Comparison Between Foot Segment Mulligan Mobilization and Ilium Mulligan Mobilization in Treatment Patellofemoral Pain Patients With Flatfeet: a Randomized Controlled Comparative Study

NCT07806929 | Not Yet Recruiting DMC

• 1 other identifier: IRB # 30/8/2025 2026
• Study Type: interventional
• Target: 90
• Locations: 1 country
• Sites: 1

Brief Summary

This three-arm, parallel-group randomized controlled trial will investigate the comparative effects of adding Mulligan foot-segment mobilization or Mulligan ilium mobilization to a standardized hip-knee focused exercise program in patients with patellofemoral pain and foot pronation. The study will compare these interventions with hip-knee focused exercises alone over a 4-weeks intervention period. The primary outcomes will be pain intensity and functional status, while secondary outcomes will include lower-limb muscle strength, dynamic knee valgus, pelvic tilt angle, and foot pronation.

Conditions

Patellofemoral Pain, PFP; Flatfeet

Outcome Measures

Primary Outcomes (2)

• Function measured by Anterior Knee Pain Scale

  Anterior Knee Pain Scale (AKPS) It is a self-administered, weighted questionnaire that examines 13 different items including pain and functionality and a maximum score of 100 points, with higher scores indicating better lower extremity function. It documents response to six activities associated specifically with AKPS (walking, running, jumping, climbing stairs, squatting and sitting for prolonged period with knee bent). This scale has demonstrated high test-retest reliability and is considered a good and valid detector for significant changes after treatment of patients with PFPS.

  baseline and after 4 weeks

• Pain measured by Numeric pain rating scale (NPRS)

  Numeric pain rating scale (NPRS) The numeric pain rating scale ranges from 0 to 10 points, where 0 represents no pain and 10 represents the worst possible suffering. Its ICC which measures the reliability of test-retests, has been 0.76, indicating that it is a reliable measure of pain intensity.

  baseline and after 4 weeks

Secondary Outcomes (3)

• Muscle strength by hand-held dynamometer

  baseline and after 4 weeks

• Pelvic tilt angle by Palpation Meter device (PALM)

  baseline and after 4 weeks

• foot pronation by Foot Posture Index (FPI)

  baseline and after 4 weeks

Study Arms (3)

Group A: Foot segment Milligan mobilization group

EXPERIMENTAL

mobilization with movement for talonavicular and talocrural joint + Hip-knee focused exercises

Other: mobilization with movement of the foot segment; Other: Hip-knee focused exercises

Group B: Ilium Milligan mobilization group

EXPERIMENTAL

mobilization with movement of ilium + Hip-knee focused exercises

Other: Mobilization with movement of the Ilium; Other: Hip-knee focused exercises

Group C: Control group

ACTIVE COMPARATOR

Hip-knee focused exercises only

Other: Hip-knee focused exercises

Interventions

Mobilization with movement of the Ilium OTHER

the patients will be in prone position with their hands at shoulder level, and the therapist will stand on the opposite side of the mobilized ilium. The therapist will stabilize the sacrum with the medial aspect of one hand, place the fingers of the other hand under the anterior superior iliac spine, and then will pull the ilium in posterior translation and rotation in relation to the sacrum. Next, the patient will be asked to perform 10 pain-free press-ups by extending the elbows. The mobilization included 3 sets with 10 repetitions for each set and a 30-s rest in between.

Group B: Ilium Milligan mobilization group

mobilization with movement of the foot segment OTHER

Mobilization with movement of the foot segment First, a dorsal glide of the talonavicular joint will be combined with plantarflexion and inversion of the foot. Second, a posterior glide of the talocrural joint will be applied in combination with the corresponding active ankle dorsiflexion. Both mobilization techniques will be applied for 10 repetitions/ 3 sets

Also known as: Mulligan mobilization of the foot segment

Group A: Foot segment Milligan mobilization group

Hip-knee focused exercises OTHER

Stretching exercises will include hamstring dynamic stretching from a supine position, soleus muscle stretching from a step-down position and standing the iliotibial band stretches first with arms at the side and then with arms extending overhead. Stretching exercises were performed 3 times, with a 30-s hold and a 1- in rest between each set and each muscle. The hip exercises will consist of bridging with an isometric hip abduction exercise from a supine position for hip extensors, side-lying hip abduction and clamshell at 30° hip flexion for hip external rotators. The knee exercises will involve mini wall squatting from 0-45° with a band around the distal thigh to engage hip abductors and external rotators, terminal knee extension exercise from a standing position and seated knee extension exercise from 90° to 45° knee flexion.

Also known as: conventional hip-knee focused exercises

Group A: Foot segment Milligan mobilization group; Group B: Ilium Milligan mobilization group; Group C: Control group

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age of the subjects between 18-35 years
• BMI was from 18.5 to ≤ 29.5 Kg/m² .
• Anterior or retro patellar knee pain for at least 6 weeks duration.
• Foot posture index score from +6 to + 12.
• Sagittal plane innominate tilt angle more than 8 degrees.
• Pain elicited at least by two of the following four screening tests; (i) isometric muscle contraction with slight bent knee,(ii) palpation of the patella, (iii) patellar compression against the femoral bone (iv) active resisted knee extension.
• Pain provoked by at least two of the following activities: running, walking, hopping, squatting, stair negotiation, kneeling, or prolonged sitting

You may not qualify if:

• Meniscal or other intra-articular pathologic conditions; cruciate or collateral ligament involvement.
• A history of traumatic patellar subluxation or dislocation..
• Previous surgery in the knee, ankle and hip joints.
• Knee, ankle and hip joints osteoarthritis.
• Taking non-steroidal anti-inflammatory drugs or corticosteroids within 24 hours before the test.
• History of brain injury or vestibular disorder within the last 6 months.
• Pregnant female.

Sponsors & Collaborators

• Cairo University: lead
• Al-Zaytoonah University of Jordan: collaborator

Study Sites (1)

Al-Zaytoonah University of Jordan

Amman, 11733, Jordan

Location

MeSH Terms

Conditions

Patellofemoral Pain Syndrome; Flatfoot

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases; Talipes; Foot Deformities, Acquired; Foot Deformities; Foot Deformities, Congenital; Lower Extremity Deformities, Congenital; Limb Deformities, Congenital; Musculoskeletal Abnormalities; Congenital Abnormalities; Congenital, Hereditary, and Neonatal Diseases and Abnormalities

Study Officials

• Labib M Ghali, PhD

  Cairo University

  PRINCIPAL INVESTIGATOR

• Samah H Nagib, PhD

  Al-Zaytoonah University of Jordan

  STUDY CHAIR

Central Study Contacts

Labib M Ghali, PhD

CONTACT

01201991948; labibmousa7@cu.edu.eg

Samah H Nagib, PhD

CONTACT

776671425; s.nagib@zuj.edu.jo

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: PRINCIPAL INVESTIGATOR
• PI Title: Lecturer

Study Record Dates

• First Submitted: September 2, 2026
• First Posted: September 8, 2026
• Study Start: October 1, 2026
• Primary Completion (Estimated): November 1, 2027
• Study Completion (Estimated): December 1, 2027
• Last Updated: September 8, 2026

Record last verified: 2026-08

Data Sharing

• IPD Sharing: Will not share

Locations

JO (1)