A STUDY ON THE EFFECTIVENESS OF INSTRUMENT

ASSISTED SOFT TISSUE MOBILIZATION AMONG

PLANTAR FASCIITIS PATIENTS

I INTRODUCTION

Plantar fasciitis is a potentially serious injury characterized by pain

primarily at the plantar medial calcaneus or origin of the plantar fascia and

running along the course of the medial band of the plantar fascia, sometimes as

distal as the first metatarsal head. The plantar fascia is a thick band of fibrous

tissue that arises from the medial and lateral calcaneal tubercles and runs to the

plantar metatarsal heads, where it connects with the transverse metatarsal

ligament. The plantar fascia provides extensive support to both the longitudinal

arch and the transverse metatarsal arc.(Warren I. Hammer, 1991).

Plantar fasciitis is classified as overuse injuries, that is, micro tears and

microruptures of the plantar fascia. The overuse injury usually occurs during

walking, running, tennis, gymnastics, or basketball. These activities stretch the

plantar fascia. The combination of a stretching activity with an underlying

biomechanical fault predisposes to the development of fasciitis. In hyper

pronation one sees increased tension along the medial longitudinal arch, and the

scenario of inflammation due to overuse becomes prevalent. The supinated or

Cavus foot also shows a predisposition toward the development of fasciitis

1
because of the constant tension on the plantar fascia. Fasciitis may also be

associated with equinus(Warren I. Hammer, 1991).

Figure 1: Plantar Fascia

Biomechanics

2
 In a normal walking motion, the heel is the first part of the foot to contact the

ground surface. Following this initial contact, the tibia rotates inward as the foot

pronates, simultaneously stretching the plantar fascia while compressing the

mediallongitudinal arch into a flatter position (Roxas, 2005).

Plantar fasciitis (or) plantar heel pain is one of the most common orthopedics

complaints relating to foot. The inflammation to the plantar fascia on the medial

process of the calcaneum tuberosity is known as plantar fasciitis. It is especially

seenamong older individual. This disease is more common in runner, volley ball

players with symptoms of arch pain (Miller, 2014).

Plantar fasciitis is the most common cause of pain in the inferior heel, is

estimated to account for 11 to 15% of all the foot symptoms requiring professional

care among adults. 10 percentage of injury that occurs commonly in runner and

military personnel. The incidence reportedly peaks in people between the ages of

40 and 60 years in the general population and in younger people among runners.

The predominance of the condition according to both varies from one study to

another (Rachelle, 2004).

Plantar fasciitis is a common cause of pain in the heel. It occurs because of

inflammation of the plantar aponeurosis and its attached on the tuberosity of the

calcaneum. (Maheshwari, 2015).

The recent studies have shown that the incidence of plantar fasciitis is on the

raise affecting over 10% of the general population. The approximately 83% of

those affected are active working adults between the ages 25 to 65 and 22% are

3
runners or active in sports requiring running and 65 to 70 % are overweight, there

is no sex predilection. (Paul, 2012).

Plantar fascia is a strong layer of white fibers tissue whose thick central part

is bounded by thinner lateral portion. The central portion is attached to the medial

calcaneal tubercle. It progresses distally it divides into 5 sections, each extending

into toe and straddling the flexor tendon. The superficial layer of each section

attaches to deep skin fold between toes and the sole; deep layers blend with the

fibrous flexors sheath on each proximal phalanx and sends septa to the deep

transverse ligament of the sole (Wheeless, 2012).

Figure 2: Anatomy of Plantar Fasciitis

The anatomy around the plantar heel in the leg for diagnosing and treating

different types of plantar heel pain. The heel pad is specifically designed to

function as a shock absorber. The skin around the heel pad is approximately 10

4
times thicker than the skin on the dorsum of the foot. Deep to the skin is a layer

of adipose tissue, which is compartmentalized into micro champers and macro

champers by fibrous septa. The next structure encountered is the plantar fascia. It

originates from the medial-plantar tubercle of the posterior calcaneus tuberosity

and inserts into the plantar aspect of flexor tendon sheaths and the base of

proximal phalanges. Dorsal to the plantar fascia is the most superficial layer of

the plantar muscle layers abductor digiti. They all originate from the calcaneus

the flexor digitorumbrevis and abductor digiti also arise from the plantar fascia. If

an inferior calcaneal spur is present it is the origin of flexor digitorumbrevis not

the plantar fascia that is attached to the spur. The medial and lateral plantar

nerves which are branches of the posterior tibial nerve and travel dorsal to the

superficial muscle layer. The first branch of the lateral plantar nerve is the nerve

to abductor digiti, which can be compressed between the deep fascia of abductor

hallucis and quadratusplantae. The posterior tibial nerve courses posterior to the

tibialis posterior and flexor digitorumlongus, travel around the medial malleolus,

and divides into the medial calcaneal branch and medial and lateral plantar

nerves. The medial calcaneal branch of posterior tibial nerve which provides

sensation to the posterior medial aspect of heel, sometimes can be initiated and

cause plantar heel pain. The most common cause of plantar heel pain is proximal

plantar fasciitis. The chronic micro tears of the fascia can create a chronic

inflammatory response. Surgical specimens of the excised portion of the fascia

often reveal degenerations, metaplasia, calcification of the collagen tissue some

systemic inflammatory disease psoriasis, ankylosing spondylitis, systemic lupus

5
erythematosus, gout, rheumatoid Arthritis, in general the heel spur does not cause

heel pain. There is a higher association between the amorphous type of heel spur

and heel pain caused by seronegativespondyloarthropathies. Other common cause

of plantar heel pain include rupture of the plantar fascia, compression of the nerve

abductor digiti. Plantar fascia can rupture after multiple steroid injection into the

heel near the fascia insertion. Heel pad atrophy is usually idiopathic but can be

associated with aging or poorly placed steroid injections stress fractures of the

calcaneus occur who have experienced intense physical activities such as

marathon runner and military recruits (Edward. V. Craig, 1992).

Figure 3: Plantar Fasciitis

Plantar fascia is a thickened fibrous aponeurosis that originates from the

medial tubercle of the calcaneus, and it inserts in the medial process of the

calcaneal tuberosity. Plantar fasciitis is the pain caused by degenerative irritation.

Plantar aponeurosis provides stability of the first metatarsophalangeal joint

and medial arch is called as windlass mechanisms. The plantar flexes the first

6
metatarsal thereby enabling the first metatarsal to carry most of body weight

during last half of stance phase.

If this mechanism is ruptured distally, plantar flexion does not occur, and

weight is transfer to the two metatarsals, often resulting in a pain full callus

beneath secondmetatarsal head. During normal walking, the plantar aponeurosis

functions mainly during heel rise to toe off and prevents the calcaneus from

everting. This mechanism brings about plantar flexion of metatarsal, which

elevates and stabilises the longitudinal arch, inverts the calcaneus and externally

rotates the tibia (Wheeless, 2012).

The site of abnormality is typically near the site of origin of the plantar fascia

at the medial tuberosity of the calcaneus. Histologic examination of biopsy

specimens from patients undergoing plantar fascia—release surgery for chronic

symptoms has shown degenerative changes in the plantar fascia, with or without

fibroblastic proliferation and chronic inflammatory changes. The risk factors are

obesity, occupations that require prolonged standing, pesplanus (excessive

pronation of the foot), reduced ankle dorsiflexion and inferior calcaneal exostosis

(or heel spurs). Proposed risk factors include running excessively (or suddenly

increasing the distance run), wearing faulty running shoes, running on unyielding

surfaces, and having a Cavus foot (high-arched foot) or a shortened achilles

tendon, but evidence for most of these factor is limited or absent. Pain in the sole

or heel during weight bearing and is relieved once it is discontinued. Pain when

stepping out of bed in the early morning. The pain is burning occasionally aching.

Tenderness present along the length of plantar fascia. Tenderness may be present

7
at the plantar fascial attachment in the medial arch area and in the abductor

hallucis muscle (Rachelle, 2004).

Clinical features of the plantar fasciitis are the complaint of pain beneath the

heel on standing or walking, the pain extends medially and in to the sole. The

disability is sometimes severe. When the condition is a part of a wide spread

inflammatory disorder both heels may be affected. On examination there is

marked tenderness over the site of attachment of the plantar fascia to the

calcaneus. The site of tenderness is further forward than it is in tender heel pad.

Radiograph usually do not show any abnormality. A sharp spur projecting

forwards from the tuberosity of the calcaneus is sometimes found, but it is

significant is doubtful because such spur may be present in patients without heel

symptoms (David L-Hamblen, 2010).

To assess the pain in the plantar fasciitis patient the visual analogue scale is

used.It is subjective measure of the pain. It consists of a 10cm line with two end

points representing no pain and worst pain imaginable (Huskisson, 1974).

A foot function index (FFI) was developed to measure the impact of foot

pathology on function in terms of pain, disability and activity restriction. To

assess the foot function in plantar fasciitis the foot function index is used. It is a

objective measure of the condition (Dubin, 2007).

IASTM refers to a technique that uses instruments to remove scar tissues

from injured soft tissues and facilitate healing process through formation of new

extracellular matrix proteins such as collagen. Recently, frequent use of this

8
instrument has increased in the fields of sports rehabilitation and athlete training.

Some experimental studies and case reports have reported that IASTM can

significantly improve soft tissue function and range of motion following sports

injury, while also reducing pain. Based on the previous studies, it is thought that

IASTM can help shorten the rehabilitation period and time to return to sports

among athletes and ordinary people who have suffered sports injuries. Moreover,

IASTM studies that have mostly focused on tendons need to broaden their scope

toward other soft tissues such as muscles and ligaments (Jooyoung Kim, 2017).

Instrument assisted soft tissue mobilization (IASTM) is a popular treatment

formyofascial restriction. IASTM uses specially designed instruments to provide a

mobilizing effect to scar tissue and myofascial adhesions

(Scott W. Cheatham, 2016).

1.1 Statement of the study

A study to find out the effectiveness of Instrument-assisted soft tissue

mobilizationin the management of pain and foot function performance among

plantar fasciitispatients.

1.2 Objectives of study

To find out the effectiveness of Instrument-assisted soft tissue mobilization

in the management of pain and foot function performance among plantar fasciitis

patients.

1.3 Need of the study

9
 This study aimed to provide awareness of plantar fasciitis to common people

and popularize technique among physiotherapist.

To provide the awareness of Instrument-assisted soft tissue mobilization

(IASTM) to reduce pain and improve function among plantar fasciitis patients.

1.4 Hypotheses

It is hypothesized that there may be no significant difference in pain and foot

function performance following instrument-assisted soft tissue mobilization

among plantar fasciitis patients.

1.5 Operational definitions

Plantar fasciitis

It is a foot condition caused by inflammation of plantar fascia, the thick

ligamentous connective tissue that runs from the heel to the ball of the foot

(Ranganathan, 2013).

Pain

Pain is defined as unpleasant sensory and emotional experience associated

with actual or potential tissue damage, or described in termed of such damage

(Susan, 2014).

Instrument-assisted soft tissue mobilization (IASTM)

10
 Instrument assisted soft tissue mobilization is a popular treatment

formyofascial restriction. IASTM uses specially designed instruments to provide a

mobilizing effect to scar tissue and myofascial adhesions (Scott W. Cheatham,

2016).

Visual analogue scale

The visual analogue scale is a subjective measure of pain. It consists of a

10cm line with two endpoints representing no pain and worst pain imaginable

(Huskisson, 1974).

Foot Function

The foot is an impressive architectural and functional design, able to act as

both a flexible supportive base and rigid lever. It is expected to work efficiently

under excessive loads and demands, often in extreme conditions imposed on it by

foot wear and environment in which it had two works. However, this complex

structure functions depend heavily on having its correct functional angles and

joints movements maintained (Dubin, 2007).

11
 II REVIEW OF LITERATURE

Section A: Studies related to the general aspect of plantar fasciitis

Section B: Studies related to the Effectiveness of instrument-assisted soft

tissue mobilization for plantar fasciitis

Section C: Studies related to the Reliability and validity of visual analogue

scale (VAS)

Section D: Studies related to the Reliability validity of foot function index

(FFI)

Section A: Studies related to the Effectiveness of plantar fasciitis

Neufeld et al., (2008) stated that plantar fasciitis is the most common cause

of plantar heel pain. Its characteristic features are pain and tenderness,

predominately on the medial aspect of the calcaneus near the sole of the heel.

Considering a complete differential diagnosis of plantar heel pain is important; a

comprehensive history and physical examination guide accurate diagnosis. Many

nonsurgical treatment modalities have been used in managing the disorder,

12
including rest, massage, non-steroidal anti-inflammatory drugs, night splints, heel

cups/pads, custom and off-the-shelf orthoses. injections, casts, and physical

therapy measures such as shock wave therapy. Most reported treatment outcomes

rely on anecdotal experience or combinations of multiple modalities.

Nevertheless, nonsurgical management of plantar fasciitis is successful in

approximately 90% of patients. Surgical treatment is considered in only a small

subset of patients with persistent, severe symptoms refractory to nonsurgical

intervention for at least 6 to 12 months.

Mario et al., (2005) stated in his study that plantar fasciitis is the most

common cause of inferior heel pain. The pain and discomfort associated with this

condition can have a dramatic impact on physical mobility. The etiology of this

condition is not clearly understood and is probably multi-factorial in nature.

Weight gain, occupation-related activity, anatomical variations, poor

biomechanics, overexertion, and inadequatefootwear is contributing factors.

Although plantar fasciitis is generally regarded as a self-limited condition. it can

take months to years to resolve. presenting a challenge for clinicians. Many

treatment options are available that demonstrate variable levels of efficacy.

Conservative therapies include rest and avoidance of potentially aggravating

activities, stretching and strengthening exercises, orthotics, arch supports and

night splinting. Other considerations include use of anti-inflammatory agents,

ultrasonic shockwave therapy, and, in the most extreme cases, surgery. This

article reviews plantar fasciitis, presents the most effective treatment options

13
currently available, and proposes nutritional considerations that may be beneficial

in the management of this condition.

Section B: Studies related to the Effectiveness of instrument-assisted soft

tissue mobilization for plantar fasciitis

Vinodbabuet al., (2014) conducted a study on effectiveness of

Instrumentalassisted soft tissue mobilization technique in subjects with plantar

fasciitis. Total of 20subjects were used for analysis. They received Instrumental

assisted soft tissue mobilization. Outcome measurements such as Intensity of pain

using Numerical PainRating Scale-101 (NPRS-101), function disability using

Foot Function Index Pain Subscale (FFI) and ankle dorsiflexion active range of

motion using Goniometer was measured before and after 2 weeks of intervention.

He concluded that there is statistically significant improvement in means of NRS-

101, ankle dorsiflexion active range of motion and Foot Function Index Pain

Subscale after intervention in both groups. He concludedthat Instrumental assisted

soft tissue mobilization technique is significantly effective than conventional

exercises on reducing pain, improving ankle dorsiflexion range of motion and

functional disability for subjects with chronic Plantar Fasciitis.

Clinton Daniels et al.., (2012) conducted a study to evaluate the

chiropractic management of pediatric plantar fasciitis with instrument assisted soft

tissue mobilization (IASTM) technique. A 10-year-old little league football

playeris involved in the study. His chief complaint was bilateral foot pain of 3

weeks. = He was treated with the instrument assisted soft tissue mobilization

14
(IASTM). Graston technique uses specially designed stainless-steel instruments

with beveled edges. The instruments are used in a multidirectional stroking

fashion applied to the skin at a 30˚ to 60˚ angle at the treatment site to

mechanically mobilize the scar tissue. They concluded that the conservative

approach for the management of a pediatric patient experiencing plantar fasciitis.

In this patient’s case the combination of joint manipulation, GT and a targeted

home exercise program seemed effective.

Section C: Studies related to the Reliability and validity of visual analogue

scale

Gillian et al., (2011) carried out a study to evaluate the reliability and

validity of pain VAS. The pain VAS is self- completed by the respondent. The

respondent is asked to place a perpendicular to the VAS line at the point that

represents their pain intensity (2, 9, 10). They concluded that the test-retest

reliability has been shown to be good.

Boonstra et al., (2004) determined that the reliability and concurrent

validity of a visual analogue scale for disability as a single item instrument

measuring disability in chronic pain patients for the reliability study a test retest

design for the validity study a cross section design was used. The study population

consisted of patients over 18years of age, suffering from chronic musculoskeletal

pain. 52 patients in the reliabilitystudy, 344 patients in the validity study. Main

outcome measures were VAS pain scorewith Roland Morris disability

Questionnaire scores were from 0.33 to 0.43 and VAS pain scores from 0.76 to

15
 0.84. Theconclusion of the study was that the reliability of the VAS for disability

is moderate good.

Section D: Studies related to the Reliability validity of foot function index

(FFI)

Tunku et al., (2007) this study compared the efficacy of intralesionalauto

logblood with corticosteroid injection for plantar fasciitis present for more than 6

weeks. A prospective, randomized, controlled, observer-blinded study was done

over a period of 6months. Sixty-four patients were randomly allocated to either

the autologous blood oncorticosteroid treatment group. All patients were assessed

for the worst pain daily on visual analogue scale (VAS) and tenderness threshold

(TT) at the plantar fascia origin using a pressure algometer before treatment, and

at 6 weeks, 3 months, and 6 months after treatment. Data were complete for 61

patients. Intralesional autologous blood injection is efficacious in lowering pain

and tenderness in chronic plantar fasciitis, but corticosteroid is more superior in

terms of speed and probably extent of improvement. The resultshows that the foot

function index is a reliable and valid tool to measure the function of the foot

among plantar fasciitis patients.

Saltzman et al., (2005) conducted a study on 30 patients with RA. They

also completed VAS pain questionnaire for both feet on two occasions 8 days

apart. For the purpose of orthopedic studies in which one foot serves as an internal

control, we assessed the side to side reliability of the 7 question FFI pain scale. It

16
concluded that the FFI is a validated and reliable instrument for measuring foot

pain, disability, and activity restriction in patients.

III METHODOLOGY

3.1 Study Setting

The study was conducted in Physiotherapy outpatient Department, RVS

College of Physiotherapy, Sulur, Coimbatore.

3.2 Selection of Subjects

10 subjects were selected who fulfilled the inclusion and exclusion criteria

and were treated with Instrument assisted soft tissue mobilization technique.

3.3 Variables

3.3.1 Dependent variables

 Pain

 Foot function performance

3.3.2 Independent variables

 Instrument assisted soft tissue mobilization technique

17
3.4 Measurement tools

VARIABLES TOOLS

Pain VAS

Foot Function Foot Function Index

Performance

18
3.5 Study Design

The study design was a pre-test and post-test experimental design.

3.6 Inclusion Criteria

 Clinically diagnosed plantar fasciitis patients.

 Age between 40 to 50 years.

 Symptoms greater than 3 months.

 Both gender included.

 Both unilateral (or) bilateral cases.

3.7 Exclusion criteria

 Previous surgery for plantar fasciitis

 Coagulation disorders

 Plantar fasciitis with pesplanus are avoided

 Pregnancy

 Peripheral neuropathies

 Any acute inflammation in ankle-foot region

3.8 Orientation to the subjects

Before the collection of data, subjects were explained about the purpose of

the study. The investigator has given a detailed orientation about the various test

procedures. Such as VAS to measure the pain and Foot Function Index to measure

the functional Disability. The consent and full co-operation of each participant

19
was sought after complete explanation of condition and demonstration of the

procedures involved in the study.

3.9 Materials used

 EDGE Mobility Tool

 Pillow

 Couch

 Towel

 Lotion

3.10 Test Administration

Pain assessment by visual analogue scale (VAS)

The visual analogue scale (VAS) is a subjective measure of pain. It consists

of a 10 cm line with two end-points representing "no pain" and "worst pain

imaginable". Before pre-test and after post-test treatment, patient was asked to rate

their pain by placing a mark on the corresponding to their normal level of pain.

Foot Function Index

It is a functional index comprising of 17 items to know how foot pain has

affected the patient ability to manage in everyday life. Each time scoring from 0-

20
 10 the patients had to rate his pain, difficulty in performing activity and how much

time of the day he had pain. This was used for assessment of foot function of the

patients.

3.11 Treatment Procedure:

Patient position:

Prone lying

Therapist position:

Walk standing position

Procedure:

 Sharp edge- for scanning.

 Blunt edge- for treatment.

 A stainless steel tool is placed on the calf region which senses the pain (B

side).The tool is designed in a way so that is able to flawlessly follow the length

of the muscle and tissue that may have been affected by the injury.

 The tool is placed in 45 degree at the edge of the skin and is slowly slide on over

the calf muscle. When it passes over the densified zone of the soft tissue, it may

feel a little bumpy. These areas of buildup are referred to as adhesive areas.

 The pressure that is applied to the skin surface increases as the therapist continues

the procedure. The tool enables the therapist to detect the densified zone. The

repeated rubbing on the affected area (the calf muscle) which reduces pain.

 Stop the treatment when pettisia (redness) develops.

21
 Duration: Alternative days for 2 weeks.

Figure 4: Instrument assisted soft tissue emobilization

3.12 Collection of data

The 10 plantar fasciitis patients were selected for the study. The patients

were given Instrument assisted soft tissue mobilization technique for 2 weeks.

Before and after completion of treatment interventions, pain was evaluated by

VAS and disability by foot function index.

3.13 Statistical analysis

The collected data were analyzed paired ‘t’ test to find out significant

difference between pre and post-test values.

22
 IV DATA ANALYSIS AND RESULTS

4.1. Data analysis

This chapter deals with the systematic presentation of the analyzed data

followed by the interpretation of the data.

a) Paired 't' test

∑d
d=
n

√
2
∑(d )
∑ d 2−
n
s=
n−1

d √n
t=
s

Where,

d — Difference between pre-test and post-test values

∑d
d= — Mean of difference between pre-test and post-test values
n

n — Total number of subjects

s — Standard deviation

Table-1

23
The table shows the mean, mean difference, standard deviation and paired ‘t’

value between pre-test and post-test values of pain.

Measurement Mean Mean Standard Paired ‘t’

Pre test 4.9

1.3 0.47 8.74*

Post test 3.6

*0.005 level of significance

The calculated ‘t’ value is 8.74 and ‘t’ table value is 3.250 at 0.005 level of

significance. Since the calculated ‘t’ value is more than ‘t’ table value, it shows

that there is significant difference in pain following Instrument assisted soft tissue

mobilization in patients with plantar fasciitis.

5
4.9

4 3.6
3

2
1.3
1

0
Pre-test Post-test Mean difference

Figure 4: A graphical representation of pre-test and post-test mean values of

pain among plantar fasciitis patients.

Table-2

24
The table shows mean, mean difference, standard deviations and paired ‘t’

value between pre-test and post-test values of foot function index

Measurement Mean Mean Standard Paired ‘t’

Pre test 448.3

19 0.73 8.22*

Post test 429.3

*0.005 level of significance

The calculated ‘t’ value is 8.22 and ‘t’ table value is 3.250 at 0.005 level of

significance. Since the calculated ‘t’ value is more than ‘t’ table value, it shows

significant difference in foot function following Instrument assisted soft tissue

mobilization in patient with plantar fasciitis.

500
448.3 429.3
450
400
350
300
250
200
150
100
50 19
0
Pre-test Post-test Mean difference

Figure 5: A graphical representation of pre-test and post-test mean values of

foot function among plantar fasciitis

4.2 Results

25
 All the plantar fasciitis patients were treated with Instrument assisted soft

tissue mobilization technique.

Analysis of dependent variable for pain in plantar fasciitis patients: The

calculated ‘t’ value is 8.74 and ‘t’ table value is 3.250 at 0.005 level of

significance. Since the calculated ‘t’ value is more than ‘t’ table value, it shows

that there is significant difference in pain following Instrument assisted soft tissue

mobilization in patient with plantar fasciitis

Analysis of dependent variable for foot functions in plantar fasciitis

patients: The calculated’ value is 8.22 and ‘t’ table value is 3.250 at 0.005 level

of significance. Since the calculated ‘t’ value is more than ‘t’ table value, it shows

significant difference in foot function following Instrument assisted soft tissue

mobilization in patient with plantar fasciitis.

26
 V DISCUSSION
The study was conducted on 10 subjects. They were treated with Instrument

assisted soft tissue mobilization technique.

The main aim of the study was to assess the effectiveness of Instrument

assisted soft tissue mobilization (IASTM) on plantar fasciitis patients.

The effectiveness of Instrument assisted soft tissue mobilization (IASTM)

technique was earlier experimented by various therapists. Joo Young Kim et al.,

(2016) performed a randomized study to find out the effectiveness of IASTM for

3 weeks and results concluded that the IASTM refers to a technique that uses an

instrument to remove the scar tissue that had formed in soft tissues and assists in

the healing process by activating fibroblasts. It was found to improve soft tissue

function and ROM in acute and chronic sports injuries to soft tissues, while also

reducing pain. Such positive effects can be helpful in the fields of sports

rehabilitation and athletic training. Clinton Daniels et al.., (2012) conducted a

study to evaluate the chiropractic management of pediatric plantar fasciitis with

instrument assisted soft tissue mobilization technique. A 10-year-old little league

football player is involved in the study. His chief complaint was bilateral foot pain

of 3 weeks. He was treated with the instrument assisted soft tissue mobilization

and results concluded that the conservative approach for the management of a

pediatric patient experiencing plantar fasciitis. In this patient’s case the

combination of joint manipulation, GT and a targeted home exercise program

seemed effective.

Hence, the hypothesis was rejected.

27
 VI CONCLUSION

The study was conducted to investigate the effectiveness of instrument

assisted soft tissue mobilization in the management of pain and disability among

plantar fasciitis patients.

10 patients were included in the study. The patients were treated with

instrument assisted soft tissue mobilization technique.

From the result, it can be concluded that there is significant difference in

reduction of pain and increase plantar flexion of the patients. I conclude that

instrumentassisted soft tissue mobilization can be used as an effective tool in the

management of plantar fasciitis patients.

6.1 Limitations

• Number of subjects was small.

• Psychological factors were not considered.

• Short term study

6.2 Suggestions

• Similar study can be carried out for larger sample size.

• Study can also be carried out for different age groups.

• The study can do long term period

28
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Scott Cheatham (2016), The efficacy of IASTM: a systematic review, the

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Saltzman, (2005),journal of foot and ankle research.

30
Websites

www.physiopedia.com

www.pubmed.com

www.googlescholer.com

www.worldhealthline.com

www.wikipedia.com

www.plantarfasciitis.com

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 ANNEXURES

ANNEXURE-I

Physiotherapy Assessment

Subjective assessment

a) Name:

b) Age:

c) Sex:

d) Occupation:

e) Chief complaints

History collection

a) Present Medical history

b) Past Medical history

c) Family history

d) Associated problem

Objective Examination

On Observation

Body built

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 Posture

Skin changes

Bony and soft tissue contour

Attitude of limb

Muscle wasting

Deformity

On Palpation

Tenderness

Swelling

Muscle tightness

Warmth

Other if any

On Examination

Muscle power

Range of motion

Foot function index scale

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Pain assessment

Onset

Duration of pain

Site of pain

Type of pain

Nature of pain

Aggravating factor

Relieving factor

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ANNEXURE-II

Foot Function Index (FFI) Instruction for the patient:

The questionnaire has been designed to give your therapist information

about how your foot pain has affected your ability to manage in every life. Please

answer every question. For each of the following question, we would like you to

score each question on a scale from O (no pain or difficulty) to 10 (worst pain

imaginable or difficult it required help) that best describes your foot over the past

week. read each question and place a number from 0-10 in the corresponding box.

Foot Function Index

Section 1: To be complete your patient

Name:

Age:

Date:

Occupation:

Number of days of foot pain: (this episode)

Section 2: To be completed by patient

This question has been designed to give your therapist information as to

how your foot Pain has your ability to manage in everyday life. For the

followingquestion, we would like You to score each question on a scale from (no

35
 pain) to 10 (worst pain imaginable) the best describes your foot over past week.

Please read eachquestion and place a number from 0-10 in the corresponding box.

(A) Foot Pain Subscale

l. Foot pain at worst?

2. Foot pain in morning?

3. Pain walking barefoot?

4. Pain standing barefoot?

5. Pain walking with shoes?

6. Pain standing with shoes?

7. Pain walking with orthotics?

8. Pain standing with orthotics?

9. Foot pain end of day?

(B) Foot function index disability subscale

1. Walking around the house?

2. Walking outside on uneven ground?

3. Walking four or more blocks?

4. Climbing stairs?

5. Descending stairs?

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 6. Standing on tip toe?

7. Getting out of a chair?

8. Climbing up or down curbs?

9. Walking fast or running?

(C) Activity Limitation Subscale

I. Stayed inside all day because of feet?

2. Stayed in bed all day because of feet?

3. Limited activities because of feet?

4. Used assistive device indoors?

5. Used assistive device outdoors?

NO pain 0 1 2 3 4 5 6 7 8 9 10 worst pain imaginable

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ANNEXURE-III

Table 3: Shows pre and post values of pain

SI.NO PRE TEST POST

1 5 3

2 8 7

3 6 5

4 7 5

5 7 6

6 3 2

7 5 3

8 2 1

9 4 3

10 2 1

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ANNEXURE-IV

Table 4: Shows pre and post values of foot function index

SI.NO PRE TEST POST TEST

1 47,1 45.1

2 42.3 41.3

3 35.3 32.3

4 58.8 56.8

5 61.8 60.8

6 29.4 27.4

7 41.2 38.2

8 50 48

9 38,3 37.3

10 44.1 42.1

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 ANNEXURE-V

PATIENT CONSENT FORM

I ……………………………………………………….. voluntarily consent

to participate in the research named on “EFFECTIVENESS OF

INSTRUMENT ASSISTED SOFT TISSUE MOBILIZATION (IASTM) ON

PLANTAR FASCIITIS PATIENTS”. The researcher has explained me the

treatment approach in brief, risk of participation and has answered the questions

related to the study to my satisfaction.

Signature of patient Signature of researcher

Signature of witness

Place:

Date:

40