The effect of additional ankle and midfoot mobilizations on plantar fasciitis: a randomized controlled trial

J Orthop Sports Phys Ther. 2015 Apr;45(4):265-72. doi: 10.2519/jospt.2015.5155. Epub 2015 Mar 4.


Study design: A single-blind randomized controlled trial.

Objective: To evaluate the efficacy of ankle and midfoot mobilization on pain and function of patients with plantar fasciitis (PF).

Background: Plantar fasciitis is a degenerative process of the plantar fascia, with a lifetime prevalence of approximately 10%. Limited ankle dorsiflexion is a common finding and apparently acts as a contributing factor to the development of PF.

Methods: Fifty patients with PF, aged 23 to 73 years, were randomly assigned to either the intervention or control group. Both groups received 8 treatments, twice a week, consisting of stretching exercises and ultrasound. In addition, the intervention group received mobilization of the ankle and midfoot joints. Dorsiflexion range of motion was measured at the beginning and at the end of treatment. The results were evaluated by 3 outcomes: the numeric pain-rating scale, Lower Extremity Functional Scale, and algometry.

Results: No significant difference was found between groups in any of the outcomes. Both groups showed a significant difference in the numeric pain-rating scale and Lower Extremity Functional Scale. Both groups significantly improved in dorsiflexion range of motion, with no difference between groups.

Conclusion: The addition of ankle and foot joint mobilization aimed at improving dorsiflexion range of motion is not more effective than stretching and ultrasound alone in treating PF. The association between limited ankle dorsiflexion and PF is most probably due to soft tissue limitations, not the joints. Trial registered at (registration number NCT01439932).

Level of evidence: Therapy, level 1b.

Keywords: ankle joint; dorsiflexion; joint mobilizations; plantar fascia.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Ankle Joint / physiopathology*
  • Fasciitis, Plantar / physiopathology*
  • Fasciitis, Plantar / therapy*
  • Female
  • Foot / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Muscle Stretching Exercises
  • Musculoskeletal Manipulations*
  • Prospective Studies
  • Range of Motion, Articular
  • Single-Blind Method
  • Ultrasonic Therapy
  • Young Adult

Associated data