Evaluation of effects of three-dimensional exercises with subtalar joint mobilization on the plantar fascia, intrinsic muscles of the foot, and medial longitudinal arch of the foot using ultrasonography in adults with plantar fasciitis

Background. Plantar fasciitis is a common cause of heel pain involving inflammation of the plantar fascia. Subtalar joint mobilization targets joint dysfunction limiting motion and is linked to reduced medial longitudinal arch height. No studies have used musculoskeletal ultrasound to evaluate the efficacy of three-dimensional exercises on the plantar fascia. Aim. This study aims to compare the effects of three-dimensional exercises with subtalar joint mobilization against stretching and intrinsic foot muscle strengthening on plantar fascia thickness, Quadratus plantae and Tibialis posterior cross-sectional area, pain threshold, and medial longitudinal arch in adults with plantar fasciitis. Materials and methods. A randomized controlled trial with 52 participants was conducted. Group A (experimental) received three-dimensional exercises with subtalar joint mobilization, and Group B (control) performed stretching and foot strengthening exercises for two weeks (10 repetitions, 3 sets). Outcome measures included plantar fascia thickness, muscle cross-sectional areas of the quadratus plantae and tibialis posterior, pain threshold (via pressure algometer), and the navicular drop test for the medial arch. Results. Significant improvements in plantar fascia thickness, muscle cross-sectional area, navicular drop, and pain threshold (p < 0.05) were observed in Group A compared to Group B. Conclusion. Three-dimensional exercises with subtalar joint mobilization improved the pain threshold, increased medial arch height, reduced plantar fascia thickness, and enhanced muscle cross-sectional areas in patients with plantar fasciitis.