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

NCT07078539 | Not Yet Recruiting

• 1 other identifier: REC/RCR & AHS/24/0164 -Adeena
• Study Type: interventional
• Target: 74
• Locations: 1 country
• Sites: 1

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.

Conditions

Plantar Fascitis; Heel Pain Syndrome

Keywords

Manual Therapy; Intrinsic Foot Muscle Strengthening; Heel Pain; Kaltenborn Mobilization; Mulligan Mobilization

Outcome Measures

Primary Outcomes (4)

• Numeric Pain Rating Scale

  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).

  Baseline and at the end of Week 3 (post-intervention)

• Foot Function Index - FFI

  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.

  Baseline and at the end of Week 3 (post-intervention)

• Ankle Dorsiflexion Range of Motion

  Ankle dorsiflexion will be measured using a universal goniometer to assess changes in passive range of motion.

  Baseline and at the end of Week 3 (post-intervention)

• Windlass Test

  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.

  Baseline and at the end of Week 3 (post-intervention)

Study Arms (2)

Kaltenborn Mobilization Group

EXPERIMENTAL

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

Other: Kaltenborn Mobilization Group

Mulligan Mobilization Group

EXPERIMENTAL

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.

Other: Mulligan Mobilization Group

Interventions

Kaltenborn Mobilization Group OTHER

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.

Kaltenborn Mobilization Group

Mulligan Mobilization Group OTHER

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.

Mulligan Mobilization Group

Eligibility Criteria

• Age: 30 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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

You may not qualify if:

• 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.

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Bashir Health Services

Sialkot, Punjab Province, Pakistan

Location

Related Publications (5)

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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.

  BACKGROUND

• 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-.

  BACKGROUND

Study Officials

• Amna Zia, Phd Scholar

  Riphah International University / Mayo Hospital, Lahore

  PRINCIPAL INVESTIGATOR

• Adeena Nazim, MSc Student

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Samrood Akram

CONTACT

03324806143; samood.akram@riphah.edu.pk

Amna Zia

CONTACT

03244686993; amna_zia_17@live.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 14, 2025
• First Posted: July 22, 2025
• Study Start: July 1, 2025
• Primary Completion: November 15, 2025
• Study Completion: November 30, 2025
• Last Updated: July 22, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)