Foot Health Status Questionnaire

The foot health status questionnaire is a questionnaire which is used to assess the health of the foot of an individual. This questionnaire is specifically designed to assess quality of life related to foot health. This questionnaire is used by researchers, doctors, podiatric and other health care professionals to understand foot health better.

Sample Foot Health Status Questionnaire

Name: _______________

Date of Birth: _______________

Sex: __________________

Address: _________________

Q1. How often do you clean your feet?

Q2. Do you feel any sort of pain when you are walking, running, jogging or exercising?

Q3. Do you have a history of pain in any of your feet?

Q4. Did you ever injured your feet or ever met with an accident that had hurt your feet?

Q5. What is the shoe size that you usually wear?

Q6. Does the shoe that you wear fit you properly?

Q7. Do you wear high heel shoes?

Q8.  If you do wear high heel shoes, does it fit you properly?

Q9. Do you have heel spur?

Q10. Has anyone in your family got history of heel spur?

Q11. Did you ever had fungal infection of the skin that causes scaling, flaking, and itching at the affected areas (athlete’s foot)?

Q12.  Have you ever suffered from callus disease?

Q13. Is there any formation of toughened area of skin which has become relatively thick and hard in response to repeated friction, pressure, or other irritation?

Q14. Is there a history of any of your family members suffering from any kind of fungal disease in the feet?

Category: Health Questionnaire

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