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VISA-A Questionnaire: An index of the severity of Achilles tendinopathy.





*

Personal Information

Name

Date of Birth

1

0

For how many minutes do you have stiffness in the Achilles region on first getting up?

0 being 100 minutes, and 10 being 0 minutes

2

0

Once you are warmed up for the day, do you have pain when stretching the Achilles tendon fully over the edge of a step? (keeping knee straight)

0 being strong severe pain, and 10 being no pain

3

0

After walking on flat ground for 30 minutes, do you have pain within the next 2 hours? (If unable to walk on flat ground for 30 minutes because of pain, score 0 for this question).

0 being strong severe pain, and 10 being no pain

4

0

Do you have pain walking downstairs with a normal gait cycle?

0 being strong severe pain, and 10 being no pain

5

0

Do you have pain during or immediately after doing 10 (single leg) heel raises from a flat surface?

0 being strong severe pain, and 10 being no pain

6

0

How many single leg hops can you do without pain?

7

0

Are you currently undertaking sport or other physical activity?

8

0

Please complete EITHER A, B or C in this question

8 A. If you have no pain while undertaking Achilles tendon loading sports, for how long can you train/practise?

8 B. If you have some pain while undertaking Achilles tendon loading sport, but it does not stop you from completing your training/practice for how long can you train/practise?

8 C. If you have pain that stops you from completing your training/practice in Achilles tendon loading sport, for how
long can you train/practise?

TOTAL SCORE: (/100)%