See bottom for scoring.

1. How much time do you spend on your feet each day?
a. less than 2 hours
b. 2 - 4 hours
c. 5 - 7 hours
d. 8 hours or more

2. How old are you?
a. under 40
b. between 40 and 59
c. 60 and over

3. How would you describe your weight?
a. less than 20 pounds overweight or at ideal weight
b. 20 - 39 pounds overweight
c. 40 or more pounds overweight

4. Have problems with your feet or ankles ever prevented you from participating in:
 a. leisure/sports activities?
    Yes
    No

 b. work activities?
    Yes
    No

5. Have you ever received medical treatment for problems with your feet and/or ankles?
a. yes
b. no

6. Do you regularly wear heels two inches or higher?
a. yes
b. no

7. What types of exercise do you engage in or plan to engage in? (check all that apply)
a. walking
b. field sports (e.g., softball, golf)
c. winter sports (e.g., skiing, ice skating)
d. court sports (e.g., tennis, basketball)
e. aerobics
f. running
g. none (if you chose answer g, skip to question 11)

8. Do you have the appropriate shoes for your sport or sports?
a. yes
b. no

9. Do you experience foot or ankle pain when walking or exercising?
a. rarely
b. sometimes
c. often
d. never

10. Do you:
 a. exercise in footwear that is more than one year old or in hand-me-down footwear?
    Yes
    No

 b. stretch properly before and after exercising?
    Yes
    No

11. Do you:
 a. have diabetes?
    Yes
    No

 b. experience numbness and/or burning in your feet?
    Yes
    No

 c. have a family history of diabetes?
    Yes
    No

12. Do you: (check all that apply)
    a. sprain your ankles frequently (once a year or more) or are your ankles weak?
    b. have flat feet or excessively high arches?
    c. experience pain in the achilles tendon or heel or have shin splints (pain in the front lower leg)?
    d. have corns, calluses, bunions or hammertoes?
    e. have arthritis or joint pain in your feet?
    f. have poor circulation or cramping in your legs?