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| Left | Right | Score |
| 1- I have pain in my ankle Never During Sport Running on uneven surfaces Running on level surfaces Walking on uneven surfaces Walking on uneven surfaces |
£ £ £ £ £ £ |
£ £ £ £ £ £ |
5 4 3 2 1 0 |
| 2- My ankle feels UNSTABLE Never Sometimes during sport (not every time) Frequently during sport (every time) Sometimes during daily activity Frequently during daily activity |
£ £ £ £ £ |
£ £ £ £ £ |
4 3 2 1 0 |
| 3- When I make SHARP turns my ankle feels UNSTABLE Sometimes when running Often when running When walking |
£ £ £ |
£ £ £ |
2 1 0 |
| 4- When going down my stairs my ankle feels UNSTABLE Never If I go fast Occasionally Always |
£ £ £ £ |
£ £ £ £ |
3 2 1 0 |
| 5- My ankle feels UNSTABLE when standing on ONE leg Never On the ball of my foot With my foot flat |
£ £ £ |
£ £ £ |
2 1 0 |
| 6- My ankle feels UNSTABLE when Never I hop from side to side I hop on the spot When I jump |
£ £ £ £ |
£ £ £ £ |
3 2 1 0 |
| 7- My ankle feels UNSTABLE when Never I run on uneven surfaces I jog on uneven surfaces I walk on uneven surfaces I walk on a flat surface |
£ £ £ £ £ |
£ £ £ £ £ |
4 3 2 1 0 |
| 8- TYPICALLY when I start to roll over (or “twist”) on my ankle I can stop it Immediately Often Sometimes Never I have never rolled over on my ankle |
£ £ £ £ £ |
£ £ £ £ £ |
3 2 1 0 3 |
| 9- Following a TYPICAL incident on my ankle rolling over, my ankle returns to “normal” Almost immediately Less than one day 1 - 2 days More than 2 days I have never rolled over on my ankle |
£ £ £ £ £ |
£ £ £ £ £ |
3 2 1 0 3 |