Ankle&Gait Tests

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Subject/ID:________________________ Date:______________________

Timepoint:________________________ AFO/AD:___________________

Ankle MAS
Grade: 0 1 1+ 2 3 4

Ankle DF MMT
Grade: 0 1 2 3 4 5

Ankle Range of Motion

Active DF
Trial 1:__________ Trial 2:__________ Trial 3:__________ Avg:__________

Active PF
Trial 1:__________ Trial 2:__________ Trial 3:__________ Avg:__________

Passive DF
Trial 1:__________ Trial 2:__________ Trial 3:__________ Avg:__________

Passive PF
Trial 1:__________ Trial 2:__________ Trial 3:__________ Avg:__________

Notes: ________________________________________________________________________
_____________________________________________________________________________________
_______________________________________________________________________

10-Meter Walk Time (s)

Trial 1:__________ Trial 2:__________ Trial 3:__________ Avg:__________

Notes: ________________________________________________________________________
_____________________________________________________________________________________
_______________________________________________________________________

6-Minute Walk (meters)

Trial 1:__________

Notes: ________________________________________________________________________
_____________________________________________________________________________________
_______________________________________________________________________

Gait Biomechanics

PSW(deg)
Trial 1:__________ Trial 2:__________ Trial 3:__________ Avg:__________

AIC(deg)
Trial 1:__________ Trial 2:__________ Trial 3:__________ Avg:__________

Heel-First Contacts(%)
Trial 1:__________ Trial 2:__________ Trial 3:__________ Avg:__________

Notes: ________________________________________________________________________
_____________________________________________________________________________________
_______________________________________________________________________

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