Effect of Kaltenborn vs Mulligan Mobilization With Intrinsic Foot Strengthening in Plantar Fasciitis

Официальное название

Comparative Effect of Kaltenborn and Mulligan Mobilization With Intrinsic Foot Muscle Strengthening on Pain, Functional Status, and Windlass Mechanism in Patients With Plantar Fasciitis

Обзор

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.

Подробное описание

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.

Вмешательства

• Другое Kaltenborn 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 exercise
• Другое Mulligan Mobilization Group
  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 minute

Первичные конечные точки

• Numeric Pain Rating Scale [Срок оценки: Baseline and at the end of Week 3 (post-intervention)]
• Foot Function Index - FFI [Срок оценки: Baseline and at the end of Week 3 (post-intervention)]
• Ankle Dorsiflexion Range of Motion [Срок оценки: Baseline and at the end of Week 3 (post-intervention)]
• Windlass Test [Срок оценки: Baseline and at the end of Week 3 (post-intervention)]

Критерии участия

Критерии включения

• 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

Критерии исключения

• 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.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Двойное слепое

Основная цель

Лечение

Центры проведения

Пакистан · 1 центр

• Bashir Health Services — Sialkot

Публикации

• Szajkowski S, Pasek J, Cieslar G. Dose Escalation Can Enhance the Therapeutic Potential of Radial Extracorporeal Shock-Wave Therapy in the Treatment of Plantar Fasciitis in Runners. Medicina (Kaunas). 2024 May 6;60(5):766. doi: 10.3390/medicina60050766. PMID 38792948
• Boob MA Jr, Phansopkar P, Somaiya KJ. Physiotherapeutic Interventions for Individuals Suffering From Plantar Fasciitis: A Systematic Review. Cureus. 2023 Jul 31;15(7):e42740. doi: 10.7759/cureus.42740. eCollection 2023 Jul. PMID 37654968
• Rathleff MS, Molgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, Aaskov S, Olesen JL. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015 Jun;25(3):e292-300. doi: 10.1111/sms.12313. Epub 2014 Aug 21. PMID 25145882
• Maheta U, Thakarar S, Thakarar J, Pandita V, Patel SB, Ranu A, et al. EFFECTIVENESS OF MAITLAND MOBILIZATION VERSUS MULLIGAN MOBILIZATION FOR FLATFOOT IN THE MIDTARSAL JOINT.
• Shabbir S, Ahmad A, Munawar A, Siddique K, Perwaiz S. Comparison of mobilization with movement and dorsiflexion night splint with and without routine exercises in patients with plantar fasciitis. Rawal Medical Journal. 2022;47(3):650-.

Идентификаторы

NCT: NCT07078539 · REC/RCR & AHS/24/0164 -Adeena

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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