Reflexology: A Close Look
Stephen Barrett, M.D.
Reflexology, also called zone therapy, is based on the notion that each body part is represented on the hands and feet and that pressing on specific areas on the hands or feet can have therapeutic effects in other parts of the body. Most proponents claim:
- The body is divided into 10 longitudinal zones—five on each side of the body.
- Each organ or part of the body is represented on the hands and feet;
- The practitioner can diagnose abnormalities by feeling the hands or feet
- Massaging or pressing each area can stimulate the flow of energy, blood, nutrients, and nerve impulses to the corresponding body zone and thereby relieve ailments in that zone.
The pathways postulated by reflexologists have not been anatomically demonstrated; and it is safe to assume that they do not exist. Similar rationales are used employed by iridologists (who imagine that eye markings represent disease throughout the body) and auricular acupuncturists who "map" body organs on the ear (a homunculus in the fetal position). The methodology is similar in both of these; and some commentators consider pressing on "acupuncture points" on the ear or elsewhere to be forms of reflexology, but most people refer to that as acupressure ("acupuncture without needles). The Reflexology Research Web site displays charts for foot and hand reflexology. The fees I have seen advertised have ranged from $35 to $100 per session.
Most reflexologists claim that their procedures can relieve stress, which is probably correct with respect to everyday stress. However, many reflexologists describe stress in terms that do not correspond to scientific knowledge. Kevin and Barbara Kunz, for example, state:
The individual's foot reflex areas reflect the individual's overall state of tension that has resulted from a lifetime of adaption to stress. Stress cues in the feet are a roadmap to the reflexologist. Wherever it is found on a foot, it is a sign that stress and its effect have begun to accumulate in the corresponding parts of the body 
Many proponents claim that foot reflexology can cleanse the body of toxins, increase circulation, assist in weight loss, and improve the health of organs throughout the body. Others have reported success in treating earaches, anemia, bedwetting, bronchitis, convulsions in an infant, hemorrhoids, hiccups, deafness, hair loss, emphysema, prostate trouble, heart disease, overactive thyroid gland, kidney stones, liver trouble, rectal prolapse, undescended testicles, intestinal paralysis, cataracts, and hydrocephalus (a condition in which an excess of fluid surrounding the brain can cause pressure that damages the brain). Some claim to "balance energy and enhance healing elsewhere in the body."  One practitioner has even claimed to have lengthened a leg that was an inch shorter than the other. There is no scientific support for these assertions.
Reflexology was introduced into the United States in 1913 by William H. Fitzgerald, M.D. (1872-1942), an ear, nose, and throat specialist who called it "zone therapy." As noted in the diagram to the right, he used vertical lines to divide the body into 10 zones. Eunice D. Ingham (1899-1974) further developed reflexology in the 1930s and 1940s, concentrating on the feet  Mildred Carter, a former student of Ingham, subsequently promoted foot reflexology as a miraculous health method [4-6]. A 1993 mailing from her publisher stated:
Some reflexologists who deny that they diagnose or treat disease claim that the majority of health problems are stress-related and that they can help people by relieving the "stress" associated with various diseases or body organs . This type of double-talk is similar to chiropractic claims that "subluxations" lower resistance to disease and that "adjusting" the spine to correct subluxations will improve health. All ten of the books I have inspected mention scores of health problems that reflexology has supposedly helped.
Pauline Wills, author of the Reflexology and Colour Therapy Workbook, teaches that colors can be applied to "areas where an abnormality has been diagnosed but which has produced no noticeable symptoms in the physical body." She states that the application can be done by imagining colors transmitted through the practitioner's hand or by Firstly, if the practitioner is sensitive to colour, they can visualize it being projected or by using "reflexology crystal torch." .
During the 1990s, I observed at least seven foot reflexologists at work during health expositions. In most cases, the process appeared to be an ordinary prolonged foot massage with little communication between the practitioners and their clients. But at one exhibit, the practitioners claimed that they could reduce stress, cleanse the body of toxins, increase circulation, assist in weight loss, and improve the health of organs throughout the body. On another occasion, I underwent a 15-minute session in which the practitioner felt my foot for diagnostic purposes and then massaged it for "therapeutic" purposes. During the previous year, I had had severe shoulder pain caused by an inflamed tendon that was rubbing against a bony surface inside my left shoulder joint. Thorough medical evaluation had determined that the appropriate treatment was arthroscopic surgery in which a drill is used to shave the bony area that was impinging on the tendon. The reflexologist claimed that he could detect the shoulder problem by feeling my left foot, that it was caused by stress, and that pressing on my foot—perhaps for a few sessions—could solve the problem. His "treatment," which lasted about 10 minutes, consisted of massaging the foot and from time to time, pressing hard on the ball of my foot, a procedure that was quite painful. The "treatment," of course, did absolutely nothing to help my shoulder. A few months later, I had the surgery, which cured the problem immediately and permanently.
Training, "Credentials," and Legal Status
Since reflexology is not recognized by law, no formal training is required to practice reflexology or call oneself a reflexologist. However, some nurses and massage therapists offer reflexology as part of their licensed practice. Some courses are accredited for continuing education for nurses and massage therapists. The most widely publicized training source is probably the International Institute of Reflexology, of St. Petersburg, Florida, which claims to have 25,000 members worldwide . Its seminar on the "Original Ingham Method of Foot Reflexology" are taught by Ingham's nephew, Dwight Byers. Its "Certified Member" status requires 200 hours of instruction plus passage of written and practical tests. As far as I know, this certification process has neither legal nor medical recognition. The Institute's Web site states:
The Ingham Method of Reflexology is used primarily for relaxing tension. Doctors agree that over 75% of our health problems can be linked to nervous stress and tension. Reflexology improves nerve and blood supply, and helps nature to normalize.
The International Institute of Reflexology® wishes to make it perfectly clear that it does not purport to teach medical practice in any form; or is the Ingham Method of Reflexology intended to replace conventional medical treatment.
Reflexology is a unique modality in the health field. Its purpose is not to treat or diagnose for any specific medical disorder, but to promote better health and well being in the same way as an exercise or diet program. Its practice should not be compared to massage or any other kind of manipulative procedure.
A brochure for a Byers seminar at the Big Sky Somatic Institute quotes him stating:
As a Reflexologist works each reflex, it triggers a release of stress and tension in the corresponding area or body zone, as well as an overall relaxation response. The release of tension unblocks nerve impulses and improves the blood supply to all parts of the body. Because reflexology works from the inside, it also has a balancing effect on each gland, organ and body region. . . ." 
Diagnosing or treating disease would constitute the practice of medicine and would be illegal for anyone who does not have a professional license to do these things. Although many diagnose and treat disease, I am not aware of any prosecutions. In some states that license massage therapists, unlicensed reflexologists might also be prosecutable for practicing massage therapy without a license .
Sandals, shoe inserts, foot-massage devices and a steering wheel cover based on reflexology theory are being marketed. As far as I know, no such product has a plausible rationale or been scientifically tested. Any medical claims made for such devices would make them "medical devices" under the law and therefore illegal to market without FDA approval.
Although the claims of reflexology are so far removed from scientific reality that testing them might seem a waste of time, a few competent researchers have conducted investigations.
- The first study I know of was supervised by William T. Jarvis, Ph.D., a professor who taught research methods to graduate students at Loma Linda University. Using questionnaires, 70 subjects were asked to state whether they had had health problems during the previous two years in any of 43 anatomical areas. These data were then compared with the findings of a reflexologist as recorded on a report form. The results did not differ from what would be expected by blind guessing. To prevent the reflexologist from asking questions or observing subtle clues, the experimental subjects were asked to remain silent and a curtain was placed so that their feet were the only part of their body visible to the reflexologist .
- In another study, 35 women with premenstrual syndrome (PMS) were randomly assigned to ear, hand, and foot reflexology or to placebo therapy done on sham reflex points. The women kept a daily record of 38 possible symptoms selected from previous PMS research questionnaires. The treatment group reported significantly fewer symptoms than the placebo group, and these improvement persisted for 2 months after treatment. Many women in this group fell asleep during the 30-minute sessions and reported feeling more energetic during the next day. The placebo group reported that they thought they were receiving genuine reflexology, The authors note, however, that it was very difficult to develop a credible placebo control group, which may have been the study's flaw. Normally, reflexology is soothing, but the placebo treatment was described as "either overly light or very rough."  Thus the differences could have been differences in the quality of the massage being administered. The study suggests that massage may relieve PMS symptoms, but it does not validate the alleged connection between reflex points and body organs
- In another study, three experienced reflexologists examined 18 adults with one or more 6 specified conditions identified from their medical records. The data showed no significant relationship between the patient's medical diagnoses and the reflexologists' findings .
- Another study compared the effects of foot reflexology, simple massage, and conversation on 130 patients who had undergone abdominal gynecologic surgery under full anesthesia. The patients were asked how they felt, and data were recorded on general condition, pain intensity, movement of the bowels, urination, and sleep, from the day before the operation until until the tenth day afterward. Simple massage turned out to be a relaxing, positive experience, whereas foot reflexology had various effects, some of which were negative. The researchers concluded that foot reflexology is not effective in acute, abdominal postsurgical situations in gynecology and can occasionally trigger abdominal pain .
- Another study examined the popular claim that reflexology treatment benefits bronchial asthma. Ten weeks of active or simulated (placebo) reflexology were compared in a controlled trial of 40 outpatients with asthma. Objective lung function tests (peak flow morning and evening, and weekly spirometry at the clinic) did not change. Subjective scores (describing symptoms, beta2-inhalations and quality of life) and also bronchial sensitivity to histamine improved on both regimens, but no significant differences were found between groups receiving active or placebo reflexology. The researchers concluded that they had found no evidence that reflexology has a specific effect on asthma beyond placebo influence .
In 2010, the medical journal Maturitas published a systematic review of 23 randomized controlled studies that concluded:
Six electronic databases were searched to identify all relevant randomised clinical trials (RCTs). . . . The methodological quality of the RCTs was often poor. . . . The best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition.
The Bottom Line
Reflexology is based on an absurd theory and has not been demonstrated to influence the course of any illness. Done gently, reflexology is a form of foot massage that may help people relax temporarily. Whether that is worth $35 to $100 per session or is more effective than ordinary (noncommercial) foot massage is a matter of individual choice. Claims that reflexology is effective for diagnosing or treating disease should be ignored. Such claims could lead to delay of necessary medical care or to unnecessary medical testing of people who are worried about reflexology findings.
- Kunz K, Kunz B. The Complete Guide to Foot Reflexology (Revised). Albuquerque, NM: Reflexology Research, 1993.
- Sachs J, New York: Dell Publishing, 1997.Berger J. Reflexology: The A-Z Guide to Healing with Pressure Points.
- Benjamin. Eunice D. Ingham and the development of foot reflexology in the U.S. Massage Therapy Journal, Winter, 1989.
- Carter M. Helping Yourself With Foot Reflexology. Parker Publishing Company, 1969.
- Carter M. Hand Reflexology: Key to Perfect Health. West Nyack, N.Y. : Parker Publishing Company, 1975.
- Carter M. Body Reflexology: Healing At Your Fingertips. Parker Publishing Company, 1983.
- Spencer R. Mildred Carter announces a new health breakthrough! Blessed relief from 34 common ailments with new body reflexology. Parker Publishing Co., West Nyack, N.Y. Undated flyer received in 1993.
- Wills P. Integrating colour with reflexology. Positive Health Magazine, Jan/Feb 1997.
- Let us introduce ourselves. International Institute of Reflexology Web site, accessed Feb 25. 2002.
- Byers D. Quoted in Somatic Standard 5(1):5, April 2002. Big Sky Institute, Helena, Montana.
- Walsh K. The regulatory net. Massage Magazine, March 30, 2001.
- Jarvis WT. Reflexology. NCAHF Web site, accessed Feb 25, 2002.
- Oleson T, Flocco W. Randomized controlled study of premenstrual symptoms treated with ear, hand and foot reflexology. Obstetrics and Gynecology 82:906-911, 1993.
- White AR and others. A blinded investigation into the accuracy of reflexology charts. Complementary Therapies in Medicine 8:166-172, 2000.
- Kesselring A. Foot reflexology massage: A clinical study. Forsch Komplementarmed 6 Suppl 1:38-40, 1999.
- Brygge T and others. Reflexology and bronchial asthma. Respiratory Medicine 95:173-179, 2001.
- Ernst E and others. Reflexology: an update of a systematic review of randomised clinical trials. Maturitas 68:116-120, 2011.
This article was revised on March 28, 2015.