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.
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.
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.
Parallel
Transverse Friction Massage
Procedure/SurgeryTransverse 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.
Instrument-Assisted Soft-Tissue Mobilization
Procedure/SurgeryInstrument-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.
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.
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.
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.
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