Reflexology

Zone therapy and the foot maps

Accounts of the modern practice begin in the United States. The University of Minnesota's Taking Charge site states that the physician William H. Fitzgerald described ten vertical zones running the length of the body in 1917, and that pressure on a zone was said to relieve pain during minor surgery. The Gale Encyclopedia of Alternative Medicine adds that Fitzgerald and Edwin Bowers published Relieving Pain at Home in 1917. A review in the Journal of Traditional and Complementary Medicine gives Fitzgerald's dates as 1872 to 1942.

These sources credit the physiotherapist Eunice Ingham, who worked with Dr. Joseph Shelby Riley, a follower of Fitzgerald, with building the foot maps in the 1930s and introducing the practice to non-medical people. Gale dates her book Stories the Feet Can Tell to 1938 and says she divided each foot and hand into 12 zones, a different scheme from the ten body-length zones of zone therapy. Gale also reports that the National Institute of Reflexology was founded in 1968 and renamed the International Institute of Reflexology in the early 1970s. All of these accounts are encyclopedia or review summaries, not primary documents.

Claims of an Egyptian origin

Many reflexology histories cite a relief in the Sixth Dynasty tomb of Ankhmahor at Saqqara, Egypt, but the sources reviewed give different dates for it: about 2330 BC in the Taking Charge account and in the review by Embong and colleagues, and about 2450 BC in the Gale entry. Archaeology magazine reports that the Egyptologist Engy El-Kilany believes some of the foot images may show reflexology and not only foot massage, and the article presents this as a possibility. It dates the Sixth Dynasty to about 2323 to 2150 BC.

A reference entry drawn from the Biographical Dictionary of Ancient Egypt states that two reliefs in the tomb show men receiving a treatment that has been variously interpreted as surgery, pedicure and manicure, or massage, and that each reading raises problems because tomb scenes usually showed pleasant activities or the owner's status. Taking Charge says reflexology may first have been recorded in the tomb, and Embong and colleagues report a claim of Chinese origin 5,000 years ago for which they note no documentation was found. The sources reviewed do not establish an unbroken line from Egyptian art to modern reflexology, and the identification remains disputed.

Reflex areas, zones and maps

The National Center for Complementary and Integrative Health (NCCIH) describes reflexology as applying different amounts of pressure to specific points on the feet or hands that are believed to correspond to other parts of the body. The Complementary and Natural Healthcare Council (CNHC), a United Kingdom register, defines it in its core curriculum as the study and practice of treating reflex points and areas in the feet and hands that relate to corresponding parts of the body. Embong and colleagues add the ears to the list of reflex areas.

Reflex zone therapy is the older term for dividing the body into ten longitudinal zones, five on each side, each running from the head to a finger and a toe. Embong and colleagues describe foot and hand maps in which a waistline reference separates the upper back and upper-body organs from the lower back and lower organs, and in which organs such as the liver appear on one side only. They name the Ingham method and the Rwo Shur method, the second using tools such as a wooden stick, as two internationally accepted approaches.

Overlapping and unrelated uses of the word

Research papers do not always separate reflexology from foot massage. One 2024 meta-analysis of pregnant women accepted trials in which the intervention was either foot reflexology or foot massage, and a 2008 review searched under both terms. Pooled results from such reviews therefore cannot be read as applying to reflexology alone. A 2024 history paper also uses reflexology for the doctrine of the Russian neurologist Vladimir Bekhterev, which its abstract links to social and political conclusions. That usage is outside the scope of this page. The sources reviewed do not evaluate ear reflexology separately from hand and foot work.

What a session involves

The Gale entry describes a conversation first, so the therapist can note the person's complaints and choose points to work. The person reclines with shoes and socks removed. A typical foot session lasts about 40 to 45 minutes, sometimes followed by about 15 minutes on the hands, with the thumb and forefinger working across the maps. Some practitioners use tools such as a pencil eraser. Embong and colleagues note that sessions may be combined with aromatherapy, music or a calm setting, and that the Ingham method uses no tools.

In the 26 trials in a 2020 meta-analysis, foot reflexology sessions ran from 10 or 15 minutes to 60 minutes, and the number of sessions varied widely, so there is no single studied protocol. The same review reported that more total reflexology time and a longer program were associated with better sleep scores. This is a pattern across trials, not a controlled comparison of doses.

Assessment and boundaries described by a professional register

The CNHC core curriculum lists what trainees are expected to know: the signs of skin, nail, foot and hand condition, deformity and infection, how to position the client, how to record sessions, and when reflexology is appropriate, needs caution, is contraindicated, or calls for referral. It lists understanding the importance of not diagnosing medical conditions and recognizing signs that need immediate medical help. These are training standards, not evidence that the practice is effective.

What practitioners and reviews attribute to it

Practitioner-facing sources describe reflexology as a way to induce relaxation, improve circulation and support the body's balance, and the CNHC curriculum states that these outcomes can activate the body's own healing systems. Embong and colleagues list reasons people choose it, including stress reduction, pain relief and a drug-free approach, and describe energy-flow theories and a suggestion that it breaks up lactic acid crystals in the feet. NCCIH states that the claim of relaxation and healing in the corresponding body parts has not been established. The sources reviewed give no tested mechanism for the maps.

Conditions that have been studied

The 2009 review of randomized trials found studies in anovulation, asthma, back pain, dementia, diabetes, cancer, foot swelling in pregnancy, headache, irritable bowel syndrome, menopause, multiple sclerosis, the postoperative state and premenstrual syndrome. Later reviews concentrate on depression, anxiety and sleep, cancer symptoms, pregnancy and labor, and premenstrual syndrome. Embong and colleagues and the CNHC curriculum both state that reflexology is not used to diagnose conditions.

Early systematic reviews

A 2008 review of five controlled studies found one statistically significant treatment effect, for urinary symptoms in multiple sclerosis, and negligible effects on the other outcomes, and concluded that routine provision was not recommended. A 2009 review of 18 randomized trials, searched to February 2009, found five positive trials, poor methodological quality and small samples, and noted that most higher-quality trials were not positive. It concluded that the best evidence did not demonstrate convincingly that reflexology is effective for any medical condition.

A 2011 update included 23 trials. Nine high-quality trials had negative findings and five trials were positive. Eight trials suggested effectiveness for diabetes, premenstrual syndrome, cancer patients, multiple sclerosis, detrusor over-activity and dementia, with important caveats, and the authors reached the same conclusion as in 2009. Only the abstracts of these three reviews were read for this page.

Later meta-analyses of mental health and sleep

A 2020 meta-analysis of 26 randomized trials with 2,366 adults, searched to August 2020, reported lower depression (Hedges g -0.92), anxiety (g -1.24) and sleep disturbance scores (g -1.67) with foot reflexology than with control groups. Every trial was rated at high or unclear risk of bias in at least one domain, many gave no allocation concealment data, and funnel plots suggested possible publication bias for anxiety, although Egger's test was not significant. A 2021 meta-analysis of 42 trials of sleep (3,928 adults) found a similar direction, and its abstract does not report risk of bias.

Cancer care

A 2024 systematic review of 26 studies in 2,465 people with cancer rated the studies as moderate to low quality with heterogeneous results, and concluded that a clear statement on effectiveness was not possible. It reported that the evidence indicated reflexology was superior to passive control groups for pain, quality of life and fatigue, and that comparisons with active controls were needed. A 2023 review of 15 trials (1,356 adults) judged the evidence on stress, anxiety, depression and quality of life mixed and conflicting, with low to very low certainty. NCCIH cites an advanced breast cancer study in which some symptoms improved and others did not.

Pregnancy, labor and premenstrual syndrome

A 2018 Cochrane review of massage, reflexology and other manual methods for labor pain included 14 trials and stated that it found no trials examining the effectiveness of reflexology. A 2024 meta-analysis of 13 trials (1,189 pregnant women) of foot reflexology or foot massage reported less anxiety and pain and shorter labor. Six trials were at high risk of bias in randomization, and the authors downgraded most outcomes for serious risk of bias.

A 2019 meta-analysis of nine studies (475 women) reported lower premenstrual syndrome scores with reflexology, but only two trials were rated high risk of bias for randomization and most items were unclear. Searches for this page did not find a Cochrane review of reflexology for menstrual disorders.

What trials report about harms

The 2020 meta-analysis found no adverse events in the few trials that assessed them, and most trials did not report on them. The 2024 cancer review found no adverse events attributable to reflexology. The Cochrane labor review said few trials reported safety. Statements that reflexology appears comparatively safe therefore rest on sparse reporting. The sources reviewed contained no case reports or case series of serious harm, and none that attributed delayed diagnosis or treatment to reflexology, which does not show that such events are absent.

Precautions described in guidance and reviews

Embong and colleagues, summarizing Malaysian Ministry of Health good practice guidance, list conditions to avoid: the first trimester of pregnancy, because a miscarriage after a session might be attributed to it; diarrhea and vomiting; fever and infection; and skin disease, inflammation or swelling of the hands, feet or ears. The Gale entry adds that people with diabetes should be cautious and notes possible tenderness in the second session. These are expert cautions without incidence data. NCCIH states that its material does not substitute for a health care provider's advice.

Training and standards

The CNHC core curriculum, revised in November 2023, sets a minimum of 630 hours of study over at least 32 weeks, including 296 guided learning hours and at least 100 treatments, 40 of them written as case studies, with independent assessment. Embong and colleagues describe far more varied provision, from apprenticeships and five-day courses to a short course of about an hour in Thailand. No single international training standard was found in the sources reviewed.

Reflexology is not a diagnostic tool. Pain, swelling, infection or a new symptom in the feet, or worsening illness, calls for medical assessment, and reflexology should not delay or replace necessary care.