The plantar fascia at the foot bottom causes pain and inflammation which affects this thick tissue that runs from heel bone to toe. This condition stands as the main source of heel pain and produces intense stabbing sensations which become noticeable in the morning and during periods of rest. The foot pain generally reduces when a foot becomes active but it often resurfaces after standing or being active for prolonged periods of time(1).

Plantar fasciitis occurs as a frequent problem which affects 10% of people worldwide during their lifespans. Annual plantar fasciitis cases in adults reach 1% within the United States while medical care is provided to over 2 million people annually. Research shows that plantar fasciitis affects a similar proportion of people in the United Kingdom during their lifetime at about 10%(2). The prevalence rate for plantar fasciitis in Pakistan remains unclear because studies show that 4.72% of housewives in Lahore experience the condition. Plantar fasciitis represents a widespread foot condition worldwide since it affects numerous population groups based on these statistical reports(3).

The main symptom of plantar fasciitis manifests as heel pain that feels either sharp and burning and stabbing. Heel pain reaches its highest intensity during the morning after a person wakes up because of the initial foot movements. Heel pain intensifies when maintaining a resting position but subsides as the affected person becomes active. The medical condition becomes worse due to high amounts of physical activity that results in daily foot pain(4).

Many patients report foot sensitivity combined with swellings that develop either in the heel zone or beneath the foot arch. The heel area tends to experience pain PRT establishes an efficient pain management strategy through its ability to treat nervous system dysfunctions which generate chronic pain and inflammatory conditions. PRRT improves health outcomes along with reducing treatment duration while it substantially enhances the life quality of people who experience prolonged pain. The body's natural pain relievers activate through non-invasive movements in Primal Reflex Release Technique which makes this method important for treating plantar fascitis.Through reflex activation PRT activates natural pain-relieving mechanisms of the brain thus leading to substantial pain reduction and improved inflammation levels. The direct intervention on pain-causing nerve dysfunctions resulting from chronic pain through PRT activates healthy nervous system operations(25).

The best results from PRT emerge when patients use it together with physical therapy along with stretching and strengthening therapeutic exercises. The therapy presents both gentle nature and noninvasive methods with combined benefits of using little to no medical drugs or special devices. The therapy serves alongside multiple therapeutic approaches for treating enduring pain issues and inflammatory conditions of the back, neck, and head along with fibromyalgia and arthritis and tendinitis and plantar fasciitis. The therapy provides therapeutic benefits in neurological medical fields which assist patients with sciatica and neuropathy complications and Parkinson's disease conditions.

The Primal Reflex Release Technique (PRRT) was used to treat Medial Tibial Stress Syndrome (MTSS) in NCAA Division I cheerleaders. Three male and two female participants, with a mean age of 20 ± 1.4 years, who had been diagnosed with Type II MTSS, received PRRT treatment. The research indicated both immediate pain relief after a single treatment session and functional enhancement after an average of 4.2 (± 0.84) sessions over 15.4 (± 5.86) days, all without any imposed training pauses. Patient outcomes from PRRT showed lasting improvements during both the initial follow-up and the two-week check-up, indicating the effectiveness of this method for MTSS patients. The study suggests that PRRT shows promise as a non-invasive therapy for the effective management of stress-related tibial pain in athletic populations (29).

Current literature on plantar fasciitis syndrome (PFS) treatment using manual physiotherapy is limited. Therefore, a randomized controlled trial was conducted by Khammas et al. (2024) to evaluate the efficacy of manual physiotherapy in altering plantar fascia morphology, including changes in the thicknesses of the central fascial portion (CFP) and the key fascial portion (KFP), pain levels, and foot function in PFS patients. The participants were divided into three groups: Group A (40 PFS patients receiving manual physiotherapy), Group B (42 PFS patients receiving no intervention), and Group C (40 healthy controls matched for age, gender, and BMI). Results showed a significant increase in plantar fascia thickness in Groups A and B (P < 0.001). However, Group A showed significant improvements in plantar fascia thickness, echogenicity, CFP thickness (P < 0.001), pain reduction, and functional performance-particularly in acute cases of PFS (30).

The foot and ankle play essential roles in locomotion, functioning as shock absorbers, allowing adaptation to uneven surfaces, and providing stability. Dysfunction in this region can contribute to issues involving the knee, hip, spine, and can lead to recurrent stress fractures, plantar fasciitis, and tibial stress syndromes. These dysfunctions need to be addressed through biomechanical and neuromuscular reflexive approaches. The Primal Reflex Release Technique (PRRT) is of interest due to its influence on involuntary reflexive responses. PRRT helps reset dysfunctional neuromuscular patterns to alleviate pain and improve function in conditions such as plantar fasciitis and MTSS, making it a promising, non-invasive intervention for both athletes and chronic sufferers of foot and lower limb pain (31).

Inclusion Criteria:

• 18-40 years and of both genders.
• Diagnosed with Plantar Fasciitis by a healthcare professional
• Experiencing heel pain or pain at the bottom of the foot for at least 3 months or more than 3 months
• Patient with acute or chronic planter fasciitis Positive windless test.
• Pain with walking or dorsiflexion of the toes, especially in the morning Willing to adhere to the study protocol

Exclusion Criteria:

• Participants were excluded if they have any of the following: Previous surgery for Plantar Fasciitis
• Systemic inflammatory conditions (e.g., rheumatoid arthritis) Pregnancy
• Neurological disorders affecting the lower limbs Other foot pathologies (e.g., tarsal tunnel syndrome)

In this randomized controlled trial, a single-masked (assessor-blinded) design was used. Participants were randomly assigned to either the experimental group receiving the Primal Reflex Release Technique (PRRT) or the control group receiving conventional treatment. Due to the hands-on and physical nature of the PRRT intervention, it was not feasible to blind participants or treating therapists. However, to reduce the risk of detection and measurement bias, the outcome assessors responsible for evaluating the pre- and post-intervention scores were blinded to the group allocation. These assessors collected data using validated outcome measures, including the Numeric Pain Rating Scale (NPRS) and Foot Function Index (FFI). They were not involved in the treatment sessions and were unaware of which participants received which intervention. so it means thatthis blinding procedure was designed to maintain objectivity in data collection and enhance the internal validity of the study results.