Effectiveness of soft tissue manual therapy in managing chronic plantar fasciitis: a systematic review

To examine the comparative effectiveness of soft tissue manual therapy (STMT) versus conventional therapy on pain, range of motion and foot function in adults with chronic plantar fasciitis (PF).

A systematic search of PubMed, Scopus, CINAHL and the Cochrane Library was undertaken to retrieve randomized control trials (RCTs) published in English between January 2010 and May 2025 assessing STMT in adults with chronic PF. Methodological strength and potential risk of bias were evaluated with the Physiotherapy Evidence Database scale. Due to clinical and methodological heterogeneity in the studies, a narrative approach was adopted to summarize the findings.

Eleven RCTs fulfilled the inclusion criteria. Physiotherapy Evidence Database scores ranged from moderate to high, indicating an overall acceptable to strong level of evidence. Across the included studies, STMT particularly when combined with conventional therapy (e.g. stretching, strengthening exercises or therapeutic modalities) was associated with greater improvements in pain, ankle range of motion, pressure pain threshold (PPT) and foot-related functional outcomes compared with conventional therapy alone. Instrument-assisted soft tissue mobilization (IASTM) and myofascial release therapy (MFR) were associated with consistent improvements in foot function and pain relief. However, heterogeneity in intervention design and comparator strategies precluded cross-study comparison of effect sizes.

The available evidence supports the integration of STMT with conventional therapy may result in greater improvements in pain and foot function in chronic PF. However, the existing comparative evidence is insufficient to determine the relative efficacy of specific STMT techniques. Further high-quality, long-term, parallel-group trials employing standardized protocols are necessary to strengthen the evidence base and establish optimal treatment protocols.