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

NCT ID: NCT07078539

Last Updated: 2025-07-22

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 74 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-07-31
• Study Completion Date: 2025-11-30

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.

Detailed Description

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.

Conditions

Plantar Fascitis; Heel Pain Syndrome

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

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

Group Type: EXPERIMENTAL

Kaltenborn Mobilization Group

Intervention Type: 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.

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.

Group Type: EXPERIMENTAL

Mulligan Mobilization Group

Intervention Type: 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.

Interventions

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 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.

Intervention Type: OTHER

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 minutes, 2 sets of 10 reps), and cryotherapy at home for 10 minutes daily. The intervention will be delivered twice weekly for 3 weeks.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• 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

Exclusion Criteria

• 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.

• Minimum Eligible Age: 30 Years
• Maximum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Riphah International University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Amna Zia, Phd Scholar

Role: PRINCIPAL_INVESTIGATOR

Riphah International University / Mayo Hospital, Lahore

Adeena Nazim, MSc Student

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

Bashir Health Services

Sialkot, Punjab Province, Pakistan

Countries

Pakistan

Central Contacts

Samrood Akram

Role: CONTACT

samood.akram@riphah.edu.pk

03324806143

Amna Zia

Role: CONTACT

amna_zia_17@live.com

03244686993

Facility Contacts

Bilal Abbas

Role: primary

03327414440

References

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.

Reference Type: BACKGROUND

PMID: 38792948 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 37654968 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 25145882 (View on PubMed)

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.

Reference Type: 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-.

Reference Type: BACKGROUND

Other Identifiers

REC/RCR & AHS/24/0164 -Adeena

Identifier Type: -

Identifier Source: org_study_id