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Aging and disease    2018, Vol. 9 Issue (5) : 861-868     DOI: 10.14336/AD.2017.1215
Orginal Article |
Transcultural Adaptation and Validation of the Spanish Bristol Foot Score (BFS-S)
Emmanuel Navarro-Flores1, Marta Elena Losa-Iglesias2, Ricardo Becerro-de-Bengoa-Vallejo3, Daniel Lopez-Lopez4, *, Juan Manuel Vilar-Fernandez5, Patricia Palomo-Lopez6, Cesar Calvo-Lobo7
1Faculty of Medicine, Universidad Miguel Hernandez de Elche, and Department of Nursing and Podiatry, University of Valencia, Spain
2Faculty of Health Sciences, Universidad Rey Juan Carlos, Spain
3School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Spain
4Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruna, Spain
5Modeling, Optimization and Statistical Inference Research Group, Universidade da Coruna, Spain
6University Center of Plasencia, Universidad de Extremadura, Spain
7Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de Leon, Ponferrada, Leon, Spain
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The Bristol Foot Score is considered an instrument for measuring the impact of foot problems and pain. It was developed and validated in United Kingdom. Therefore, this aim was to perform the transcultural adaptation and validation of the Spanish version. The recommended forward/backward translation protocol was applied for the procedure of translation, transcultural adaptation and validation to Spain. Considering each domain and question, internal consistency and reliability were analyzed through the Crombach alpha (α) and intraclass correlation coefficient (ICC) with a 95% confidence interval (95% CI). A very good internal consistency was shown for the 3 domains: concern and pain showed a Cronbach of 0.896, footwear and general foot health of 0.790, mobility 0.887. Each question had a very good test-retest reliability, ranged from 0.721 to 0.963 with no systematic differences (P>0.05) in each question of the Spanish Bristol Foot Score (BFS-S) questionnaire. The test-retest reliability was excellent (ICC 95%): concern and foot pain 0.950 (0.913-0971); footwear and general foot health 0.914 (0.851-0.950), mobility 0.973 (0.953-0.984) and there were no sistematic differences in any domain (P > 0.05). The BFS-S was shown to be a valid and reliable tool with an acceptable use in the Spanish population.

Keywords foot      quality of life      health impact assessment      validation studies     
Corresponding Authors: Daniel Lopez-Lopez     E-mail:;;;;;
About author: These authors contributed equally to this work.
Issue Date: 28 October 2017
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Navarro-Flores Emmanuel
Losa-Iglesias Marta Elena
Becerro-de-Bengoa-Vallejo Ricardo
Lopez-Lopez Daniel
Vilar-Fernandez Juan Manuel
Palomo-Lopez Patricia
Calvo-Lobo Cesar
Cite this article:   
Navarro-Flores Emmanuel,Losa-Iglesias Marta Elena,Becerro-de-Bengoa-Vallejo Ricardo, et al. Transcultural Adaptation and Validation of the Spanish Bristol Foot Score (BFS-S)[J]. Aging and disease, 2018, 9(5): 861-868.
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Total group
Mean ± SD Range N = 53
Mean ± SD Range N = 23
Mean ± SD Range N = 30
P Value
Age, years49.55±16.17 (23-78)54.33±15.32 (47.86-60.79)45.58±16.01 (39.49- 51.66)0.004
Weight (kg)69.26±11.92 (47-98)72.20±9.11 (73.35-81.04)62.68±9.84 (58.93-66.42)0.747
Height (cm)168±0.08 (151-189)1.74±0.7 (1.70-1.77)164±0.05 (161-166)0.756
BMI (kg/m2)24.20±3.37 (17.68-35.54)25.42±0.07 (25.39-25.44)23.18±3.69 (21.77-24.58)0.082
Table 1  Socio-demographic characteristics of the sample population.
TEST (n=53) Mean ± SD (CI 95%)RETEST (n=53) Mean ± SD (CI 95%)ICC (CI 95%)P- valueSEM%CVSEM%LoA Mean diference (limits)MDCP-value Breusch-Pagan
Question 1. Do problems with your feet affect whether you go out of the house to visit family or friends?1.60±0.92
0.963 (0.936-0.79)0.4190.0051.6840.3210.038
Question 2. Do problems with your feet affect whether you walk to the shops?1.62±0.90 (1.37-1.87)1.67±0.91
Question 3. Do problems with your feet affect you when standing still?1.67±0.97
1.73 ±.092 (1.48-1.99)0.962 (0.935-0.978)0.2610.0082.3440.457-0.057
Question 4. Do problems with your feet affect you when walking on bumpy or stony ground?2.18±1.05
2.15 ±.1.02
Question 5. Over the last two weeks how painful have your feet been?2.16±1.29
Question 6. Over the last two weeks, how often have you felt this way about your feet?
"I have felt conscious of my feet".
0.918 (0.857-0.953)0.2010.0263.4020.9490.132
Question 7. Over the last two weeks, how often have you felt this way about your feet?
"I have felt fed up about my feet".
Question 8. Over the last two weeks, how often have you felt this way about your feet?
"I have felt worried that my feet will get worse in the future".
Question 9. Over the last two weeks, have you felt this way about your feet?
"I have felt my feet are not really part of me".
0.1590.0183.9841.3560.075 (-0.369-1.139)0.0500.163
Question 10. Because of your feet have you had problems sleeping, in the last two weeks?1.24±0.75
Question 11. In the last two weeks have you been able to put your everyday
shoes on easily.
Question 12. Over the last two weeks how often have you been able to wear any
shoes you liked.
Question 13. If you could afford any shoes you wanted, how easily could you find new
shoes that fit comfortably?
Question 14. In general, would you say your foot health is:2.64±1.19
Question 15. Would you say your general health is:2.62±0.94
Table 2  Results of reliability, test-retest of the Spanish Bristol Foot Score (BFS-S) questionnaire according to each question.
Mean ± SD (CI 95%)
Mean ± SD (CI 95%)
ICC (CI 95%)P-valueSEM%CVSEM %LoA Mean diference (limits)MDCP-value Breusch-Pagan
Concern and pain13.69±7.81
Footwear and general foot health8.35±3.51
Mobility5.43 ±2.64
(0.953- 0.984)
Table 3  Results of reliability, test-retest of the Spanish Bristol Foot Score (BFS-S) questionnaire according to each domain.
Figure 1.  Bland-Altman plot showing the agreement between test and retest for the mobility (A), concern and pain (B), and footwear and general health (C) domains.
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