Tag Archives: body mass index (BMI)

Foot Health and Elevated Body Mass Index

by H.F. Jelinek 1 , D. Fox 2 

The Foot and Ankle Online Journal 2 (8): 4

Objective: Investigate the relationship between the subcategories included in the Foot Health Status Questionnaire (FSHQ) and body mass index (BMI).
Design: Cross-sectional study of people attending a general health screening clinic.
Subjects: Fifty participants aged between 40 and 60 years filled out the FHSQ and were included in this study. These were divided into the three groups according to the BMI classification of underweight to Class 3 obesity.
Measurements: Demographic variables, blood pressure, BMI as well as medical history were recorded. Relationships between the subcategories of the FSHQ and BMI were investigated. All statistics were deemed significant if p < 0.05.
Results: We found that there is a significant correlation between BMI and foot pain (p = 0.047), foot function (p = 0.004), footwear (p = 0.007) and general foot health (p = 0.013).
Conclusion: The foot health questionnaire is an internally consistent, all in one foot health and function assessment tool, which indicated significant impact of BMI on pain, foot function and foot health, as well as choice of foot wear. These issues can ideally be addressed by primary care physicians to improve health and quality of life for people that are overweight through effective weight loss programs.

Keywords: Obesity, foot health, Body Mass Index, Foot Health Status Questionnaire.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License.  It permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ©The Foot and Ankle Online Journal (www.faoj.org)

Accepted: July, 2009
Published: August, 2009

ISSN 1941-6806
doi: 10.3827/faoj.2009.0208.0004

Obesity is a significant health problem and the incidence of the condition is increasing. Studies by the World Health Organization have found more than one billion adults are overweight (body mass index [BMI] >25) and at least 300 million of them are clinically obese (BMI > 30). [1] In Australia, the levels of obesity have been increasing by about one percent per year since 1980.

Effect of obesity on the foot

Obesity leads to an increase in the occurrence of diverse diseases either independently or in association with other diseases and exacerbates disease progression as well as adversely affecting foot function. [2,3] Increased weight on the feet significantly increases contact areas, with increased pressure on these areas leading to increased foot problems such as pain, vascular and neuropathic disease, deformity and joint mobility. [4,5,6] The Foot Health Status Questionnaire (FHSQ) measures foot specific health related quality of life incorporating the domains of functional ability, social functioning psychological wellbeing, somatic sensation (e.g. pain), and life satisfaction. [7]

The advantage of this questionnaire is that it is internally consistent and includes both physical and psychological variables. The focus of this project was to identify if an association exists between an increased body mass index and the four domains of the Foot Health Status Questionnaire.

Foot Health Status Questionnaire

The FHSQ is comprised of three sections. Questions in section one span the four domains of foot health: foot pain, foot function, footwear, and general foot health. Psychometric evaluation of the FHSQ found that the tool demonstrated a high degree of content, criterion, and construct validity and test retest reliability. [7]


The research project was approved by the Charles Sturt University Ethics in Human Research Committee. Participants were selected via stratified random sampling from the Allied Health and Diabetes Screening Program database. Individuals had the questionnaire explained and any other questions answered prior to completing the FHSQ.

Participants completed the FHSQ version 1.03. [7] Missing items in the questionnaires (when fewer than 50% of the items for any one scale were missing) were assigned with the average value of the completed items for that scale as suggested in the instructions. [8] Statistical analysis was undertaken using Spearman’s correlation coefficient for non-normally distributed data. Significance level was set at p < 0.05 for a one tailed test.


Data from 50 participants who had completed the FHSQ was analysed. Overweight was taken as a BMI greater than 25. Participant’s characteristics are presented in Table 1.

Table 1 Participant characteristics.

Body Mass Index and FHSQ scores

The relationship between BMI divisions and FHSQ domain scores were analysed using Spearman’s rho correlation coefficient as the data was not normally distributed. There was a significant negative Spearman’s rho correlation coefficient between increased BMI and foot pain, r(47) = 27, p < 0.05, foot function, r(47) = 37, p<0.01, footwear, r(47) = 34, P < 0.01, and general foot health, r(47) = 31, P < 0.05 (Table 2). These results indicate that as BMI increases the foot health domain scores decrease.

Table 2  Correlation between FHSQ domains and BMI.


Several studies and different questionnaires have addressed foot function and foot health. However previous work has not utilised the FHSQ as a tool, which combines both function and psychological aspects of foot health.

Landorf and Keenan compared the Foot Function Index to the FHSQ, as measures of health related quality of life. These authors suggested that the FHSQ be viewed as the preferred questionnaire when evaluating health related quality of life where there is no marked impairment or disability. [9]

The findings of the study reported here suggest that obesity has a significant effect on the level of foot pain independent of condition (p<0.05). An increased BMI was also found to be associated with a reduction in perceived foot function by the participants using the FHSQ (p<0.01). This is in line with previous work but does not require separate test batteries to be performed for foot pain and foot function. [4,10] Han, et al., quantified the impairment of quality of life attributable to body fatness using the SF 36 Health Survey and concluded that quality of life measures were related to body mass index, and that participants with a high body mass index were more likely to have poor physical functions that limited many common basic activities of daily living. [11] The current study showed that comfortable and appropriate footwear was perceived as more difficult to find as BMI increased as extra wide shoe fittings are not always commercially available (p< 0.01). [12] Finally, BMI has an impact on general health as reported by previous authors. [13,14]

The relationship between obesity and foot specific health is unclear. The FHSQ is capable of measuring physical and social functioning as subjectively reported by individual, therefore the four domains of the FHSQ may be considered suitable to determine if a relationship exists between obesity, as measured by BMI, and foot specific health. Similarly covariates, such as age, gender, BMI and diabetes mellitus, account for much more of the variance explained by the foot function domain of the FHSQ than do foot disorders themselves. [10]


The findings of the present study and similar findings from other authors clearly support the concept that obesity influences foot function. The main aim of this study was to identify if a relationship existed between increased BMI and foot health as measured by the four domains of the FHSQ, foot pain, foot function, footwear, and general foot health.

This study showed that obesity has a significant effect on the level of foot pain, normal foot function, the adequate fit of footwear, and general foot health as determined by the FHSQ.


1. WHO. World Health Organisation, Global strategy on diet, physical activity and health. Available at: http://www.who.int. Accessed 14 October, 2008.
2. Hills AP, Henning EM, Byrne NM, Steele JR: The biomechanics of adiposity – structural and functional limitations of obesity and implications for movement. Obesity Reviews 3: 35 – 43, 2002.
3. Rejeski WJ, Focht BC, Messier SP, Morgan T, Pahor M, Penninx B: Obese, older adults with knee osteoarthritis: weight loss, exercise and quality of life. Health Psychology 21: 419 – 426, 2002.
4. Gravante G, Russo G, Pomara F, Ridola C: Comparison of ground reaction forces between obese and control young adults during quit standing on a baropodometric platform. Clinical Biomechanics 18: 780 – 782, 2003.
5. Lievense AM, Bierma-Zeinstra SMA, Verhagen AP, van Baar ME, Verhaar JAN, Koes BW: Influence of obesity on the development of osteoarthritis of the hip: a systematic review. Rheumatology 41: 1155 – 1162, 2004.
6. van Schie CHM, Boulton AJM: The effect of arch height and body mass on plantar pressure. Wounds 12 (4): 88 – 95, 2000.
7. Bennett PJ, Patterson CP, Wearing S, Baglioni T: Development and validation of a questionnaire designed to measure foot-health status. Journal of the American Podiatric Medical Association 88: 419 – 428, 1998.
8. Bennett PJ, Patterson CP, Dunn JE: Health related quality of life following podiatric surgery. Australasian Journal of Podiatric Medicine 32 (3): 164 – 173, 2001.
9. Landorf KB, Keenan A-M: An evaluation of two foot-specific, health-related quality-of-life measuring instruments. Foot and Ankle International. 23: 538 – 546, 2002.
10. Badlissi F, Dunn JE, Link CL, Keysor JJ, McKinlay JB, Felson DT: Foot musculoskeletal disorders, pain and foot-related functional limitation in older persons. Journal of the American Geriatrics Society 53: 1029 – 1033, 2005.
11. Han TS, Tijhuis MAR, Lean MEJ, Seidell JC: Quality of life in relation to overweight and body fat distribution American Journal of Public Health 88: 1814 – 1820, 1998.
12. Burns SL, Leese GP, McMurdo ME: Older people and ill fitting shoes. Postgraduate Medical Journal 78: 344 – 346, 2002.
13. Fontaine KR, Bartlett SJ, Barofsky I. Health-related quality of life among obese persons seeking and not currently seeking treatment. International Journal of Eating Disorders 27: 101 – 105, 2000.
14. Hakim Z, Wolf A, Garrison LP: Estimating the effect of changes in body mass index on health state preferences. Pharmacoeconomics 20: 393 – 404, 2002.

Address correspondence to: Herbert F. Jelinek, email: hjelinek@csu.edu.au

1,2  School of Community Health.  Diabetes Complications Screening Research Initiative (DiScRi)
Charles Sturt University, Albury, NSW 2640,Australia.

© The Foot and Ankle Online Journal, 2009

Comparison of Calcaneal Eversion, Gastrocnemius Extensibility and Angle of Toe-Out between Normal and Overweight Females

by Megha Masaun1 , P. Dhakshinamoorthy2  , Rahul Singh Parihar3  

The Foot and Ankle Online Journal 2 (8): 2

Background: Obesity is a major health problem worldwide. An increase in body weight is considered to cause overload of the foot, which represents the interface between the body and ground. This can induce various stress and strains during walking that can predispose to overuse injuries of the lower limb.
Purpose: To compare and correlate the effect of weight on calcaneal eversion, gastrocnemius extensibility and angle of toe-out.
Method: Forty females with a mean age of 24.3 years were divided into 2 groups according to their body mass index (BMI). Group A (n = 20, BMI = 19 – 24) and Group B (n=20, BMI = 25 – 29). Measurements for calcaneal eversion were obtained in double limb and single limb stance, whilst gastrocnemius extensibility was obtained in a prone position. The angle of toe-out was obtained during walking.
Result: There was a significant difference (p<0.05) between the two groups for double limb stance, gastrocnemius extensibility and angle of toe-out. No significant difference (p>0.05) was noted for single limb stance.
Conclusion: The angle of calcaneal eversion and angle of toe-out are greater in overweight individuals, whilst gastrocnemius extensibility is greater in normal subjects.

Key words: Calcaneal eversion, gastrocnemius extensibility, angle of toe-out, weight, body mass index (BMI).

This is an Open Access article distributed under the terms of the Creative Commons Attribution License.  It permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ©The Foot and Ankle Online Journal (www.faoj.org)

Accepted: July, 2009
Published: August, 2009

ISSN 1941-6806
doi: 10.3827/faoj.2009.0208.0002

Obesity is a major worldwide health problem where the body weight is more than 20% of the ideal. There are many long-term debilitating effects of obesity that may impair quality of life. These include cardiovascular disease, diabetes mellitus and various musculoskeletal disorders. Of these musculoskeletal disorders, foot problems in obese adults are most important. This may be due to
the increased stress placed on the feet through the need to bear excessive mass. [1]

Foot problems are frequent because the interface between body and ground is subjected to high stresses and load. [2] The foot provides a stable support for the body, attenuates impact and rotational forces, provides sensory information3, and combines flexibility and stability for propulsion of body. [4,5]

The rearfoot acts as the central mechanism and a major weight bearing structure during stance. [6] However, excessive pronation has been linked with injuries due muscle imbalance which disrupt normal lower limb alignment. This malalignment is thought to place undue stress and strain on the joints, ligaments and muscles. [7]

One of the common muscle imbalances that affect the ankle joint is a tight gastrocnemius-soleus [5] These muscles use 85% of their voluntary contraction during normal walking to help restrain the body’s forward momentum by working eccentrically and concentrically. [8]

Purpose of the Study

To compare the effect of weight on calcaneal eversion, gastrocnemius extensibility and angle of toe-out. A further aim was to establish the correlation between calcaneal eversion, gastrocnemius extensibility and angle of toe-out.


There will be an effect of weight on calcaneal eversion, gastrocnemius extensibility and angle of toe-out.


Subjects: Female students of SBSPGI, Balawala, Dehradun took part in the study. All data were collected at the Research Laboratory, Department of Physiotherapy, SBSPGI, Dehradun. Forty female subjects with a mean age of 21.1 ± 1.0 years were divided into 2 groups based on their Body Mass Index (BMI). Twenty females with a mean age of 21.8 ± 1.8 years with BMI = 19 – 24 were assigned to Group A (normal). A further twenty females with a mean age of 20.5 ± 1.6 with BMI = 25 – 29 were assigned to Group B (overweight).

Table 1 shows the subjects information. None of the subjects had a history of congenital deformity, ligament injury, other soft tissue injury, fracture, pain, limb length discrepancy at least 6 months prior to the start of the study. Informed consent was obtained from all the subjects prior to participation.

Table 1  Description of of subjects.  S = Significant (p<0.05 ); NS = Not Significant (p>0.05); SD = standard deviation.


Group A (n = 20): BMI = 19–24 (normal)
Group B (n = 20): BMI = 25–29 (overweight)

1. Measurement of calcaneal eversion in double and single limb stance.
2. Measurement  of gastrocnemius extensibility in prone position
3. Measurement of angle of toe-out during walking


Subject’s height and weight was determined for calculating BMI as per Quetel’s Index:* [9,10]
BMI = Weight (Kg)/Height (M2)

*Measurements were taken for double limb stance (DLS), single limb stance (SLS), angle of turn out (ATO) and gastrocnemius extensibility (GE). Two measurements were taken and the average was calculated.

Measurement of Calcaneal Eversion

Subtalar joint eversion was determined with subjects positioned prone with lower half of calf off the edge of plinth. Sliding calipers were used to identify mid points on the calf and calcaneus and lines were drawn along the midlines on the posterior third of calf and calcaneus. Range of eversion was measured using a goniometer. The axis of standard goniometer was placed between the malleoli in the frontal plane. The stationery arm of goniometer was placed over the line on the posterior region of the calf and the movable arm was placed over the line on posterior calf.

The calcaneus was passively everted to obtain subtalar joint range of motion (ROM). This method of approach has shown good intrarater reliability with Elveru, et al., reporting intraclass correlation coefficients of 0.75 for calcaneal eversion. [11] This measurement was repeated in double limb stance and single limb stance. [2]

Measurement of Gastrocnemius Extensibility

The subject was positioned in prone position and a marker was used for marking the fibular head, lateral malleolus, base of 5th metatarsal tuberosity and 5th metatarsal head. The stationary arm of the goniometer was placed along the long axis of fibula by using the mark on the fibular head and the lateral malleolus. The moving arm of the goniometer was then placed parallel to the lateral border of the foot by using the marks on the base and head of 5th metatarsal. The axis of the goniometer was kept on the lateral border of the foot. The zero position of dorsiflexion was defined as 900 between the long axis of fibula and the lateral border of the foot. All measurements were recorded as the subjects achieved maximum dorsiflexion. [12,13]

Measurement of Angle of Toe-Out

A 3-meter walkway was created using crepe paper. A chair was placed at the end of walkway to provide orientation during the ambulation trail. Water-soluble ink was applied to the plantar surface of the right foot.

The subject was instructed to walk along the walkway. If they hesitated or no imprint was obtained, the trail was repeated. From the second footprint, three consecutive footprints were evaluated for angle of toe-out. The line parallel to the edge of paper represented the line of progression. The longitudinal axis of footprint was determined as the line drawn from bisecting the widest part of heel through the center of 2nd toe. The angle between line of progression and longitudinal foot axis presented the angle of toe-out. The average of all 3 right foot prints was calculated. [14]

Data Analysis

The significance level selected was 0.05.  An independent t–test was performed for comparing calcaneal eversion, gastrocnemius extensibility and angle of toe-out between Group A (normal ) and Group B (overweight).  Pearson’s correlation coefficient to establish the association between the variables within Group A and B.


Subjects Information: Independent t–test was performed for comparing age, height, weight and BMI in Group A and B which showed significant value ( p < .05 ) ( Table 1)

Comparison of variables between Group A and B:

Independent t-test results showed Significant (P < 0.05) values for DLS, GE and ATO with mean for DLS in Group A and B (8.6° ± 1.0° and 10.2° ± 1.5° respectively). The mean value of GE in Group A and B is 11.6° ± 2.7° and 9.5° ± 2.5°  respectively.  The mean value for ATO between Group A and B is 9.4° ± 2.8° and 11.6° ± 1.9° respectively. The result showed no significant (p>0.05) differences for SLS with the mean for Group A and B at 11.1° ± 1.1° and the mean for Group A and B at 11.1° ± 1.1° and 11.8° ± 3.0° respectively ( graph 1, table 2 )

Correlation between variables:

For Group A (Normal): The DLS and SLS showed a positive correlation (r = 0.65). DLS and GE have a weak positive correlation (r = 0.22). SLS and GE share a positive correlation (r = 0.44). SLS and ATO have a weak positive correlation (r = 0.11) Table 3 shows the correlation between the variables in Group A and B.

Table 2   Description of subjects.  S = Significant (p<0.05 ); NS = Not Significant (p>0.05); SD = standard deviation.  (DLS: Double Limb Stance, SLS: Single Limb Stance; GE: Gastrocnemius Extensibility; ATO: Angle of Toe-Out)   

Table 3   Correlation between variables of Groups A and B.  (DLS: Double Limb Stance, SLS: Single Limb Stance; GE: Gastrocnemius Extensibility; ATO: Angle of Toe-Out)   

Graph 1  Comparison of variables between Group A and B. (mean values presented in degrees; DLS: Double Limb Stance, SLS: Single Limb Stance; GE: Gastrocnemius Extensibility; ATO: Angle of Toe-Out)  

For Group B (overweight): The DLS and SLS have a positive correlation (r = 0.47). DLS and GE have a very weak positive correlation (r = 0.02). SLS and GE have weak negative correlation (r = -0.05). SLS and ATO have very weak negative correlation (r = – .004). While GE and ATO have negative correlation (r = -0 .26)


The significant difference for the double limb stance for Group A and Group B can be due to the extra load through arches of the foot. Schiew and Andrew (2000) suggested a link between higher body mass and flattening of the arches. [15] Moreover, Hall and Broody (1999) also concluded that obesity has an excessive pronatory effect. [16] The results showed no significant difference between the two Groups in SLS. These findings are in contrast to Steven, et al., (2004) who suggested that obesity can contribute to excessive pronation and foot pain. [7]

According to the results, GE is less in the overweight, this could be due to the subjects presenting with excessive pronation, which causes shortening of the tendo-Achilles (Harris and Beath,1948) and instability at the subtalar and midtarsal joints. [17] Overweight subjects showed greater ATO which is supported by Charrette (2002) as they have an increased foot flare during walking.18 Kendall (1993) concluded that in the weight bearing position, there is flatness of longitudinal arch, which is usually accompanied by out-toeing. [19]

There is a positive correlation between SLS, calcaneal eversion and GE in normal subjects, but a negative correlation in overweight subjects. This may be because there is a greater calcaneal eversion in subjects who are overweight, which can lead to less active ROM of ankle dorsiflexion. According to Charrette (2002), excessive pronation is due to tight a tight tendo-Achilles (as stated above) or gastro-soleal equinus. [18] Coetzee (2004) also concluded that the tight Achilles can cause eversion of the calcaneus. [7]

The compensation for reduced ankle dorsiflexion takes place at the subtalar and midtarsal joints in the form of excessive pronation. [20] The results reported showed a weak positive correlation between GE and the angle of toe-out in normal subjects and a negative correlation in the overweight subjects. Magee (2002) concluded that toe-out may present due to contracture of the gastrocnemius and soleus. [8]

There is a very weak negative correlation between SLS, calcaneal eversion and AOT. The same result has also been proved by Kernozek (1990), but is contrary to Lapidus who stated that individuals with abducted foot tend to pronate more. [21] Chang, et al.,(2004) concluded that increased out-toeing increases pressure on the medial foot and provides mechanical force directed at the valgus foot. The in-toeing gait unloads the medial foot and increases the severity of the varus foot. [22]

The hypothesis proves that increased weight has an effect on calcaneal eversion, angle of toe-out and gastrocnemius extensibility. This is because extra weight puts stress on the foot causing flattening of the arches Kapandji (1985). Severely obese females have significantly greater rearfoot motion and foot angle values than normal weight females [23] which can lead to certain dysmorphism of foot specially flat foot. [15]

The differences found between weight bearing and non-weight bearing could be the result of gravitational and ground reaction forces imparted to foot which causes excessive pronation leading to Tendo Achilles shortening. Kendall (1993) concluded that in a weight bearing position, there is flatness of longitudinal arch that is usually accompanied by out toeing (i.e. increased ATO). [19] An out toe position was found in subjects with a tight gastrocnemius. This result is found in overweight because toeing out in walking may result from tightness of tendo Achilles. [19] This is likely to place strain on structures associated with the longitudinal arch as weight is transferred from heels to toes. [13]


Whilst not particular strong, a number of positive and negative correlations were found between the variables for each of the 2 groups. In particular, the study revealed that calcaneal eversion and ATO are associated whereas GE is less in overweight when compared with normal subjects. The findings of this study show that a higher BMI can influence foot characteristics which may therefore predispose individuals to musculoskeletal pain.


We are thankful to all the staff members of SBSPGI, Balawala, Dehradun.


1. Riddiford-Harland DL, Steele JR, Storlien LH: Does obesity influence foot structure in prepubescent children? International J Obesity 24 (5): 541 – 544, 2000.
2. Valmassy RL: Clinical Biomechanics of Lower Extremities. St. Louis, MO: Mosby, 1996.
3. Hennig EM: The Human Foot During Locomotion- Applied Research for Footwear, 2002. http://www.cuhk.edu.hk/iso/weilun/en/hennig/hennig_fulltext1.html Accessed 27th July 2009.
4. Vicenzino B, Fielding J, Howard, R, Moore R, Smith S: An Investigation of the antipronation effect of two taping methods after application and exercise. Gait Posture 5: 1 – 5, 1997.
5. Doxey GE: Calcaneal pain – A review of various disorders. J Bone Joint Surg 72A 884 – 888, 1987.
6. Karas A, Hoy J: Compensatory midfoot dorsiflexion in individuals with heelcord tightness. J Prosthetics Orthotics 14 (2) 82 – 93, 2002.
7. Stovitz SD, Coetzee JC. Hyperpronation and foot pain: step toward painfree feet. Physician Sports Medicine 32 (8): 1 – 10, 2004.
8. Magee DJ: Orthopaedic Physical Assessment. 4th edition, WB Saunders, Philadelphia, 2002.
9. Garrett WG, Kirkendall DT: Exercise and Sports Science. Lippincott Williams and Wilkins, Philadelphia, 2000.
10. Pryor J, Prasad A, Ammani S: Physiotherapy for Respiratory and Cardiac Problems. 3rd edition, Churchill Livingstone, Edinburgh, 2001.
11. Johanson MA, Donatelli R, Wooden MJ, Andrew P, Cumminge GS: Effects of three different posting methods on controlling abnormal subtalar pronation. Physical Therapy 79 (2): 149 – 158, 1994.
12. Wang SS, Whitney SL, Burdett RG, Janosky JE: Lower extremity muscular flexibility in long distance runners. 17 (2): 102 – 107, 1993.
13. Wessling KC, Devane DA, Hylton CR: Effects of static stretch versus static stretch and US combined on triceps surae muscle extensibility in healthy women. Physical Therapy 6 (5): 674 – 679, 1987.
14. Rossner Buchanan K, Davis IM. The relationship between forefoot, midfoot and rearfoot static alignment in pain-free individuals. J Orthopaedic Sports Physical Therapy 35 (9) 559 – 566, 2005.
15. van Schie CHM, Boulton AJM: The effect of arch height and body mass on plantar pressure wounds 12(4): 88 – 95, 2000.
16. Hall CM, Thein Broody L: Therapeutic Exercises – Moving Towards Function. Lippincott and Wilkins, Philadelphia, 1999.
17. Harris RI, Beath T: Hypermobile flatfoot with short Tendo Achilles. J Bone Joint Surg 30A 116 – 150, 1948.
18. Charrette M: Orthotic Support for Overweight and Obese patients- The Chiropractic Journal, 2002. http://www.worldchiropracticalliance.org/tcj/2002/jul/jul2002charrette.htm Accessed 27th July, 2009.
19. Kendall FP, McCreary EK, Provance PG: Muscles: Testing and Function. 4th edition. Williams and Wilkins; Baltimore, 1993.
20. Brown LP, Yavorsky P: Locomotor biomechanics and pathomechanics: A review. J Orthopaedic Sports Physical Therapy 9 (1) 3 – 10, 1987.
21. Kernozek TW, Ricard MD: Foot placement angle and arch type: Effect on rearfoot angle. Arch Phys Med Rehabilitation 71 (12) 988 – 991, 1990.
22. Chang WN, Tsirikos AI, Miller F, Schuyler J, Glutting J: Impact of changing FPA on foot pressure measurement in children with neuromuscular diseases. Gait Posture 20 (1): 14 – 19, 2004.
23. Messier SP, Davies AB, Moore DT, Davis SE, Pack RJ, Kazmar SC: Severe obesity: Effects on foot mechanics during walking. Foot Ankle Int 15(1);29-34, 1994.

Address correspondence to:1 Megha Masaun,
email: meghamasaun115@yahoo.com

1  Qualification- MPTh (Neurology), Institution and Address- Department of Physiotherapy, SBSPGI, Balawala, Dehradun , Uttarakhand-248161, India.
2  Senior Lecturer, Qualification- MPTh (Sports Medicine), Institution and Address- Department of Physiotherapy, SBSPGI, Balawala, Dehradun , Uttarakhand-248161, India.
3  Lecturer, Qualification- MPT (Sports), Institution and Address- Department of Physiotherapy, SBSPGI, Balawala, Dehradun , Uttarakhand-248161, India.

© The Foot and Ankle Online Journal, 2009