Visual Analog Scale Foot and Ankle (VAS FA)

A validated score for foot and ankle outcome was missing so far. Furthermore, the insufficiency of supposed objective data acquisition was clearly stated. We constructed and validated a new score under consideration of the flaws of existing scores. A new score named Visual Analogue Scale Foot and Ankle (VAS FA) with the following features was constructed: questionnaire based with 20 subjective questions (Pain, 4 questions; functional deficits, 13 questions; other complaints, 3 questions), visual analogue scale (VAS) based rating, computerized evaluation. The score evaluation is also possible with missing answers. The VAS FA is available in the following questions: German, English, Italian, Turkish and Thai. The score was validated in 121 healthy individuals (exclusion criteria: age<18 or >65, positive medical history concerning the entire lower extremity, diabetes mellitus, drug abuse, psychiatric diseases, rheumatoid arthritis). The Hannover Questionnaire (HQ) and SF-36 scores were obtained and correlated with the VAS FA scores for validation. No significant differences between SF-36 and VAS FA occurred. Consequently, the VAS FA score is the first validated, subjective, VAS based outcome score for foot and ankle. This score has important advantages in comparison with other scores. Many scores use problematic objective measures (for example AOFAS score or Hannover Scoring System) and/or problematic data acquisition (not VAS based). Both, VAS based and subjective data acquisition is the only possibility to obtain a validated score. The introduced score is computerized that enables faster evaluation than SF 36 or HQ.

After validation of the VAS FA on healthy subjects, normative data of the validated VAS FA for pathological conditions have been missing so far. The only validated score for different pathological conditions is the Short Form 36 (SF 36) which is not foot and ankle specific. As far as we know, specific data for different foot and ankle pathologies have not been defined with any scoring system so far despite several efforts. The purpose of this study was to analyze the VAS FA in patients to obtain normative validated foot and ankle specific data for pathologic conditions. This data may serve as a basis for more specific assessment than with the SF36. We hypothesized that different pathological foot and ankle conditions show different scores and score categories.

414 patients were evaluated. Overall scores and score categories of all pathology groups differed from non pathologic data (n=121). Within the different groups, no score differences occurred. Score standards were defined for these groups with sufficient statistical power (>.8): isolated Hallux valgus, Hallux valgus and claw toes, forefoot other pathology, midfoot other pathology, hindfoot pathology and ankle deformity. No standards were defined for other pathology groups.

In conclusion, the scores and score categories differed between the control group and all different pathologies except the category other complaints. The overall scores and all score categories did not differ between different pathology groups. Thus the different pathologies do not show different scores or score patterns as initially suspected. The obtained data is normative for different pathologic conditions of the earlier validated VAS FA. This data could serve as a basis for assesment patient scoring before, during and after treatment which has to then to be proved by ongoing research.

Template / Gauche for manual score evaluation. Print on fitting transparency (DIN-A-4-format or letter-format) for correct evaluation. The formats of the template-transparency and the score form must be identical. Placement of the template-transparency on the score form allows fast, easy and accurate reading of the score values. Enter the values into the "Result-Calculation-Instrument" (see below).

Spreadsheet-Based-Result-Calculation-Instrument. Klick on the link with the right mouse button and chose "save target as..." for download. Open the file with Microsoft Excel^® and enter the score values. The results of the score categories (pain, function, other complaints) and the entire score result are calculated by the program independently from the numer of missing values. Four different evaluations of the same patient can be entered. Save the file under a different name (e.g. patient name) to maintain the original file without entered values for later use with other patients.