Is it painful when you walk four steps?
Yes
No
Do you have pain when you press on the bone on the inside or on the outside of your ankle?
Yes
No
Do you have pain when you push on the bone on the inside or the outside of your foot?
Yes
No
Was there a noise such as a crack or a pop when the injury to your foot or ankle occurred?
Yes
No
Is your foot or ankle misshapen or deformed after the injury?
Yes
No
Does your foot or ankle feel numb?
Yes
No
Where Should We Send Your Survey Results?
Full Name
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Email
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Cell Phone
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Based on your answers you might have a fracture. Please call us immediately at
Based on your responses it is difficult to tell if you have a fracture or not. To be safe we recommend you see us in our office. Please call
THANK YOU