Heel Pain Syndrome, Plantar Fascitis
Conditions
Keywords
Manual Therapy, Intrinsic Foot Muscle Strengthening, Heel Pain, Kaltenborn Mobilization, Mulligan Mobilization
Brief summary
This study will compare the effects of Kaltenborn and Mulligan ankle mobilization techniques, combined with intrinsic foot muscle strengthening, on pain, functional status, and dorsiflexion range of motion in patients with plantar fasciitis. Eighty-two participants with chronic heel pain will be randomly allocated into two groups. Both groups will receive standard care including ultrasound therapy, stretching, and cryotherapy, while Group A will receive Kaltenborn mobilization and Group B will receive Mulligan mobilization. Pain, function, and ankle range of motion will be assessed at baseline and after three weeks of treatment.
Detailed description
This prospective randomized clinical trial will aim to evaluate and compare the effectiveness of two manual therapy techniques-Kaltenborn and Mulligan mobilizations-combined with intrinsic foot muscle strengthening in the treatment of plantar fasciitis. The study will be conducted at two physiotherapy clinics in Sialkot, Pakistan. A total of 82 eligible participants aged 30-60 years, diagnosed with plantar fasciitis, will be enrolled using non-probability convenience sampling and then randomised into two equal groups through the lottery method. Group A will receive Kaltenborn mobilization techniques applied to the talocrural and subtalar joints, in addition to conventional treatment (therapeutic ultrasound, plantar fascia and calf stretching, intrinsic foot muscle strengthening, and cryotherapy). Group B will receive Mulligan mobilization with movement (MWM) applied to the same joints, alongside the same conventional treatment. Interventions will be delivered twice weekly for three weeks (total six sessions). The primary outcomes will include changes in pain intensity (Numeric Pain Rating Scale), functional disability (Foot Function Index), and ankle dorsiflexion range of motion (measured using a goniometer). Measurements will be taken at baseline and at the end of the third week. It is hypothesised that Kaltenborn mobilization may demonstrate superior outcomes in pain reduction and functional improvement compared to Mulligan MWM when combined with strengthening exercises.
Interventions
OTHERKaltenborn Mobilization Group
Participants in this group will receive Kaltenborn mobilization techniques applied to the talocrural and subtalar joints. Mobilizations will be performed as Grade III passive accessory glides for 10 repetitions per joint, each sustained for 15 seconds with a 10-second rest interval Conventional treatment includs therapeutic ultrasound (3 MHz, 1.5 W/cm², continuous mode for 5 minutes), plantar fascia and calf stretching (10 minutes, 1 set of 10 reps), intrinsic foot muscle strengthening exercises (toe curls and towel curls for 10 minutes, 2 sets of 10 reps), and cryotherapy at home for 10 minutes daily. The intervention will be delivered twice weekly for 3 weeks.
Participants in this group will receive Mulligan mobilization with movement (MWM) techniques applied to the talocrural and subtalar joints. Mobilizations will be applied as 3 sets of 10 repetitions per joint with 1-minute rest between sets. Conventional treatment includs therapeutic ultrasound (3 MHz, 1.5 W/cm², continuous mode for 5 minutes), plantar fascia and calf stretching (10 minutes, 1 set of 10 reps), intrinsic foot muscle strengthening exercises (toe curls and towel curls for 10 minutes, 2 sets of 10 reps), and cryotherapy at home for 10 minutes daily. The intervention will be delivered twice weekly for 3 weeks.
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
30 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Age group between 30-60. * Both genders (male and female) included. * Subjects with the ankle and heel pain complain especially morning or after rest and limited ankle ROM due to pain * Positive Windlass test: Pain increase upon toe standing and decreases upon walking. Duration of pain in 4 weeks or more. * Tenderness on medial calcaneal tuberosity. * NPRS score of 4 or more
Exclusion criteria
* Patients contraindicated to manual therapy (tumor, fracture or osteoporosis). Any history of knee, tibia, fibula, ankle or foot surgery or stress fracture of calcaneum. * Previously received physiotherapy treat. * History of non-steroidal anti-inflammatory medications or corticosteroid injection in last 3 weeks prior to surgery. * Pregnancy (because of sudden weight changes and pedal edema which causes heel pain). * Conditions like rheumatoid arthritis, ankylosing spondylitis, systematic lupus erythematous, peripheral neuropathy, sever's disease, severe vascular disease or tarsal tunnel.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numeric Pain Rating Scale | Baseline and at the end of Week 3 (post-intervention) | Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS), a validated 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain). |
| Foot Function Index - FFI | Baseline and at the end of Week 3 (post-intervention) | Functional disability will be evaluated using the Foot Function Index (FFI), a validated questionnaire assessing foot pain, disability, and activity limitation. It comprises 23 items scored on a visual analogue scale, with higher scores indicating greater impairment. |
| Ankle Dorsiflexion Range of Motion | Baseline and at the end of Week 3 (post-intervention) | Ankle dorsiflexion will be measured using a universal goniometer to assess changes in passive range of motion. |
| Windlass Test | Baseline and at the end of Week 3 (post-intervention) | The Windlass Test will be used as a clinical indicator of plantar fascia integrity and responsiveness. The test will be performed in a weight-bearing position by passively dorsiflexing the great toe while the patient stands on the affected foot. A positive result is defined by reproduction of heel or arch pain during the manoeuvre. |
Countries
Pakistan
Contacts
Primary ContactSamrood Akram
Backup ContactAmna Zia
Outcome results
None listed