Revisión sistemática

Published on 22 de mayo de 2026 | http://doi.org/10.5867/medwave.2026.04.3085

Effects of manual therapy on pain and function in patients with plantar fasciitis: A systematic review of the literature

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GRADE rating and narrative summary of the evidence.
GRADE frameworkFindingsConcerns about certainty domains
Methodological limitations of the studiesBased on the results of the risk-of-bias assessment for the included studies, we concluded that the clinical trials had serious methodological limitations.Serious
Indirect evidenceThe patients, interventions, and comparison groups in the studies provide direct evidence regarding the clinical question posed. All interventions included a component of manual therapy administered as a standalone treatment. The type and severity of symptoms (outcome) were assessed using different scales across the various trials. We considered the evidence was not indirectly significant, but we observed some variability in the intervention protocols used and certain differences in how the outcome was measured.Not serious
UncertaintyThe total number of patients included in all trials was approximately 224. The studies reported controversial statistical differences regarding pain and function. In addition, two studies reported clinically relevant changes in favor of manual therapy, likely due to the small number of participants. This likely resulted in wide confidence intervals that encompassed both significant benefits and no effect. We considered the evidence to be of marginal precision.Serious
InconsistencyThe direction and magnitude of the effect varied across the different trials. Grim et al. [40] reported that the group treated with manual therapy showed a 35% improvement compared to the group that received a custom foot orthosis, as measured by the Foot and Ankle Orthopedic Society’s Ankle and Hindfoot Scale. In the study by Ajimsha et al. [23], a large effect size was observed for the pressure pain threshold variable, with values ranging from d = 0.87 to d = 1.32 across the three assessed points, favoring the manual therapy group over the control group. Meanwhile, Jadhav et al. [25] found that pain intensity, measured using the numerical pain rating scale, showed a large effect size (d = 1.16) in favor of the Gua Sha group compared with the group treated with the positional release technique. Regarding the pressure pain threshold, a small effect size (d = 0.14) was observed in favor of the cryostretching group compared to the Gua Sha group.We consider the evidence to present a serious inconsistency.Serious
Publication biasWe do not strongly suspect publication bias, because both negative and positive trials were published, and the search for studies was exhaustive.Not suspected

GRADE, Grading of Recommendations, Assessment, Development, and Evaluation.

Source: Prepared by the authors based on the study results.