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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)%