effect of ankle joint mobilization along with foot core strengthening to improve functional status in patients with plantar fasciitis: A randomised controlled trial.
- Conditions
- Acquired deformity of musculoskeletal system, unspecified,
- Registration Number
- CTRI/2023/07/054698
- Lead Sponsor
- Dr APJ Abdul Kalam College of Physiotherapy
- Brief Summary
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|Plantar fasciitis (PF; also known as “plantar heel painâ€) is a common foot disorder in adults secondary to an inflammatory response caused by repetitive micro-trauma.(1)a localized inflammation of the plantar aponeurosis, is reported to be the most common cause of heel pain. An estimated 1 in 10 people will develop the condition over a lifetime.(2) Complaint is usually of an insidious sharp pain in the medial heel along the medial plantar fascia at the insertion at the medial tuberosity of the calcaneum on weight bearing after a period of non-weight bearing.(3)Typically, this pain is described as “burningâ€, “aching†and, occasionally, “lancinatingâ€.(1) The typical pain of PF is located at the hindfoot,(4) medial tubercle of the calcaneus and normally occurs during the first few steps in the morning or after a prolonged non-weight bearing activity.(5) And can often be a challenge for clinicians to treat successfully. It occurs over a wide age range and is seen in both sedentary and athletic individuals.(4,6) PF may affect >1 million people worldwide per year. The exact prevalence of PF is not known. The lifetime prevalence may reach 10% of the general population worldwide. Affect all the age groups, sexes, and ethnicities, with a higher prevalence noted in females aged 40–60 years. (1) There is no clear consensus on the etiology of plantar fasciitis, but overuse due to prolonged weightbearing or unaccustomed activity, obesity, and limited dorsiflexion range of motion have all been implicated as contributing factors.(2) After the initial inflammatory response and repetitive micro-trauma of plantar aponeurosis, myxoid degeneration with PF fragmentation as well as vascular ectasia in bone marrow, are the most common histologic findings. Therefore, PF may be considered a degenerative fasciosis in the absence of inflammation.(1)Plantar heel pain also results in mild disability and decrease in quality of life of an individual.(3) . Diagnosis of PF can be made through the patient history, clinical symptoms, and objective assessments such as pain level, palpation, muscle tightness, joint range of motion, or muscle strength. In addition, diagnostic imaging may be used to exclude other causes of pain such as heel spurs or tissue inflammation.(5) . Patients with PF who have painful episodes at the heel commonly avoid weight bearing on the symptomatic foot and are at risk for developing antalgic gait. Patients with PF tend to walk more slowly than healthy individuals in order to avoid or reduce pain. They show significant decreases in cadence, gait speed, stride length, and increases in stride time.(5) Conservative treatments for PF usually include rest, anti-inflammatory drugs, shoe inserts, shoe wear modification, stretching exercises, and physical therapy. Examples of physical therapy are massage, mobilization, therapeutic ultrasound, and taping.(5)
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|One of the reasons of heel pain may be due to Subtalar joint dysfunction that will affect the movement of calcaneus and thus potentially affect the tension in plantar fascia.(3) Subtalar joint mobilization is a manual therapy intervention that increases the mobility of the calcaneum that contributes an increased pronation and thus increased tensile stress through the plantar fascia.(7) Studies have shown substantial benefit from manual therapy on conditions like Osteoarthritis knee, neck pain, and cervicogenic headaches. There exists less evidence to support the use of manual therapy intervention and their effectiveness in subjects diagnosed with PF.(3,8)
The foot is a highlycomplex structure with many articulations and multiple degrees of freedom that playan important role in static posture and dynamic activities.(9,10) Thefoot core system consists of a complex foot structure, including active,passive, and neural subsystems, providing stability and flexibility when copingwith changing foot demands.(11) The theoretical basis oflumbopelvic-hip core stability is applied to the foot core system.(12)Thepassive subsystem of the foot core consists of the bones, ligaments and jointcapsules that maintain the various arches of the foot. The active subsystemconsists of the muscles and tendons that attach on the foot. The localstabilizers of the foot are the plantar intrinsic muscles that both originateand insert on the foot, whereas the global movers are the extrinsic musclesthat originate in the lower leg, cross the ankle and insert on the foot. Theneural subsystem consists of the sensory receptors in the plantar fascia,ligaments, joint capsules, muscles and tendons involved in the active andpassive subsystems. (9) The intrinsic foot muscles and extrinsicfoot muscles, which constitute the foot active subsystem, also play an activerole in maintaining foot core stability.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Not Yet Recruiting
- Sex
- All
- Target Recruitment
- 30
Age group 40-60years Both Male and Female Patients with positive windlass test Diagnosed case of plantar fasciitis Patients with navicular drop.
History of ankle or foot surgery Patients with any congenital/acquired deformity of foot Patients with any neurological condition Refuse to participate or sign informed consent.
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method foot function index Baseline to 4 weeks Visual analogue scale Baseline to 4 weeks
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (1)
PRAVARA INSTITUTE OF MEDICAL SCIENCES
🇮🇳Ahmadnagar, MAHARASHTRA, India
PRAVARA INSTITUTE OF MEDICAL SCIENCES🇮🇳Ahmadnagar, MAHARASHTRA, IndiaKETAKI PATILPrincipal investigator9970796007ketakipatil61298@gmail.com