Heel Pain Questionnaire Barrett Foot and Ankle Centers

Please fill out the following form and click on "Submit Questionnaire"

Is your pain worse after periods of rest or with the first step in the morning?

Right Never Yes Sometimes Rarely    Left Never Yes Sometimes Rarely

Does your heel pain increase in relation to the amount of time you are on your feet?

Right Never Yes Sometimes Rarely    Left Never Yes Sometimes Rarely

Does your pain have a burning nature?

Right Never Yes Sometimes Rarely    Left Never Yes Sometimes Rarely

Do you have pain in your heels at night or when your not on your feet?

Right Never Yes Sometimes Rarely    Left Never Yes Sometimes Rarely

Does your pain worsen through out the day?

Right Never Yes Sometimes Rarely    Left Never Yes Sometimes Rarely

Do you have pain in both heels?

Right Never Yes Sometimes Rarely    Left Never Yes Sometimes Rarely

Have you had prior treatment with Orthotic devices which increased the pain?

Right Never Yes Left Never Yes