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 Table of Contents  
Year : 2014  |  Volume : 1  |  Issue : 4  |  Page : 251-254

Biomechanical variation of joint angles in overweight females

School of Physiotherapy, RK University, Rajkot, Gujarat, India

Date of Submission10-Aug-2014
Date of Decision14-Oct-2014
Date of Acceptance11-Nov-2014
Date of Web Publication11-Dec-2014

Correspondence Address:
Pooja P Popat
30 Baasera Park, Near Rani Tower, Kalawad Road, Rajkot, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-9906.146807

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Background: 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 strain during walking that can predispose to overuse injuries of the lower limb. The purpose of the present study is to determine biomechanical variation of the joint angles of the lower limb such as calcaneal eversion (CE), gastrocnemius extensibility (GE), angle of toe-out (ATO), and Q-angle in overweight females. Methodology: The total of 25 overweight female subjects (body mass index [BMI] =25-29.9) were assigned as test group to determine biomechanical variation CE, GE, ATO and Q-angle. While 25 healthy female subjects (BMI = 18.5-24.9), were selected as a control group. CE and GE were measured in the prone position. While, Q-angle was measured in weight bearing and ATO was measured in walking position. Result: Independent Student's t-test was performed for comparing age, BMI, various angles among both normal and overweight female subjects. Significant increase in CE and ATO were found among overweight females as compared to normal females. While GE was significantly decreased among overweight female. Conclusion: Within limits of the present study, significant variation was found in CE, ATO (increase) and GE (decrease) in overweight females.

Keywords: Angle of toe-out, calcaneal eversion, gastrocnemius extensibility, overweight females, Q-angle

How to cite this article:
Popat PP, Parekh AR. Biomechanical variation of joint angles in overweight females . J Obes Metab Res 2014;1:251-4

How to cite this URL:
Popat PP, Parekh AR. Biomechanical variation of joint angles in overweight females . J Obes Metab Res [serial online] 2014 [cited 2021 Oct 16];1:251-4. Available from: https://www.jomrjournal.org/text.asp?2014/1/4/251/146807

  Introduction Top

In a normal weight individual, the major joints of the lower extremity are exposed to reaction forces of approximately three to six times body weight during locomotion (single leg stance phase). [1],[2] It may be reasonable to hypothesize that obese individuals experience greater absolute loads at these joints than individuals of normal weight. [3]

Overweight and obesity are worldwide major health problem where body weight is >20% of the ideal. Overweight leads to obesity and there are many long-term debilitating effects of obesity that may impair the quality of life. These include cardiovascular disease, diabetes mellitus and various musculoskeletal disorders. [4]

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. [5] The quadriceps angle (Q-angle) is an important indicator of biomechanical function in the lower extremity. There is an effect of excessive pronation on Q-angle. [6] Foot problems are frequent because the interface between body and ground is subjected to high stresses and load. [7] The foot provides a stable support for the body, attenuates impact and rotational forces, provides sensory information, [8] and combines flexibility and stability for propulsion of the body. [9],[10] Such a mal-alignment is thought to place undue stress and strain on the joints, ligaments and muscles. [11]

One of the common muscle imbalances that affect the ankle joint is a tight gastrocnemius-soleus. [10] These muscles use 85% of their voluntary contraction during normal walking to help restrain the body's forward momentum by working eccentrically and concentrically. [12]

The purpose of present study is to determine biomechanical variation of the joint angles of the lower limb such as; calcaneal eversion (CE), gastrocnemius extensibility (GE), angle of toe-out (ATO) and Q-angle in overweight females. Furthermore, correlation among these angles was also determined in the present study.

  Methodology Top

About Twenty-five overweight female subjects and 25 healthy female subjects visited Civil Hospital, Rajkot and Ramkrishna Ashram Physioyherapy Center, Rajkot during March-April 2014 were enrolled in the present study. The individuals with body mass index (BMI) value 18.5-24.9 were assigned as control group (Group A: Healthy controls) while individuals with BMI value 25-29.9 were assigned to the test group (Group B: Overweight) in the study. Those subjects with the use of external appliances, traumatic injury to lower limb in last 6 months, limb length discrepancy were excluded.


The measurements of various angles and BMI were performed by a single well-trained examiner.

Subject's height and weight were determined for calculating BMI as per Quetel's index:

BMI = weight (kg)/height (m 2 )

Outcome measures:

  • Measurement of CE
  • Measurement of GE
  • Measurement of Q-angle
  • Measurement of ATO.

Measurement of calcaneal eversion

Subtalar joint eversion was determined with subjects positioned prone with a lower half of the calf off the edge of the plinth. The axis of standard goniometer was placed between the malleoli in the frontal plane. The stationery arm of the goniometer was placed over the line on the posterior region of the calf, and a movable arm was placed over the line of calcaneum. 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 CE [13] [Figure 1].
Figure 1. Measurement of calcaneal angel (calcaneal eversion)

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Measurement of gastrocnemius extensibility

The subject was positioned in the prone position, and a marker was used for marking the fibular head, lateral malleolus, base of fifth metatarsal tuberosity and fifth metatarsal head. The axis of the goniometer was kept on the lateral border of the foot [Figure 2]. The zero position of dorsiflexion was defined as 90°° between the long axis of fibula and the lateral border of the foot. All measurements were recorded as the subjects achieved maximum dorsiflexion. [14]
Figure 2. Measurement of gastrocmieus angel (gastrocnemius extensibility)

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Measurement of angle of toe-out

It represents the angle of foot placement. And it is formed by each foot's line of progression and line intersecting the center of heel and the 2 nd toe. [15] The subject was instructed to walk away. From the second footprint, three consecutive footprints were evaluated for ATO [Figure 3] and [Figure 4].
Figure 3. Measurement of angle of toe-out

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Figure 4. Measurement of angle of toe-out

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Measurement of Q-angle

It is an angle formed between a line connecting the anterior superior iliac spine to the mid point of the patella and a line connecting tibial tuberosity to the midpoint of the patella. It is measured in a standing position [Figure 5] and [Figure 6]. [15]
Figure 5. Measurement of Q-angle

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Figure 6. Measurement of Q-angle

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Statistical analysis

Statistical analysis of data was performed using Instat GraphPad computerized software. An independent student's t-test was performed for comparing CE, GE, ATO and Q-angle between Group A (normal) and Group B (overweight). The Pearson's correlation coefficient was calculated to establish an association between the variables within Groups A and B. p < 0.05 was considered to be statistically significant

  Result Top

Significant increase in CE and ATO were found among overweight females (Group B) as compared to normal females (Group A). While, GE was found to decrease significantly among overweight females (Group B) as compared to normal females (Group A). Nonsignificant decrease in value of Q-angle was found in overweight females (Group B) as compared to normal females (Group A) [Table 1] [Figure 7]. While, different correlation was observed among different angles in both the groups [Table 2].
Table 1: Biomechanical variation in joint angles

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Table 2: Correlation between the variables of Group A and B

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Figure 7. Comparision of Variables between Group A and B. (CE=Calcaneal eversion; GE=Gastrocnemius Extensibility; ATO=Angle Of Toe-out)

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  Discussion Top

Heel forces while walking increase as body weight increases. [16] Due to the excessive pronation subjects presenting with less GE, which causes shortening of the tendo-achilles and instability at the subtalar and midtarsal joints. [17] Charrette concluded that overweight subjects showed greater ATO as they have an increased foot flare while walking. [18] According to Kendall et al. in the weight bearing position, there is the flatness of the longitudinal arch, which is usually accompanied by out-toeing. [19]

There is a greater CE in subjects who are overweight, which can lead to less active ROM of ankle dorsiflexion. According to Charrette, excessive pronation is due to tight tendo-achilles (vide supra) or gastro-soleal equines. [18] By this, there is a negative correlation between CE and GE.

Tight tends-achilles can cause the eversion of the calcaneus. [7] And ATO increase due to contracture of the gastrocnemius and soleus. [11] By this, there is a positive correlation between CE and ATO. The same result proved by Chang et al. 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. [20] An out toe position was found in subjects with a tight gastrocnemius. [21] 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. [22]

Charrette concluded that there is a decrease in Q-angle is due to muscles commonly found to be tight include the quadriceps, hamstrings, iliotibial band and gastrocnemius. [23] There is increased weight has an effect on CE, ATO and GE and Q-angle. Kapandji conclude that the extra weight puts stress on the foot causing flattening of the arches. [21] Severely obese females have significantly greater rear foot motion and foot angle values than normal weight females [24] which can lead to certain dysmorphism of foot specially flat foot, [25] negative impact on balance and alteration in the gait. [26]

There are female participants only with age group of 24-45 years and normal and overweight (18-29.5) BMI included in this study are the limitations of the study.

  Conclusion Top

Calcaneal eversion and ATO are more in the overweight whereas GE is less in overweight when compared with normal subjects. There is a negative correlation of GE CE and ATO. And positive between CE and ATO, GE and Q-angle. There is a negative correlation of GE and ATO and positive between calcaneus eversion and ATO.

  References Top

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Messier SP, Ettinger WH Jr, Doyle TE, Morgan T, James MK, O'Toole ML, et al. Obesity: Effects on gait in an osteoarthritic population. J Appl Biomech 1996;12:161-72.  Back to cited text no. 3
Willmore JH, Costill DH. Physiology of Sports and Exercises. 2 nd ed. Champaingn, IL: Human Kinetic Publishers; 2004.  Back to cited text no. 4
Riddiford-Harland DL, Steele JR, Storlien LH. Does obesity influence foot structure in prepubescent children? Int J Obes Relat Metab Disord 2000;24:541-4.  Back to cited text no. 5
Charret M. Abnormal Q-angle and orthotic support. Dyn Chiropr J 2002;35:15.  Back to cited text no. 6
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Hennig EM. The Human foot during locomotion - Applied research for footwear, 2002. Available from: http://www.cuhk.edu.hk/iso/weilun/en/hennig/hennig_fulltext1.html. [Last accessed on 2009 Jul 27].  Back to cited text no. 8
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Stovitz SD, Coetzee JC. Hyperpronation and foot pain: Steps toward pain-free feet. Phys Sportsmed 2004;32:19-26.  Back to cited text no. 11
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Johanson MA, Donatelli R, Wooden MJ, Andrew PD, Cummings GS. Effects of three different posting methods on controlling abnormal subtalar pronation. Phys Ther 1994;74:149-58.  Back to cited text no. 13
Wang SS, Whitney SL, Burdett RG, Janosky JE. Lower extremity muscular flexibility in long distance runners. J Orthop Sports Phys Ther 1993;17:102-7.  Back to cited text no. 14
Norkin CC, Levangie PK. Joint Structure and Function, Comprehensive Analysis. 4 th ed. Philadelphia: FA Davis Co.; 2005.  Back to cited text no. 15
Albensi RJ, Nyland J, Caborn DN. The relationship of body weight and clinical foot and ankle measurements to the heel forces of forward and backward walking. J Athl Train 1999;34:328-33.  Back to cited text no. 16
Harris RI, Beath T. Hypermobile flat-foot with short tendo achillis. J Bone Joint Surg Am 1948;30A: 116-40.  Back to cited text no. 17
Charrette M. Orthotic support for overweight and obese patients. Chiropr J 2002;12, 2004; 22; 04 .  Back to cited text no. 18
Kendall FP, McCreary EK, Provance PG. Muscles: Testing and Function. 4 th ed. Baltimore: Williams and Wilkins; 1993.  Back to cited text no. 19
Chang WN, Tsirikos AI, Miller F, Schuyler J, Glutting J. Impact of changing foot progression angle on foot pressure measurement in children with neuromuscular diseases. Gait Posture 2004;20:14-9.  Back to cited text no. 20
Masaun M, Dhakshinamoorthy P, Parihar RS. Comparison of calcaneal eversion, gastrocnemius extensibility and angle of toe out in normal and overweight females. Foot Ankle Online 2009;2:2.  Back to cited text no. 21
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Charrette MJ. Abnormal Q-angle and orthotic support. Dyn Chiropr 2003;21:24.  Back to cited text no. 23
Messier SP, Davies AB, Moore DT, Davis SE, Pack RJ, Kazmar SC. Severe obesity: Effects on foot mechanics during walking. Foot Ankle Int 1994;15:29-34.  Back to cited text no. 24
van Schie CH, Boulton AJ. The effect of arch height and body mass on plantar pressure. Wounds 2000;12:88-95.  Back to cited text no. 25
Sarkar A, Singh M, Bansal N, Kapoor S. Effects of obesity on balance and gait alterations in young adults. Indian J Physiol Pharmacol 2011;55:227-33.  Back to cited text no. 26


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]

  [Table 1], [Table 2]


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