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select arch type from examples shown
mysorefoot.com

Section 1


Questions all about your symptoms, your relevant medical history and activity level

what foot is sore?
right
left
both
neither but i think my feet are making another body part sore (knee/hip/back) or changing how i walk
how long have you been sore?
less than a month
1 - 3 months
3 - 6 months
6 - 12 months
over a year
always been an issue
how old are you?
Determine your foot arch type by selecting the shape closest to your weight bearing foot print simply dip your foot into water and step on the floor or review your footprint when coming out the bath or shower.(see pic below)
flat (no arch)
normal (arch visible)
high (much less imprint around the midfoot)
very high (mainly the heel and ball of foot on imprint)
Stand with your weight equally distributed between both feet and knees straight. Get someone to stand behind you with their hands on top of your pelvis (in the waist) Look in the mirror and look at the hands
Both appear to be level
Right side is high
Left side is high
pelvis is level but right knee wont straighten and is bent
pelvis is level but left knee wont straighten and is bent
what is your activity level?
very active - work out every day
active - 3 - 5 times a week
no additional activity but generally active - active job/lifestyle - active job, dog walking, housework, gardening etc
fairly active - 1 - 3 times a week
no additional activity - desk job and no regular physical activity
sedentary - sitting or lying most of the day with very little activity
Select any of the following conditions you have been diagnosed with
which healthcare professional diagnosed the above condition(s) select all that apply
which of the following describes your knees when you are standing with your weight equally distributed on both feet
do you do yoga?
yes regularly
yes sometimes
yes but very rarely
no
do you understand the benefits of yoga?
yes its great!
I think so?
not really
no
rate your average pain level (1 is low and 10 is high)
1
2
3
4
5
7
8
9
10
no pain
pain level on rising in the morning
1
2
3
4
5
6
7
8
9
0
no pain
pain level at night following increased activity
1
2
3
4
5
6
7
8
9
10
no pain
pain level at rest (after no real activity)
1
2
3
4
5
6
7
8
9
10
no pain
pain level after activity such as walking
1
2
3
4
5
6
7
8
9
10
no pain
when are you struggling MOST with your foot related issue?
any weight bearing activity
Walking
running
Driving
Golfing
Dancing
Gym - weight machines
Standing for prolonged periods
At the end of an average day
On first rising after a period of rest (e.g. getting out of bed)
Constantly - the pain level doesn't change regardless of what you are doing
No real pattern
what have you tried to control your pain or issue with your foot? select all that apply
What activities do you participate in normally (select the option even if your sore foot/pain is stopping you from doing this currently)
do any of the following cause you pain?
where is your pain? select all that apply
type of symptoms (select all that apply)
select any of the following things you do when you walk
when you walk what direction do your toes face?
both point forward
both point out
both point in
one points forward one points in
one points forward one points out
one points in one points out
How did your foot (or other area) become sore?
ankle injury whilst on your foot (e.g. went over ankle)
Recent injury leading to ligament damage whilst on your foot
Traumatic injury - crush injury e.g. from a car crash or a large fall
Recent stress fracture
Increase in weight bearing aerobic activity eg. Running
Increase in weight bearing activity - e.g. new job in which you are on your feet more
Historical injury - fracture
Historical injury - ligament injury
Started in pregnancy
Weight gain
It's directly related to one of the conditions listed above eg. knee replacement
Honestly no idea
Started gradually with no real obvious cause
pain elsewhere? select all that apply
Look at your shoes. Are the soles worn down excessively in a certain area? Note any that apply
Did you have any interventions with your feet or walking when you were a child?
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