	□	□	0
3. When I make SHARP turns, my ankle feels UNSTABLE
Never	□	□	3
Sometimes during running	□	□	2
Often when running	□	□	1
When walking	□	□	0
4. When going down the stairs, my ankle feels UNSTABLE
Never	□	□	3
If I go fast	□	□	2
Occasionally	□	□	1
Always	□	□	0
5. My ankle feels UNSTABLE when standing on ONE leg
Never	□	□	2
On the ball of my foot	□	□	1
With my foot flat	□	□	0
6. My ankle feels UNSTABLE when
Never	□	□	3
I hop from side to side	□	□	2
I hop on the spot	□	□	1
When I jump	□	□	0
7. My ankle feels UNSTABLE when
Never	□	□	4
I run on uneven surfaces	□	□	3
I jog on uneven surfaces	□	□	2
I walk on uneven surfaces	□	□	1
I walk on a flat surface	□	□	0
8. TYPICALLY, when I start to roll over (or “twist”) on my ankle, I can stop it
Immediately	□	□	3
Often	□	□	2
Sometimes	□	□	1
Never	□	□	0
I have never rolled over on my ankle	□	□	3
9. After a TYPICAL incident of my ankle rolling over, my ankle returns to “normal”
Almost immediately	□	□	3
Less than one day	□	□	2
1–2 days	□	□	1
More than 2 days	□	□	0
I have never rolled over on my ankle	□	□	3