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Please provide us with your full name and email address.

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Have you experienced foot/ankle pain in recent years?

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Did you have to stop working?

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Does the problem affect your function or social life (e.g. sports, home life, relationships, etc.?)

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Do you have difficulty or increased foot/ankle pain with standing for greater than 30 minutes?

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Do you have difficulty or increased foot/ankle pain with walking for greater than 15 minutes?

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Do you have difficulty or increased foot/ankle pain when going up and down the stairs?

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Have you tried other treatment options (drugs, exercise, surgery, etc.) without full recovery?

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Would you like some help with your current situation?

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