Cross-cultural adaptation and validation of the Foot Function Index for use in German-speaking patients with foot complaints

Foot Ankle Int. 2008 Dec;29(12):1222-8. doi: 10.3113/FAI.2008.1222.


Background: The purpose of this study was to cross-culturally adapt the Foot Function Index (FFI) for use in German-speaking patients with foot complaints.

Materials and methods: The FFI was adapted for the German language according to the recommended forward/backward translation protocol. The following metric properties were assessed in 53 consecutive patients (mean age, 57.2 years; 39 women) undergoing foot surgery at our department: feasibility, reliability (intraclass correlation coefficient ICC), internal consistency (Cronbach's alpha, CA), and construct validity (correlation with the Short Form (SF-36), a VAS assessing pain, a VAS assessing function, and the University of California at Los Angeles (UCLA) activity scale.

Results: The German FFI (FFI-D) comprised 18 items separated into a pain and a disability subscale. Completion of the FFI-D was feasible. The reliability and the internal consistency were both excellent with an ICC of 0.98 and a CA of 0.97 for the total score. We found moderate to high correlations between the FFI-D and the physical related SF-36 domains (r = -0.43 to -0.80), the VAS pain (r = 0.81), the VAS function (r = 0.77), and the UCLA (r = -0.52). Correlation coefficients between the FFI-D and the mental health related SF-36 domains were significantly lower (r = -0.08 to -0.32; p < 0.01), indicating divergent validity.

Conclusion: The German version of the FFI is a reliable and valid questionnaire for the self-assessment of pain and disability in German-speaking patients with foot complaints.

MeSH terms

  • Cross-Cultural Comparison*
  • Female
  • Foot
  • Foot Diseases / classification*
  • Germany
  • Humans
  • Language*
  • Los Angeles
  • Male
  • Middle Aged
  • Pain / classification*
  • Reproducibility of Results
  • Surveys and Questionnaires / standards*
  • Translations*