Comparison of Transverse Friction Massage and Instrument- Assisted Soft-Tissue Mobilization in Plantar Fasciitis

NCT07856147 | Recruiting

• 1 other identifier: FUI/FUCP/CTR/MSMSK/AdeebaAfzal
• Study Type: interventional
• Target: 34
• Locations: 1 country
• Sites: 1

Brief Summary

Plantar fasciitis is a common musculoskeletal condition characterized by plantar heel pain, particularly during the first steps after waking or following prolonged rest. It can substantially affect walking, standing, daily activities, and overall functional ability. Although conservative physiotherapy management is commonly used, the relative effectiveness of different manual therapy techniques remains unclear. The present study aims to compare the effectiveness of Transverse Friction Massage (TFM) and Instrument-Assisted Soft-Tissue Mobilization (IASTM) in patients with plantar fasciitis. The study will be conducted as a single-blinded randomized controlled trial at Foundation University College of Physical Therapy, Islamabad. A total of 34 participants will be recruited using purposive sampling and subsequently randomized into two groups through a sealed opaque envelope method. Participants will be adults aged 19-44 years with clinically diagnosed plantar fasciitis and symptoms. persisting for more than three months. Group A will receive Transverse Friction Massage, while Group B will receive Instrument-Assisted Soft-Tissue Mobilization. Both groups will additionally receive a standardized physiotherapy protocol consisting of stretching exercises, strengthening exercises, ultrasound therapy, home-based exercises, and activity modification. The interventions will be administered twice weekly for four weeks, resulting in a total of eight treatment sessions. The primary clinical outcomes will include pain intensity, foot-related functional impairment, and ankle range of motion. Pain will be assessed using the Numeric Pain Rating Scale (NPRS), foot function using the Foot Function Index (FFI), and ankle range of motion using a goniometer. Assessments will be performed at baseline, after two weeks, and at the end of four weeks. Data will be analyzed using SPSS. Appropriate parametric or non-parametric statistical tests will be applied according to data distribution, with statistical significance set at p\<0.05 and a 95% confidence interval. The study is expected to provide evidence regarding the comparative effectiveness of TFM and IASTM for reducing pain, improving foot function, and enhancing ankle mobility in patients with plantar fasciitis.

Conditions

Plantar Fasciitis

Outcome Measures

Primary Outcomes (3)

• Foot Pain

  Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS), a standardized patient-reported measure used to quantify perceived pain severity. Participants will be asked to rate the intensity of their plantar heel pain on a numerical scale from 0 to 10, where 0 represents no pain and 10 represents the worst possible pain. The participant will select the number that best represents their current pain intensity at the time of assessment. The NPRS provides a simple and reproducible method for evaluating changes in pain severity following physiotherapy intervention. Pain scores will be recorded for each participant at baseline before treatment, after two weeks, and after four weeks. Changes in NPRS scores across assessment points will be used to evaluate treatment-related improvement and compare pain outcomes between the two intervention groups.

  before and at 4 weeks

• Foot Disability

  Foot disability will be assessed using the Foot Function Index (FFI), a validated patient-reported outcome measure designed to evaluate the impact of foot problems on function. The FFI consists of 23 items divided into three domains: pain, disability, and activity limitation. Participants rate each item according to the degree of difficulty or limitation experienced during daily activities. Each item is scored on a numerical scale, with higher scores indicating greater pain and disability. The FFI provides information regarding pain-related impairment, difficulty performing activities, and limitations in daily activities. It will quantify foot-related disability and functional limitations in participants with plantar fasciitis. The FFI will be recorded at baseline, after two weeks, and after four weeks to determine changes in foot disability following the intervention and compare outcomes between treatment groups.

  Before and at 4 weeks

• Ankle Range of motion

  Ankle range of motion (ROM) will be assessed using a standard universal goniometer to measure dorsiflexion and plantar flexion of the involved ankle. Participants will be positioned appropriately, and the goniometer will be aligned with established anatomical landmarks to measure the angular movement of the ankle joint in degrees. Dorsiflexion will be assessed by measuring movement of the foot toward the anterior aspect of the lower leg, while plantar flexion will be assessed by measuring movement of the foot away from the lower leg. The measurements will provide an objective assessment of ankle mobility and identify limitations in ankle ROM associated with plantar fasciitis. ROM will be recorded at baseline, after two weeks, and after four weeks to determine changes following treatment and compare outcomes between the two intervention groups.

  Before and at 4 weeks

Study Arms (2)

Group A Transverse Friction Massage

ACTIVE COMPARATOR

Procedure: Transverse Friction Massage

Group B Instrument-Assisted Soft-Tissue Mobilization

EXPERIMENTAL

Procedure: Instrument-Assisted Soft-Tissue Mobilization

Interventions

Transverse Friction Massage PROCEDURE

Transverse Friction Massage (TFM) will be administered to participants in Group A as an adjunct to the standardized physiotherapy protocol.The technique is intended to address abnormal soft-tissue adhesions, improve plantar fascia mobility, reduce scar formation, and alleviate chronic pain. The participant will be positioned in supine lying, and the most painful area of the plantar fascia insertion will be identified. The foot will be dorsiflexed to facilitate stretching of the plantar fascia. Deep friction massage will then be applied using a reinforced index finger in a transverse direction, perpendicular to the tissue fibers. The therapist will perform controlled back-and-forth movements across the affected tissue within the participant's tolerance for approximately 5 minutes. TFM will be provided twice weekly for four weeks, resulting in eight treatment sessions.

Group A Transverse Friction Massage

Instrument-Assisted Soft-Tissue Mobilization PROCEDURE

Instrument-Assisted Soft-Tissue Mobilization (IASTM) will be administered to Group B along with the standardized physiotherapy protocol. The technique is used to facilitate soft-tissue mobility, address adhesions, stimulate local circulation, and promote tissue remodeling. It may help reduce pain, improve tissue flexibility and function. A 3-minute cycling or walking warm-up will be performed before treatment. The participant will be positioned prone with the involved knee flexed to 90° and ankle in neutral. An emollient will be applied to the plantar surface. IASTM will then be performed for approximately 6 minutes using a specialized instrument held at approximately 45° to the skin. Sweeping and fanning strokes will be applied from the calcaneus toward the metatarsal heads, with pressure adjusted according to participant tolerance. Treatment will be provided twice weekly for four weeks, totaling eight sessions.

Group B Instrument-Assisted Soft-Tissue Mobilization

Eligibility Criteria

• Age: 19 Years - 44 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age (adults 19 - 44 years).
• Male and female both are included.
• Pain in plantar heel lasting more than 3 months.
• Clinically diagnosed plantar fasciitis patients in compliance with the American physical therapy association's (APTA) Orthopedic Section clinical practice guidelines.
• Positive windlass test;
• Negative tarsal tunnel tests;
• Limited active and passive talocrural joint dorsiflexion range of motion;
• Plantar medial heel pain; most noticeable with initial steps after a period of inactivity but also worse after prolonged weight bearing.

You may not qualify if:

• Previous surgical intervention for plantar fasciitis.
• Congenital abnormalities of foot.
• Lower extremities affected by systemic disorders, such as rheumatoid arthritis, diabetes or peripheral neuropathy.
• The presence of additional foot disorders, such as stress fractures, Achilles tendinopathy, or nerve entrapment syndromes.
• Any contraindications to Instrument-Assisted Soft-Tissue Mobilization such as open wounds, skin infections, acute inflammation or intolerance to mechanical pressure.
• Not willing or not capable of adhering to the study procedure and completing follow- up examinations.
• Pregnant women, mental illness, immune suppressed patients, patients with peripheral vascular disease, thrombocytopenia patients, anti-coagulant therapy patients and post mastectomy.

Sponsors & Collaborators

• Foundation University Islamabad: lead

Study Sites (1)

Foundation University College of Physical Therapy

Islamabad, Punjab Province, 44000, Pakistan

RECRUITING

MeSH Terms

Conditions

Fasciitis, Plantar

Condition Hierarchy (Ancestors)

Fasciitis; Musculoskeletal Diseases; Foot Diseases

Central Study Contacts

Adeeba Afzal, DPT

CONTACT

+923341822252; adeebaafzal10888@gmail.com

Anam Rehman, MS-OMPT

CONTACT

+923355082299; anam.rehman@fui.edu.pk

Study Design

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

Study Record Dates

• First Submitted: September 28, 2026
• First Posted: October 2, 2026
• Study Start: February 11, 2026
• Primary Completion (Estimated): December 18, 2026
• Study Completion (Estimated): January 18, 2027
• Last Updated: October 2, 2026

Record last verified: 2026-09

Locations

PA (1)