The Foot and Ankle Flexibility Index (FAFI)


This paper presents the development and validation of a new foot measure – the FAFI – from a specific paediatric foot and ankle perspective:

This is a new tool for identifying joint hypermobility of the paediatric foot and ankle, based on the Lower Limb Assessment Score (the last seven items pertinent to foot and ankle).

This study was carried out in 205 healthy children, aged 5 to 10 years, a cross-sectional study (note the age range for application of results).

What is new?

  • FAFI is the first tool to identify foot and ankle hypermobility.
  • We have found a cut-off point of 4/6 with a sensitivity of 95% and a specificity of 86%.

The FAFI identified high reliability between examiners, and high sensitivity and specificity, rendering the FAFI as a new reliable and valid tool for the identification of paediatric foot and ankle joint hypermobility.

FAFI consists of 6 foot and ankle items, and the demonstrated cut-off score ≥ 4/6 indicates foot and ankle joint hypermobility.

From now on, we should discard general hypermobility tests and focus on FAFI for research in the foot and ankle area.

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Kind regards,

Angela Evans  

Dr Angela Evans AM