F1BD 34 Reflexology 130 Page

LEARNING SOLUTIONS FOR SCOTLANDS COLLEGES
F1BD 34
Reflexology
June 2009
COLEG
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Acknowledgements
No extract from any source held under copyright by any individual or organisation has
been included in this publication.
Colleges Open Learning Exchange Group (COLEG) Material developed by Jewel & Esk
College.
No part of this publication may be reproduced without the prior written consent of COLEG,
except as authorised in the paper entitled Intellectual Property Rights of COLEG Members.
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Contents
Acknowledgements
Contents
Introduction to the unit
What this unit is about
Outcomes
Unit structure
How to use these learning materials
Symbols used in this unit
Other resources required
10
Assessment information
13
How you will be assessed
13
When and where you will be assessed
13
What you have to achieve
13
Opportunities for reassessment
13
Section 1: Consultation and development
15
Introduction to this section
17
Assessment information for this section
18
Purposes and processes of reflexology
19
History and philosophy of reflexology
20
Reflexology consultation
24
Client assessment
25
Foot analysis
27
Contraindications to reflexology
28
Special care conditions for reflexology
30
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Medications
32
Treatment objectives and limitations
34
Comparison of subsequent treatments
35
Summary of this section
37
Answers to self assessed questions
38
Answers to activities
39
Section 2: Preparation for treatments
41
43
44
Preparation for reflexology treatment
45
Position and comfort of the client
48
Health and safety
50
53
54
Section 3: Performing treatments
55
57
59
Timing, sequence and duration of treatment
60
Relaxation techniques
62
Reflexology techniques
64
Structure of the foot
67
Structure of the lower leg
70
Reflexology points
73
Physiology of the body and possible effects
85
93
94
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95
Section 4: Evaluation
97
99
100
Possible reactions to reflexology treatment
101
Sensitivity chart
104
Evaluation
107
109
Glossary
111
Appendices
113
Appendix 1
113
Appendix 2
119
Appendix 3
127
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Introduction to the unit

What this unit is about
This is a Higher National Unit worth 2 credits at level 7 and is an optional unit for both
Complementary Therapies and Beauty Therapy. This unit is designed to enable you to
gain the basic knowledge of, and develop the practical skills required to perform,
reflexology treatments. It will guide you through the processes of consultation and
client management.
Outcomes
On completion of the unit you should be able to:
1. Consult with clients to develop reflexology treatment plans
2. Prepare for reflexology treatments
3. Perform reflexology treatments
4. Evaluate the effectiveness of the reflexology treatments.
Unit structure
This unit contains the following study sections:
Section number and title
Approximate
study time
Consultation and development
20 hours
Preparation for treatment
20 hours
Performing treatments
30 hours
Evaluation
10 hours
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How to use these learning materials

This unit has been developed in flexible learning format for students on the HN
Complementary Therapy course. In studying these materials you will become familiar
with the terms and landscape of the therapy environment. There may be unfamiliar
terms or concepts and you should work through them in the way suggested in the text
until you become familiar with them. You will also learn skills that can be transferred to
other therapy areas. The written theory can be studied in an open learning format and
supported by practical training carried out in college and at home. Self assessment
questions and tasks are included in each section to help check your understanding of a
topic before moving on. Attempting these will help to consolidate your learning and
highlight any areas that you need to work on. The student files supplied will aid you in
learning and practising the consultation and practical application of the reflexes. They
should be used as a guide to maximise learning the practical element of this unit.
It is recommended that attendance at college is undertaken at least one full day per
month to receive guidance and support with the practical element of this unit.
You should hold an existing anatomy and physiology qualification prior to undertaking
this unit or be studying towards one. There is a COLEG pack Complementary
Therapies: Anatomy and Physiology F1BN 34 published August 2008 which should
complement this unit.
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Symbols used in this unit

These learning materials allow you to work on your own with tutor support. As you
work through the course, youll encounter a series of symbols which indicate that
something follows which youre expected to do. Youll notice that as you work through
the study sections you will be asked to undertake a series of self assessed questions
(SAQs), activities and tutor assignments (TAs). An explanation of the symbols used to
identify these is given below and in the next page.
Self assessed question
1.1
This symbol is used to indicate a Self Assessed Question (SAQ). Most commonly,
SAQs are used to check your understanding of the material that has already been
covered in the sections.
This type of assessment is self contained; everything is provided within the section to
enable you to check your understanding of the materials.
The process is simple:
you are set SAQs throughout the study section
you respond to these, either by writing in the space provided in the assessment
itself, or in your notebook
on completion of the SAQ, you turn to the back of the section to compare the model
SAQ answers to your own
if youre not satisfied after checking out your responses, turn to the appropriate part
of the study section and go over the topic again
Remember the answers to SAQs are contained within the study materials. You
are not expected to guess at these answers.
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Activity
1.1
This symbol indicates an activity which is normally a task youll be asked to do which
should improve or consolidate your understanding of the subject in general or a
particular feature of it.
The suggested responses to activities are at the end of each section.
Remember that the SAQs and activities, if contained within your package, are intended
to allow you to check your understanding and monitor your own progress throughout
the course. It goes without saying that the answers to these should only be checked
out after the SAQ or activity has been completed. If you refer to these answers before
completing the activities, you cant expect to get maximum benefit from your course.
Tutor assignment formative assessment
1.1
This symbol means that a tutor assignment (TA) is to follow. These will be found at the
end of each study section. The aim of the TA is to cover and/or incorporate the main
topics of the section and prepare you for unit (summative) outcome assessment.
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The other resources which you will require to complete this unit are:
Therapy bed or reflexology chair
Foot support
Pillows
Towels
Blanket
Tissues
Cream
Antiseptic wipes
Couch roll
Trolley
Bowls
Watch
Pens
Consultation sheet supplied as student file in the appendix
Blank foot charts supplied as student file in the appendix
Reflex sensitivity sheet supplied as student file in the appendix
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Recommended reading
Books
Arnold, M, 1999, Chi-Reflexology Guidelines For The Middle Way, Hazlebrook,

Moss Arnold (self published)
Byers, D C, 2001, Better Health with Foot Reflexology, St Petersburg, Ingham

Publishing.
Crane, B, 2005, Reflexology Therapies and Techniques for Well-being, London,

Duncan Baird Publishers
Crane, B, 1997, Reflexology The Definitive Practitioners Manual, London, Element
Corvo, J, 1990, Zone Therapy The Unique New System of Pressure Point
Massage, London, Guild Publishing
Cross, J R, 2001, Acupressure & Reflextherapy in the Treatment of Medical

Conditions, Oxford, Butterworth-Heinemann
Dougans, I, 2005, Reflexology the 5 elements and their 12 meridians a unique

approach, London, Thorsons
Dougans, I, Ellis, S, 1992, The Art of Reflexology, Shaftesbury, Element
Gillanders, A, 2002, Reflexology Simple routines for home, work & travel, London,
Gaia Books Ltd
Hall, N, 1994, Reflexology for Women, London, Thorsons
Ingham, E D, 1938, Stories the Feet can Tell Thru Reflexology and Stories the Feet
Have Told Thru Reflexology, St Petersburg, Ingham Publishing.
Kunz, B. Kunz, K, 2003, Reflexology health at your fingertips, London, Dorling

Kindersley
Kunz, B, Kunz, K,1984, Hand and Foot Reflexology The Unique Self-Health
Approach to Wellness, Wellingborough, Thorsons
Mackereth, P, Tiran, D, 2002, Clinical Reflexology A Guide For Health

Professionals, Edinburgh, Churchill Livingstone
Norman, L, Cowan, T, 1988, The Reflexology Handbook A Complete Guide,

London, Piatkus
Oxenford, R, 2002, Healing with Reflexology, Hong Kong, Hermes House
Parsons, T, 2003, An Holistic Guide to Reflexology, London, Thomson Learning
Peeters, J, 2005 Reflexology A gentle therapy for correcting and preventing ill
health, Bath, Parragon
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Rick, S, 1987, The Reflexology Workout, Rochester, Thorsons
Stormer, C, 1995, Language of the Feet, London, Hodder & Stoughton
Wagner, F, 1987, Reflex Zone Massage, The Handbook of Therapy and Self-Help,
London, Thorsons
Wright, J, 1999, Reflexology and Acupressure pressure points for healing,

London, Hamlyn
Websites
General Regulatory Council for Complementary Therapies www.grcct.org
Complementary and Natural Healthcare Council www.cnhc.org.uk
Association of Reflexologists www.aor.org.uk
British Reflexology Association www.britreflex.co.uk
Centre for Clinical Reflexology www.clinicalreflexology.org.uk
Complementary Therapists Association www.embody.uk.net
International Federation of Reflexologists www.IntFedReflexologists.org
Barbara & Kevin Kunz http://www.reflexology-research.com
International Institute of Reflexology http://www.reflexology-usa.net
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Assessment information
Two papers of ten extended response questions in closed-book, supervised conditions
will be required to ensure that you have knowledge of all four learning outcomes. In
addition, 4 case studies of 6 treatments each will be carried out with one observation
completed by your tutor or qualified practitioner. A reflective account should
accompany the 4 case studies showing the learning achieved and assessments made.

Formative assessments in the form of tutor assignments (TAs) are provided as part of
these materials and are intended to prepare you for the type of question you will
receive in the summative assessment, but are not as in-depth. Summative
assessments will be produced and supplied by your college. Please contact your
college for summative assessment information.

You have to achieve 70% pass marks on each of the two exam papers and produce 4
client consultation documents that show the process and treatments of 4 clients for 6
treatments each and include a reflective account of the treatments.

Normally, you will be given one attempt to pass an assessment with one reassessment
opportunity.
Your college will also have a policy covering 'exceptional' circumstances, for example,
if you have been ill for an extended period of time. Each case will be considered on an
individual basis and is at your college's discretion (usually via written application) and
they will decide whether to allow a third attempt. Please contact your tutor for details
regarding how to apply.
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Section 1: Consultation and development
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What this section is about
This section will cover the following topics:
History and philosophies of reflexology
Client assessment
Foot analysis
Contraindications/special care situations
Objectives
At the end of this section you should be able to:
assess the client, taking into consideration physical condition, emotional state and
lifestyle
confirm treatment objectives with client indicating limitations
analyse the foot in terms of skin texture, temperature, colour, smell, tone, moisture
content, mobility, abnormalities and condition of nails
recognise diseases and disorders of the foot
discuss the possible effect of common medication in terms of the agreed treatment
deal with contraindications and cases requiring special care
establish a measurable marker of client condition to allow comparison of one

treatment to the next
interact with clients in a professional and empathic manner.
Approximate study time

This section should take approximately 20 hours study time.
In addition to the text in this section you will require the:
Consultation sheet supplied as student file in the appendix
Blank foot charts supplied as student file in the appendix.
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This section will form part of the two papers of ten extended response questions.
These will be closed-book. This means that you will not be permitted to take notes,
handouts, books or any other aid into the assessment location when you sit the
assessment. The assessment will be conducted in supervised conditions. In addition,
4 case studies of 6 treatments each will be carried out with one observation completed
by your tutor or qualified practitioner. A reflective account should accompany the 4
case studies showing the learning achieved and assessments made.
Normally, assessment will be arranged when you and your tutor agree that you are
sufficiently prepared to undertake each assessment. This will usually take place at the
college or centre where you are enrolled. Please contact your college for assessment
information.
You have to achieve 70% pass marks on each of the two exam papers and produce 4
opportunity.
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The purpose of a reflexology treatment will vary with each client. It should always be
the intention of the therapist to carry out a treatment in a way that will assist the client
in reaching their expected outcome. A therapist should always use their clinical
judgement as to whether a treatment is appropriate for each client based on a full and
thorough consultation. It is always the therapists prerogative to refuse treatment if
they do not feel it is in the best interests of the client.
A reflexology treatment will usually be carried out on the feet but can also be performed
on the hands, face and ear with the appropriate training. Pressure is applied to the
reflex areas of the feet in order to bring about change and balance within the body.
The pressure applied will depend on the area of the feet being treated and the
condition of the clients feet.
Reflexology works on the basis that the whole body is mapped onto the feet and that
by treating the feet the whole body is being worked. The feet are mapped into reflex
areas that are a reflection of the anatomy of the body and are treated in a sequential
order.
This sequence is adhered to throughout all treatments. No area of the foot should be
missed. The left foot represents the left side of the body and the right foot the right
side of the body. It is sometimes not possible to treat both feet (eg if a client has had
an amputation), in which case the hands can be treated.
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History and philosophy of reflexology

Reflexology as a treatment dates back to ancient times. There is evidence of such
treatments in the tomb of Ankhmahor (which is also known as the physicians tomb) at
Saqqara in Egypt dating from 2300 BC. The Indian and Chinese cultures both record
methods of treating the feet and hands, as do Russian, Japanese and Inca histories.
The Chinese in particular used the method of applying pressure using the thumbs and
fingers to different areas of the body to relieve pain and bring about healing. The
treatment became known as acupressure and was developed into different forms
including acupuncture, shiatsu and reflexology.
Modern reflexology is based on the Zone Theory which was developed by Dr. William
H. Fitzgerald in America. He published his book in 1917 entitled Relieving Pain At
Home. This was one of the first times that there was a correlation made between mind
and body, albeit in the form of neural responses. He mapped the body into ten
longitudinal zones with 5 on each side of the body. There are also 5 complete zones in
each of the thumbs and big toes. Dr Fitzgerald discovered that when pressure was
applied to an area within a particular zone that an analgesic effect was achieved in a
corresponding area within the zone and that all organs, tissue and structures within that
zone were affected and/or aided by the pressure applied.
In the 1930s Dr Fitzgeralds work was used and enhanced by Eunice Ingham who
treated many people using zone theory. She concluded that some areas of the body
may be more accessible and effective for treatment and discovered that the feet were
one of the best areas to treat as they were extremely sensitive. She developed this
treatment known as compression massage and, later, reflexology. She went on to
produce the first reflex map of the feet and many reflexology charts are based on this
first map, although many other therapists have produced their own versions. It is
generally accepted that by varying the pressure applied in the mapped areas of the feet
that pain could be reduced or relieved and that other changes are taking place.
The other theory that reflexology is based on is the Traditional Chinese Medicine
(TCM) aspect of Meridians. There are 12 main meridians in the body, 6 starting on
the feet and ending on the body and 6 starting on the body and ending on the fingers.
These are energy pathways that keep the Chi or energy of the body flowing. If the chi
becomes stuck, or out of balance, then the meridian and all associated organs and
structures will be affected. In the same way that zones are longitudinal so are
meridians. They are also bilateral. As with zone theory when accessing meridians on
the feet it is possible to affect all the associated areas of the body within each meridian,
helping to unblock stuck energy or causes of imbalance. Each meridian is known by
the name of its associated organ and two meridians are paired with each other in the
same away that TCM pairs them, these are:
Lung Colon (large intestine)
Stomach Spleen
Heart Small Intestine
Bladder Kidney
Pericardium Triple Burner
Liver Gall Bladder
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Reflex map of the feet
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1.1
What are the two theories that reflexology is based on?
Check your answer with the one given at the end of this section.
1.2
Apart from the feet what other parts of the body can reflexology be carried out on?
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Holism
Reflexology is a holistic therapy and this means that the therapist should take a holistic
approach to treatment. Holism is an approach to treatment that does not treat in
isolation and considers all factors that may affect a client or their environment. The
body is seen as a working entity that cannot necessarily be broken down into individual
parts without taking into account how those individual parts interact with the rest of the
body. It also allows for assessment of the physical, mental, emotional and spiritual
nature of disease or imbalance and how this may have impacted on the person on all
four of these planes. Holism tends to look at the cause of disease rather than the
symptoms and will attempt to return the person to a state of harmony rather that perfect
health. The concept of wellness in holism is slightly different too. The absence of
illness or disease does not necessarily indicate that a person is well and this is another
reason why client observation is so important. When observing a client, do so
holistically and look at their physical body as well as their manner, emotional state,
posture, mood, reactions and how they interact.
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Reflexology consultation
Whenever you see a new client it is extremely important to do a full consultation with
them. Under the Data Protection Act any information gathered needs to be for a
specific purpose and used only for that purpose. The consultation is designed to get
the relevant information that the therapist needs. The therapist should only ask
questions which result in relevant information. It is not necessary to ask questions
which will merely express the clients opinion on something, ie their favourite colour.
This will not assist the therapist at all in their assessment and treatment. The therapist
should ask about medical history, family medical history, lifestyle factors, exercise, fluid
intake, mental state, emotional health and reasons for seeking treatment.
Procedure
1. Introduce yourself
2. Explain the treatment and how the client may feel afterwards (see section 4)
3. Check contraindications and special considerations
4. Fill out a consultation sheet
5. Note any health problems the client tells you about
6. Remember ethics
7. Check for foot disorders
8. Check feet for colour, shape, tissue or temperature changes note these on the
record card and/or the blank foot charts
9. Communicate facing the client and use eye contact often to show interest in
him/her
10. Maintain a professional and empathic attitude at all times and always be tactful
11. Consultation should always be carried out in private.
It is important to conduct a consultation prior to a reflexology treatment for the following
reasons:
1. To record the clients details
2. To check contraindications and to establish whether you may require a doctors
consent to treat
3. To explain the treatment to the client and how they may feel afterwards
4. To check for any foot diseases or disorders
5. To establish the clients reasons for attending treatment
6. To enable a suitable treatment plan to be formed
7. To allow the therapeutic relationship to be established and built upon.
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Ethics
Ethics are the principles by which we work as therapists. We each have our own
personal code of ethics that govern how we deal with and react to everyday situations
in our lives. It is important to remember that we will also have to work to a code of
professional ethics. These are published by both professional and governing bodies
and it is your responsibility to familiarise yourself with the code published by the
professional or governing body you choose to join. These codes are to protect the
therapists as well as the client. They include items such as confidentiality, respect for
others, non judgement of others, controlled emotional involvement and empathy.
Client assessment
Client assessment is essential when treating as it is important to gain a full medical
history for the client as well as lifestyle and emotional information. In this way it is
possible for the therapist to assess the needs of the client and then carry out the best
treatment for the client.
It is important to establish with the client their expectations of the treatment before it
begins. Many people will come for treatments purely to relax and unwind from their
daily life, while others may want help with coping with medical or emotional conditions.
It is important to remember that while reflexologists assess the client and the feet they
do not diagnose. Also, it is important to remember that while it is possible to carry
out a treatment reflexologists do not cure. A reflexologist also does not treat for a
specific ailment.
When a client comes into your clinic or treatment room you will start your observations
right away. You will be looking for the manner in which they present themselves. Are
they happy, tired, angry, lethargic or apprehensive?
When doing the consultation, are they willing and eager to provide information or
nervous and reticent at answering questions? Do they seem agitated or relaxed,
stressed or calm? Is their physical appearance at odds with their emotional
appearance? Are they weepy, loud, timid or expressive?
All of these (and many more) are indications of the emotional and physical state of the
client and may be noted on the consultation sheet. You should continue to observe
your client once the treatment has started to see any changes that occur as well as any
reaction to the areas being worked. It is often the non-verbal signs that tell us more
about the client than what they actually say.
Any changes that occur should be noted on the consultation sheet and measured and
compared with subsequent treatments to gauge improvement, worsening of conditions
or behaviours and a return to homeostasis.
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1.3
Why is it important to carry out a client assessment?
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Foot analysis
In addition to assessing the client it is necessary to observe and assess the feet too.
When first seeing the feet it is always a good idea to take time to look at them and
touch them to assess their condition and traits.
When looking at the feet note on a blank foot chart where there are marks, cuts or
abrasions present. There may be corns, blisters or verrucas that you will want to mark
then cover with a plaster before treatment. The colour of the feet and any changes
that appear should be noted as this can indicate the emotional state of a person as well
as any trauma being caused by footwear or walking. The tone of the skin and muscles
of the feet should be noted and areas of imbalance mapped on a blank foot chart to
measure change. The temperature of the feet should be noted and, in particular, if
this changed during treatment. It can often be the case that feet will sweat during
treatment and this can be a sign or symptom of emotional or physical responses.
Conditions of the nails are important as they can reveal the first signs of fungal
infections. The moisture content can help to assess the amount of fluid intake of the
client and also be an indication of particular conditions such as dehydration or infection.
You will also need to check the mobility of the foot as this can impact on the treatment
and you may need to adapt. It is also important that you do not move the clients feet
in a way that will cause damage or harm if mobility problems exist.
The smell of the feet is important. If there is a sweet smell this may indicate a viral
infection is present and an earthy smell may indicate a bacterial infection is present. In
addition, those with diabetes often display a distinct pear drop smell. Smells may also
change during the course of a treatment indicating changes in the body and these
should be noted and used as an indicator of whether it is appropriate to continue
treatment or refer to another health care professional or doctor.
The angle that the feet lie at can be an indication of physical and emotional conditions
and should be noted on the consultation notes and any change noted at the end of the
treatment and at the beginning and end of any subsequent treatments to show
improvement or change. Someone with lower back problems may have a foot leaning
more lateral and with pelvic problems more medial. Emotional disharmony can cause
feet to react and can be flaccid and limp (for more on this read Cross, 2001 and
Stormer, 1995).
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Contraindications to reflexology
Contraindicated conditions, when present, indicate that reflexology treatment should
not take place, as doing so could worsen the condition or harm the client. If these
conditions are present do not treat or only treat after consent is sought from the clients
GP. Among these conditions are:
Thrombosis
Thrombosis is the formation of a blood clot. Increased blood flow may disturb the
clot. Thrombosis may become lodged in other areas of the body, brain, heart,
lungs causing serious medical problems.
Phlebitis
Phlebitis is a blood clot in the deep leg veins, called thrombophlebitis, which can
lead to the clot travelling to the lungs. The client may be under medical care and
receiving medication.
Shingles
Shingles is a skin condition caused by the herpes zoster virus and is characterised
by a painful rash that often restricts itself to a particular dermatome on the body
surface and is painful and infectious.
Heart conditions
Increased blood flow may not benefit all heart conditions. A possible other illness
may be present. The client may be on drugs to regulate the heart or thin the blood.
Other body systems may already be depleted and it would be unwise to carry out a
full treatment in case the clients body could not deal with toxins being released into
already overburdened tissue and organs.
Increased temperature
The client may have an infection and increased blood flow could spread an
infection and treatment may release more toxins into the body. The cause of the
increased temperature may be undiagnosed or unclear. The client may already
feel irritated and unwell by the increased temperature and would not benefit from
the treatment.
Cancer
Systems may already be depleted and reflexology would release toxins into already
overburdened organs and tissue. The lymphatic system would be overloaded and
may cause the spread of cancer to other areas of the body. The client may be
unwell due to the type and stage of cancer or other allopathic treatment being
received. Treatment may be carried out on terminally ill clients for pain relief and
relaxation with medical approval.
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Trauma to the foot

If damage has occurred to the structure of the foot it may be too painful to treat.
Broken bones, inflammation and bruising are all contraindicated. The condition
would need to have healed fully before treatment could take place.
Recent surgery
The increase in blood flow would make reflexology unsuitable. There is also a risk
of thrombosis immediately after surgery. The area may also be too painful to touch.
Healing organs should not be stimulated by reflexology.
Medication
Unexpected side effects may occur (allergic reaction); powerful drugs have
powerful side effects. Some drugs alter chemical reactions within the body. There
may be another reason why the client is on medication and this itself may be
contraindicated.
Foot infection
Bacterial, fungal or viral infections may be present which could be passed to the
therapist and other clients. Any increase in the circulation will move the infection
through the body. The area may be painful and inflamed.
Sepsis
Sepsis is a pus filled organism. The client would be too unwell and unsuitable for
treatment. Any increase in the circulation will move the infection throughout the
body quicker.
Pregnancy
It is not recommended that pregnant clients have reflexology, especially in the first
trimester and where there has been a history of miscarriage. Organs such as the
uterus should not be stimulated. Increased blood flow may not benefit all pregnant
clients.
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Special care conditions for reflexology

Special care must be taken in certain circumstances or medical permission sought to
carry out treatments. Each client is an individual and must be treated as such. As you
become more experienced and knowledgeable at assessing a client you will be able to
recognise automatically when to provide treatment and when to adapt the techniques
for each client. Some special care conditions are:
Epilepsy
Epilepsy requires extreme care when working the head and brain areas. Clients
may be on medication. Precise techniques can be used to work areas of
assistance.
Diabetes
People with diabetes have a slower rate of healing, their skin is thinner and bruises
easily and, therefore, less pressure is needed. Careful attention is needed not to
scratch the skin and treatment time may be shorter. Diabetic clients also often
have impaired blood supply to extremities and reduced tactile sensation.
Clients currently undergoing medical treatment

This depends on the individual type of medical treatment and the need for that
treatment. You may wish to ask for GP consent.
High blood pressure

A client may be on medication and there may be other conditions present. You
may wish to seek GP consent before treating.
Low blood pressure

A client may be on medication. They may feel lightheaded and should not be left
unattended. You may wish to seek GP consent before treatment.
Electronic implant
It depends where the implant is fitted and you should adapt the treatment
accordingly.
Arthritic foot
This requires gentle pressure.
Osteoporosis
This requires gentle pressure as bones are fragile.
Broken bones or sprains

This requires gentle pressure or, alternatively, treat the hands.
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1.1
Contraindication
Special care
Place these conditions in the correct column:
High blood pressure
Cancer
Diabetes
Pregnancy
Electronic implant
Epilepsy
Thrombosis
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Medications
It is important to have a working knowledge of some of the more common types of
medication and some of the brand and generic names that are used for them. It is
always a good idea to keep a reference book of drugs in your clinic and refer to it when
necessary. This would be useful prior to treatment if you are concerned about the
effects reflexology may have on medication the client is taking. It is also important to
understand any changes that may be present in the client and their feet as a result of
the medication they are taking. Some medications may change the appearance and
function of the foot and this will need to be explored and checked before treatment
commences. The treatment may need to be adapted or altered to take these changes
into account.
Main categories of medication
The main categories of medication are:
Prescription this is medication that has been prescribed by a doctor or hospital

and should be taken under their guidance and following the instructions given
(remember to include herbal and homeopathic prescriptions)
Over The Counter (OTR) this is medication that can be bought freely without
consulting a doctor or pharmacist and are commonly used
Supplements these can be prescribed by doctors, other health professionals or

bought over the counter and should be noted on consultation
Recreational people do take recreational drugs including illegal ones and some
knowledge of these and their impact on the body is essential.
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Here are some common types of medication, the purpose they are used for and the
brand or generic names by which they are known:
Type of medication
Purpose
Names
Anti-inflammatories
Non-steroidal antiinflammatories are used in

conditions such as
osteoarthritis, rheumatoid
arthritis and other
rheumatic conditions
Ibuprofen, Acelofenac,
Benorylate, Diclofenac,
Naproxen
Anti-coagulants
Help to maintain normal

blood flow in people who
are at risk from clot
formation. They are also
given when a clot is
present but do not
dissolve the clot.
(Thrombolytic drugs are
used to dissolve the clot)
Warfarin, Heparin
Hormonal
Oral contraceptive and

hormone replacement
therapy
Estradiol, Estrone,
Tibolone, Levonorgestrel,
Norgestrel
Diuretics
Most commonly used in

treatment of hypertension
(high blood pressure) by
removing a larger amount
of water from the
bloodstream. The kidneys
reduce the volume of
blood circulating and this
reduces the pressure
within the blood vessels
Bumtanide, Furosemide,
Amiloride, Trimatrene,
Bendroflumethiazide,
Chlortalidone
Analgesics
These are drugs that

relieve pain
Co-codamol, Codeine, Coproxamol, Morphine,

Pethidine, Tramadol,
Aspirin, Ibuprofen,
Mefenamic Acid,
Paracetamol
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It is important to discuss with your client prior to treatments commencing their reasons
for seeking treatments and their expectations of the course of treatments.
When consulting with a client it can be helpful to:
record their experience of any previous treatments they have had
get a clear understanding of what they would like to achieve from the treatments
find out their reasons for seeking treatments
explain any limitations to treatment, ie not treating specific conditions,

contraindicated or special care conditions.
Throughout a course of treatments it is important to discuss with your client any

feedback at the end of each session and at the start of the subsequent one. At the end
of a course of treatment it is always a good idea to ask the client for feedback on the
course of treatments.
The reasons for doing this are:
to ascertain the satisfaction level of the client
to monitor and record progress made throughout the course of treatments
to ensure that the objectives the client set have been met
to provide reflective feedback for the therapist and indicate any changes that may
need to be made.
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Each consultation document should have a follow up sheet attached for each
subsequent treatment. At the start of each treatment the client and their feet should be
reassessed and changes recorded. In this way the original consultation will act as a
standard by which changes can be gauged and recorded.
Each treatment may or may not show changes in the feet and the client and this can
aid the therapist in assessing the effectiveness of the treatment and help to identify
areas where there may be imbalance.
1.4
Why is it important to record the condition of the client and their feet and how will these
help you to build a picture of treatments?
A Client Consultation Sheet is included as a student file in the appendix for your use
throughout this unit.
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1.1
1. Explain what holism is.
2. Name four things you would look at on the feet when assessing them.
3. What kind of questions should be included in the consultation sheets? Think about
the things listed below, which ones should be included and why?
Date of birth
Favourite colour
Fluid intake
Sleep pattern
Occupation
Contraceptives
Medication
Religion
Ethnic origin
Marital status
Exercise
Medical
conditions
Reasons:
4. What is the difference between a contraindication and a special care condition?
5. Who discovered the main theory that reflexology is based on and who went on to
develop the treatment and map the reflexes of the feet?
When completed, submit this assignment to your tutor for marking and feedback.
Please remember to include your name, contact details and your tutors name on your
submitted work.
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This section has introduced you to what reflexology is, how it has developed into the
therapy it is today and what theories it is based on. The purposes and processes of
reflexology were outlined and described. The need for client assessment and foot
analysis were set out as were the reasons a therapist needs to carry out these
activities.
Contraindications and special care conditions were listed along with any appropriate
action the therapist needs to take. The need for treatment objectives and limitations
were discussed and the need for comparison of subsequent treatments was outlined.
A client consultation sheet is supplied as a separate file in the appendix and this can be
used when treating clients for case studies later in this unit. This section has
introduced you to the theory and practice of reflexology as well as some of the skills
you will need as a practitioner.
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Answer to SAQ 1.1
Reflexology is based on Zone Theory or Meridian Theory.
Zone Theory 10 longitudinal zones running down the body, there are 5 on each side
of the body from the midline.
Meridian Theory based on the TCM concept of 12 main meridians that carry the chi
or energy in the body and are associated with the organs and structures of the body.
Each theory works on the premise that, by working the reflexes of the feet, any
associated organs and structures within the zone or meridian area will be affected and
may benefit from the treatment.
Answer to SAQ 1.2
Reflexology can be performed on the hands, ear and face with appropriate training.
Answer to SAQ 1.3

Client assessment is essential when treating as it is important to gain a full medical
history for the client as well as lifestyle and emotional information. In this way it is
possible for the therapist to assess the needs of the client and then carry out the best
treatment for the client.
Answer to SAQ 1.4
It is important to have a record of the client and their feet at the outset of treatments to
mark progress and the effect of the treatments. The foot analysis should be recorded
on the consultation sheet and any changes marked each week after treatment which
will allow the therapist to gauge the changes taking place and any associated benefits.
This will help the therapist to assess the impact that reflexology treatments are having
and decide if there is any need to adjust the treatment or techniques to aid the client.
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Answer to activity 1.1
Contraindication
Special Care
Cancer
High blood pressure
Electronic implant
Thrombosis
Epilepsy
Pregnancy
Diabetes
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Section 2: Preparation for treatments
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This section is about:
the preparation of the treatment environment/equipment/the client and yourself
the position and comfort of the client
health and safety.
Objectives
By the end of this section you should be able to:
ensure the treatment environment is clean, warm and relaxing for the client
prepare equipment in accordance with good practice
correctly position couch and stool to ensure good posture and freedom of
movement
ensure your personal presentation is to a high standard in terms of appearance and

hygiene
position and cover the client to ensure comfort and enable treatment to be
performed.

No other resources in addition to the learning materials in this section are required.
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This section will form part of the two closed-book papers of ten extended response
questions in supervised conditions. In addition, 4 case studies of 6 treatments each
will be carried out with one observation completed by your tutor or qualified practitioner.
A reflective account should accompany the 4 case studies showing the learning
achieved and assessments made.
information.
You have to achieve 70% pass marks in each of the two exam papers and produce 4
opportunity.
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Preparation for reflexology treatment

Equipment
Different equipment will be used depending on where the treatment takes place. It is
not always possible to carry a treatment couch with you and therefore as a therapist
you must be able to adapt your treatment to the environment. A portable reflexology
chair is useful and can be stored and carried much easier than a couch. Other
equipment includes:
Couch roll to cover the pillows, bed and towels during treatment to ensure the bed
is clean and ready for each new client
Foot support for under the clients feet to raise them to the optimal working height
Pillows to ensure the client is well supported throughout the treatment
Pillow cases to cover the pillows and ensure a clean environment for the client
Towels to cover the bolster and the clients feet
Blanket to put over the client if they feel cold
Tissues to have to hand in case the client becomes emotional
Cream to use as the treatment agent on the feet
Wipes to wipe the feet prior to treatment
Consultation sheet to record the treatment session
Pen always have 2 with you in case one fails to work
A watch or clock to ensure you keep to time as you may have another client
waiting
A glass of water for the therapist and one for the client.
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The therapist
Clothes
The therapist should be dressed appropriately for the clinical environment. This may
include tunic, trousers and flat shoes. They should allow for ease and range of
movement for the therapist. As the therapist moves round the feet during treatment
there should be no areas of restriction. In particular, when elbows or shoulders are
raised the therapist needs a good range of movement and be able to maintain comfort.
Hair
Long hair should be pulled back out of the eyes to make sure the therapists view of the
feet is not hampered throughout the treatment. The hair should also not come into
contact with the feet and tying it back ensures this does not happen.
Nails
Nails need to be short and clean. They should be cut as short as possible then filed to
ensure that any rough edges are removed as this can cause the client pain or
discomfort during treatment. Nail enamel should not be worn.
Hands
Hands should be washed thoroughly before touching the feet. It is also important to
ensure they are dried thoroughly to ensure cleanliness at all times.
Working environment
The treatment couch or chair should be height adjustable to ensure the therapist is
working at the optimum height that will allow safe access to all areas of the feet. A
stool or chair with wheels is recommended as it allows for movement throughout the
treatment to gain access to reflex areas while remaining in the correct postural position.
It is best to ensure that all areas of the feet are accessible before treatment begins as
adjusting the height of the bed or stool once started can interrupt the flow of the
treatment.
Trolley
It can be helpful to have a trolley at the side of the treatment couch with the items the
therapist will need throughout treatment. Ideally this should also be on wheels so it can
be moved throughout the treatment too. All items needed should be placed on the
trolley prior to treatment commencing so that the therapist does not need to break
contact with the foot which interrupts the flow of treatment and can disturb the client.
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Jewellery
Jewellery should be removed before treatment, particularly rings or bracelets that may
hurt the client. This is good practice for hygiene reasons too.
2.1
When carrying out a treatment what steps would you take to minimise the possibility of
cross-infection?
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Position and comfort of the client

Explanation of treatment
It is important to explain the reflexology treatment to the client and some of the
principles of reflexology as part of the consultation. Painful reflexes should be
explained as areas where there are corresponding painful/congested areas on the
body or imbalances in the bodys energy. Explain that this is a common reaction to
reflexology treatment and note any area and reaction on the consultation sheet. The
consultation should take into account medical history, lifestyle, contraindications and
any specific complaints. Remember to record any reactions the client has throughout
the treatment as you may not be able to ask questions of the client if they are relaxed
or sleeping. There may be verbal and non-verbal reactions to treatment such as
pulling a face, wincing, pulling or jerking of the foot or body.
Positioning the client
When using a treatment couch it is best to have the client semi-reclined as this allows
them to relax while allowing the therapist to observe the clients face. If using a
reflexology chair the position is set and the client will be in a semi-reclined position.
The client should have ample support at the head and neck from pillows and under the
thighs to support the lower back. It is helpful to use a bolster or rolled up towel under
the ankles to ensure the feet are in the optimum position for the therapist to access
them throughout the treatment. A blanket should be offered to the client as their
temperature can drop as they relax during the treatment. Clients should be asked if
they need to visit the toilet before the treatment begins to minimise potential disruption
to the treatment.
Treatment environment
The best place for a treatment to take place is a private treatment room within a clinic,
although if treating at the clients home this can be adapted to suit. Treatment rooms
are not always available and therefore it is often necessary to carry out a treatment in a
private area that is screened by curtains. The therapist should be aware of the impact
this may have on treatment and will need to ensure their clients comfort and
confidentiality at all times. It is the therapists duty to create a therapeutic space
wherever the treatment takes place.
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2.2
What benefits are there from spending time explaining the treatment process to a
client?
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Health and safety

It would be beneficial to familiarise yourself with current Health and Safety Legislation.
The Health and Safety at Work Act, 1974 and Control of Substances Hazardous to
Health Regulations, 2002 are the minimum it is recommended that you look at. Both
are available from the Health and Safety Executive website www.hse.gov.uk
There are several factors the therapist will need to consider when carrying out
treatments whether at home or within a clinic setting. These include:
temperature
lighting
hygiene
washing and toilet facilities
privacy.
Temperature
The temperature of the treatment room is important for both the client and the therapist.
If the room is too hot it will be difficult for the therapist to stop from becoming lethargic
and tired. Also, clients will overheat and become uncomfortable and irritable. If the
room is too cold the client will not relax and will not enjoy the treatment. The therapist
will also become uncomfortable and will not perform the best treatment possible. A
room temperature of between 20C and 25C is ideal and any heating should have a
thermostatic control to accommodate seasonal changes. It would be beneficial for
there to be natural ventilation via a window or adjustable air vents.
Lighting
Lighting can make a huge difference to the ambience of the treatment room but there
are also other considerations. The client needs to feel they can relax and not have a
light directly in their face; however the therapist needs to be able to see the feet clearly.
The ideal solution is a dimmer switch overhead and a lamp that can be positioned by
the therapist at the clients feet.
Hygiene
Reflexology uses very little equipment but that which is used must be kept clean and
hygienic. Towels, blankets, pillow cases and couch covers should be changed after
each client to ensure cleanliness. As this can be costly it is recommended that paper
couch roll be used which will reduce the amount of times the couch cover and pillow
cases need to be changed. Fresh towels should be used for each client. It is important
to be aware of the potential for cross-infection and the therapist must wash their hands
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prior to touching the clients feet and immediately after the treatment is finished.
Plasters should be kept to cover corns or verrucas on the feet. The premises should
be kept clean and germ free at all times, as should all surfaces such as sinks and
floors. A therapist may decide not to treat a client who has a contagious condition of
the feet.
Washing and toilet facilities

There should be access to toilet facilities for the client and therapist within the clinic or
home. There should be access to hand washing facilities and clean towels or paper
towels for client and therapist use. Hands should be washed after using the toilet to
prevent any germs being passed between clients and the therapist. In addition, there
should be adequate laundry facilities and an adequate supply of the linen required for
the clients that will be seen that day.
Privacy
Clients need to feel that they are free to disclose their personal details. Total privacy
should be a priority. The client only has to remove shoes and sock for reflexology but
this is still a big deal for some clients and if the treatment room is not private a curtain
should be drawn round the client when they enter the treatment area. This will ensure
the area is appropriate for the treatment to be carried out and encourage the client to
relax and get the best out of the treatment.
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2.1
1. Name the equipment you will need to carry out a reflexology treatment within a
clinical environment.
2. Why is it important to discuss the clients expectations of reflexology before

treatments begin?
3. The therapists hands and nails are important to the treatment; explain how they
should be when treating a client?
4. When thinking about the health and safety aspects of the treatment area and
therapists, what things should be taken into consideration?
submitted work.
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This section has focused on the way the therapist needs to prepare for a treatment and
the equipment and procedures needed to achieve this. How to approach the client was
explained and how to position the client to ensure maximum comfort so that the
treatment is as effective as possible. Health and safety has been discussed and the
things that the therapist will need to think about, manage and adhere to before, during
and after treatment. This section has also introduced the equipment that will be
needed and the need for the therapist to be able to create a therapeutic space
wherever the treatment is being carried out.
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Answer to SAQ 2.1
The therapist should always ensure that the treatment area is as clean as possible.
This means that each client should have freshly laundered linen and towels and the
couch roll should be replaced for each client if it is being used. The therapist should
always wash their hands thoroughly before touching feet and should wipe the feet with
wipes prior to touching them for the first time. When assessing the feet the therapist
should be looking for any signs of infection or contagious conditions, eg athletes foot,
and decide whether or not to proceed with the treatment. The therapist should wash
their hands thoroughly at the end of the treatment before touching anything else.
Answer to SAQ 2.2
The time taken to explain the treatment and some background to reflexology is that it
allows for a more in-depth observation and assessment of the client. It also allows the
therapist to build a rapport that will aid the therapeutic relationship. It can put the client
at ease by demystifying the treatment and allows them time to ask questions should
they want to.
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Section 3: Performing treatments
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the timing, sequence and duration of treatment
relaxation techniques effleurage, petrissage, mobilisation techniques
foot support
reflexology techniques thumb and finger walking, hooking, pointing
location of body organs
the physiology of body systems
the possible effects on the body systems
the structure of the foot, ankle and lower leg
reflex points
safe and effective treatments.
Objectives
By the end of this section you should be able to ensure that treatment is appropriate in
terms of timing, sequence and duration. This includes the following:
apply techniques appropriate to the client
support the foot throughout the treatment
identify tenderness in reflex points in the foot
record position and degree of tenderness in the reflex points using a scale and
diagram
define cross-reflexes
explain possible reactions during the treatment to the client
maintain a safe and effective treatment when diseases and disorders are
presented.

This section should take approximately 30 hours study time, including time needed for
practical activities.
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In addition to the text in this section you will require the following:
coloured reflex map of the feet a good example can be downloaded from
http://www.reflexology-research.com/footchart.html
clinical space and equipment to carry out a treatment.
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information.
You have to achieve 70% pass marks in on each of the two exam papers and produce
4 client consultation documents that show the process and treatments of 4 clients for 6
opportunity.
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Timing, sequence and duration of treatment

The treatment should be carried out appropriate to the clients needs. The average
time it will take for a consultation will be from 20-30 minutes prior to treatment
commencing. On subsequent treatments it is good practice to ask for feedback prior to
the treatment commencing. This should take approximately 5-15 minutes depending
on what the client has to tell you. The treatment itself should take between 40-60
minutes, although to begin with it may take a little longer. Practice makes perfect and,
once proficient, a consultation and treatment can be done in 1 hour. It is up to the
client and therapist to agree the length of a course of treatment but it is often beneficial
to have at least 4 consecutive weekly treatments in order to see any significant
changes and benefits from the treatments.
Treatment sequence
1. Introduction to the feet and application of cream
2. Relaxation techniques (minimum of 3 techniques)
3. Solar plexus
4. Diaphragm
5. Plantar thoracic
6. Heart
7. Breast dorsal (including lymphatic drainage)
8. Sinuses
9. Thyroid/great toe
10. Eyes/ears/thymus
11. Upper GI
12. Lower GI
13. Pelvic
14. Lymph/groin/fallopian tubes
15. Chronic pelvic area
16. Spine
17. Musculature of the spine
18. Leg/hip/knee
19. Endocrine (may be used for treatment or balance)
20. Grounding techniques (hacking, feathering)
21. Close treatment.
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3.1
What is the average time for a consultation and treatment once you are a proficient
therapist?
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Relaxation techniques
It is a good idea to include some relaxation and warm up techniques in every
treatment. In order to maximise the treatment the feet need to be introduced to the
therapist's touch and also to the work that is about to commence. The therapist can
also assess the tone and structure of the feet at this stage.
It is suggested that three or four of the following moves are included in the treatment.
Use whichever ones you prefer or which you think would suit your client.
Foot brushing
Using the flat palms and fingers, brush the foot surface in one direction. Remove the
hands and repeat on another surface. For the medial aspects of the foot use the flat
back of the hand.
Foot rotations
Holding the heel firmly in the palm of your supporting hand, grip lightly just below the
toes and rotate the foot clockwise 6 times then anti-clockwise 6 times.
Wringing
Using the hands on the medial aspect of the foot, wring the foot from the ankle to the
toes and back again. This is a surface move and should not drag over the skin.
Tapping
Using the fingertips, tap all over the foot surfaces.
Metatarsal relaxation
This move is carried out on the dorsal surface of the foot. Using your thumbs to
support at the solar plexus, use your first two fingers of both hands to walk/glide down
the intertarsal spaces from the toes webbing to the ankle work only in a downward
direction.
Spinal twist
Using your supporting hand, grip the ankle firmly on the medial edge and with the other
hand twist the foot away from you, working the medial edge from the ankle up to the
toes. This is similar to wringing but is a firmer move and the foot should be well
supported as this opens up the spinal area.
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Ankle rotations
Place your thumbs in the small indent at the front of the ankle with your hands on the
malleolus on each side of the ankle. Using the knuckles of the index finger rotate
clockwise round the malleolus together and then repeat anti-clockwise.
Feathering
Using your fingertips in a firm manner, pull the hands up over the feet in an upward
motion working from the ankle up to the toes on plantar and dorsal surfaces.
Hacking
The hand should be flat for this move with fingers together. Using the lateral edge of
your hand, hack over the feet this is like a loose karate chop move and should
come from the wrist with only the top third of the hand making contact. This is a great
move for grounding the client and reducing the feeling of light-headedness and a good
move to finish on.
These moves can be mixed and matched and should always be included at the start
and finish of a treatment.
3.2
Why is it important to perform relaxation moves on the feet at the start of treatment?
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Reflexology techniques
When carrying out reflexology treatments it is important that nails are cut very short
and filed to remove any areas of roughness. Skin around the nails should be smooth
and callous free. When using the reflexology techniques the thumb is pressed into the
foot on the medial edge and if nails are long this can cause pain, discomfort and even
damage to the foot. The hands should be soft, pliable and free from warts, infection or
cuts. Hands and nails should be clean at all times.
Wiggle
The main technique is the wiggle which is performed with the medial aspect of the
thumb. To find the medial aspect, place the hands palm down on a flat surface. The
edge of the thumb that is farthest from the fingers is the medial edge (when the palms
are flat on the surface the thumb will naturally lie on the medial edge). To wiggle, the
thumb lies on the working surface and is bent at the first joint of the thumb and moves
forward in bite-sized caterpillar movements so that the thumb moves forward with
each bite. (A bite is the tiny forward movement that occurs when the thumb is bent and
moved forward as described above.)
The pressure used will depend on the reflex area being worked but can be from a very
light pressure right up to a heavy pressure when hooking or pointing. The pressure
should always be within the clients tolerance.
This move is the most important and frequently used and should be practised on your
own using a flat surface, your forearm or other hand. You will need to be able to use
both thumbs to do the wiggle and practice is essential especially in your less dominant
hand.
The wiggle is a slow move to start with until some experience allows you to move more
quickly over an area. As you practise, the bites that your thumb takes will be smaller
and smaller and the wiggle will become more refined. As you perfect this move you will
feel the responses in the feet more keenly. The sensitivity of the thumb increases and
more information is picked up from the feet areas being worked.
Each reflex area is usually worked three times with a wiggle. (More information is
contained in the reflex descriptions later in the section.)
If pain is felt when wiggling over an area it can be beneficial to stop and hold the area
for a count of 6 breaths to see if the pain passes. When the pain or tenderness is
chronic it can be beneficial to use other techniques such as pointing, etc.
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Finger walking and reinforced finger

Finger walking is where the flat pad of the index finger is used to treat, instead of the
thumb. This is used on the breast dorsal, eyes and ears and fallopian reflexes. The
move should still employ a wiggle and cover the reflex thoroughly.
Reinforced finger is the same thing but the middle finger is placed on top of the index
finger nail to apply more pressure and stability.
Hooking
Hooking is carried out on the ileo caecal valve, sigmoid colon and pituitary reflexes.
The thumb tip is used and is applied vertically to the reflex and pushed in with some
pressure. The thumb then hooks under the flesh towards the mid-line (for pituitary
more information is contained in the reflex descriptions). It is best to hook three times
to the midline. This can be uncomfortable for the client so proceed with care.
Pointing
To perform pointing the foot is firmly grasped round the shoulder line (at the bottom of
the toes) by the holding hand. The thumb of the working hand is then pressed firmly
into the tender reflex in a squeeze action. The foot is then circumducted by holding
the hand in a circular motion. This gives the benefit of a varying pressure. As the foot
is rotated the thumb should be slackened off or increased while it remains pressed in
on top of the painful reflex. Six clockwise and six anti-clockwise rotations are sufficient
to treat with this method. Having treated the area the thumb is moved to the next area
and the technique can be reapplied if necessary. This technique is used for plantar
reflexes.
Pointing in the eyes and ears is carried out with the tip of the index finger rocked back
and forth with pressure over the reflex.
Dorsal reflexes also use the index finger but the foot is circumducted as per the plantar
reflexes.
Pointing should not be used on the sinus or pituitary reflexes and care must be taken
when pointing on the endocrine reflexes.
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3.3
1. What is the most important and most frequently used technique?
2. Name 2 reflexes that this move would be used on.
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F1BD 34
Structure of the foot

The foot has three main functions which are support, leverage and propulsion. We
would not be able to move in different directions efficiently if the feet were not
structured in the way they are.
Bones of the foot
There are 26 bones in each foot. These are:
Tarsals
This is the name given to the group of seven bones, two large and five smaller
bones which support the weight of the body. They are calcaneum, talus, navicular,
cuneiforms and cuboid.
Calcaneum
This is the heel bone and the largest in the foot. It articulates above with the talus
and anteriorly with the cuboid.
Talus
This is superior to the calcaneum and the second largest bone. It articulates with
the medial and lateral malleolus above, anteriorly with the navicular and below with
the calcaneum.
Navicular
This is on the medial side of the tarsus. It articulates with the talus posteriorly, the
cuboid laterally and anteriorly with the three cuneiform.
Cuneiform
There are three cuneiform bones; medial, intermediate and lateral. They articulate
posteriorly with the navicular and anteriorly with the 1st, 2nd and 3rd metatarsals.
Cuboid
This is anterior to the calcaneum and lateral to the navicular and cuneiform. It
articulates posteriorly with the calcaneum, medially with the navicular and
cuneiform and anteriorly with the 4th metatarsals.
Metatarsals
This is a group of five long bones which form the upper dorsal of the foot. They join
the tarsus with the phalanges. The 1st, 2nd & 3rd articulate posteriorly with the
cuneiform and the 4th and 5th with the cuboid.
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Reflexology
F1BD 34
Phalanges
The big toe has two bones while the other toes have 3; the proximal (1st and
nearest to the metatarsals), the intermediate (2nd and in the middle) and distal (3rd
and the tip of the toes).
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F1BD 34
3.1
1. There are _______ bones in the feet
2. The big toe has only ____ phalange bones
3. The 3 cuneiform are called ______, intermediate and _________
4. The heel bone is called the __________________
5. The group of 5 long bones are called the ____________
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Reflexology
F1BD 34
Structure of the lower leg

Bones and joints
The lower leg has two bones. The tibia is the larger of the two and is medial. The
fibula is the smaller bone and it is located on the lateral side of the lower leg. The
distal end of each bone creates the malleolus, the tibia the medial malleolus and the
fibula the lateral malleolus.
Muscles
The lower leg is divided into four compartments, these are:
the anterior compartment
the lateral compartment
the posterior compartment
the deep posterior compartment.
The anterior compartment

The anterior compartment holds the tibialis anterior, the extensor digitorum longus, the
extensor hallucus longus and the peroneus tertius muscles. These muscles dorsiflex
the foot and toes (pull the foot and toes upward). The tibialis anterior is also involved in
turning the foot inward.
The lateral compartment
The lateral compartment holds the peroneus longus and peroneus brevis muscles.
These muscles pull the foot outward. They also help with plantar flexion (pointing the
foot).
The posterior compartment
The posterior compartment holds the calf muscles the gastrocnemius and soleus. It
also holds the plantaris muscle. The gastrocnemius is shorter, thicker and has two
attachments (inner and outer). It is the most visible of the calf muscles. The soleus
lies underneath. These three muscles attach to the Achilles tendon. They all aid with
plantar flexion.
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The deep posterior compartment

The deep posterior compartment holds the tibialis posterior, flexor digitorum longus and
flexor hallucus longus. Tibialis posterior pulls the foot inward, flexor digitorum longus
flexes the toes and flexor hallucus longus flexes the big toe. All three assist plantar
flexion.
Other terms and groups of bones
Ankle joint
The medial and lateral malleolus are the bottom ends of the bones of the leg, ie tibia
(medial malleolus) and fibula (lateral malleolus).
Medial longitudinal arch
This is the first three metatarsals. All three are cuneiform, navicular, talus and
calcaneum.
Lateral longitudinal arch
This is the fourth and fifth metatarsals. They are cuboid and calcaneum.
Proximal transverse tarsal arch
This is cuboid. All three are cuneiform.
Posterior transverse metatarsal arch
This is five proximal metatarsal heads.
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3.2
Fill in the names of the two leg bones in the first row of each column below and the
blanks spaces in the muscles in the column relating to each bone.
peroneus ________
extensor __________ longus
_________ tendon
________ brevis
_______ hallucus longus
tibialis _________
Cross-reflexes
The foot also has cross-reflexes where areas of the body are energetically reflected to
other areas of the body (and foot). These are worked if the area of treatment is too
tender or if there is a chronic problem which would benefit from being worked in more
than one area.
These energetically linked areas are:
Shoulder hip
Elbow knee
Wrist ankle
Big toe thumb
Foot hand
Top of foot back of hand
Sole of foot palm of hand.
In addition to the longitudinal zones there are also transverse zones which are
represented by four transverse lines on the feet. The shoulder line transverses the feet
at the base of the toes in zones 1 to 5, following the phalangeal metatarsal joints. The
diaphragm line is the same as the diaphragm reflex and transverses the feet below the
ball of the feet from zone 1 to 5. The waistline transverses the feet in line with the base
of the metatarsal bones, just above the bladder reflex from zones 1 to 5. The pelvic
line transverses the feet between the tarsals and calcaneum from zones 1 to 5.
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F1BD 34
Reflexology points
All treatment should start on the left foot as this is the foot that receives energy. All
reflexes should be covered on the left foot then repeated on the right. It will be
necessary to treat both feet at the same time when carrying out some of the balance
sequences. The right foot expels any excess energy.
Clinical application of reflexes
(More information on these applications can be gained from reading Crane 1997)
Diaphragm:
to commence treatment and encourage relaxation of the client
to relax the muscles and structures of the thoracic cage
to help breathing and digestion
to promote the movement of energy
Plantar thoracic:
to enhance relaxation
to assist with breathing difficulties if present
to enhance the respiratory rhythm of the client
to help reduce diaphragm and thoracic tension aiding cardiac function
Breast dorsal:
to assist clients with respiratory problems
to help reduce fluid retention linked to the menstrual cycle
to help alleviate pre menstrual syndrome
to assist circulation of breast and thoracic lymph
Sinus:
to assist with upper respiratory conditions
to alleviate pain in the facial area caused by sinus congestion
to assist with the relief of any symptoms of allergies
to clear congestion in the nasal cavities due to colds, etc
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F1BD 34
Great toe/thyroid:
to help alleviate stress levels
to help ease headaches and migraines
to help reduce anxiety and tension
to assist with problematic sleep patterns
to improve and aid circulation
Ear:
to help with sinus problems
to help with toothache
to assist with hearing problems and disorders
Eye:
to help with sinus problems
to help with eye conditions or infections
to assist with headaches and migraines
to help with tooth problems
Thymus:
to aid the production of lymph tissue
to stimulate the immune system
to support the elimination of infections
to promote endocrine function
Upper GI:
support digestion
to aid relaxation
to encourage the elimination of toxins from the body
to aid digestive problems
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F1BD 34
Lower GI:
to support digestion
to stimulate elimination
to promote mucus production
Pelvic:
to support treatment and management of lower back pain
to assist with effective movement patterns and skeletal alignment
to promote and support reproductive function
Spinal:
to support treatment and management of musculo-skeletal pain
to support integrated functioning of organs and body systems
Leg/hip/knee:
to help with muscular pain
to help with lower back pain
Endocrine:
to maximise endocrine function
to stimulate the immune system
to reduce stress levels
to assist reproductive function
to help with digestive problems.
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Reflexology
F1BD 34
Reflexes, surfaces, zones and treatments

The following table lists surfaces, zones and treatments for each of the reflexes shown:
Reflex
Solar
plexus
Surface
Zone
Treatment
Plantar
surface of
both feet
This move is done on both feet at the same time

and each hand supports and treats at the same
time. Using the thumb to locate the reflex just
below the diaphragm line, place the thumb on
the reflex while using the fingers on each hand
to support the foot round the lateral edge onto
the dorsal surface.
Push into the reflex three times asking your
client to breathe in as you push in and breathe
out as you release. It is beneficial if the
therapist also does this as it helps to centre and
ground as well as set the tone for the treatment.
Diaphragm Plantar
surface of
both feet
1-5
Location appears on both feet and follows a

line across zones 1 to 5 and is proximal to the
ball of the feet.
Supporting hand place this hand with fingers
over the dorsal surface and the thumb under the
toes on the plantar surface and hyper extend the
foot.
Working hand working from medial to lateral
edge use medial aspect of the thumb to wiggle
across the metatarsal heads.
Plantar
thoracic
Plantar
surface of
both feet
2-5
Location under the shoulder line and above

the diaphragm line in zones 2-5 on both feet.
Supporting hand place the hand on the
dorsal surface and use the index and middle
finger to separate the toes when working
between the metatarsal spaces. The thumb
supports each toe on the plantar surface.
Working hand use the medial hand and work
from medial to lateral edge of the foot. Using
the medial edge of the thumb wiggle start from
zone 2 and work up the metatarsal spaces from
the diaphragm line to the toe webs. Cover the
move three times. Repeat from lateral to medial
in the metatarsal spaces. Then cover the area
again from medial to lateral with the flat of the
thumb on the flat of the metatarsals.
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Reflexology
Reflex
Heart
F1BD 34
Surface
Zone
Plantar
surface of
left foot
Treatment
Location located on the plantar surface in
zone one proximal to the big toe. It is situated
below the shoulder line and above the
diaphragm line on the left foot (there is a small
section of the heart reflex on the medial border
of the plantar surface of the right foot).
This reflex is treated using a cross hatching
technique.
Supporting hand the fingers rest on the
dorsal of the foot and the thumb on the plantar
surface of the 2nd toe.
Working hand the fingers of this hand rest on
top of the supporting hand and the medial edge
of the thumb is used to cover the area in vertical,
horizontal and diagonal strips.
Breast
dorsal
Dorsal
surface of
both feet
1-5
Location this is on the dorsal aspect of the

foot and covers zones 1 to 5. It is located
between the shoulder and diaphragm line.
Supporting hand either this is formed into a
fist and pressed into the plantar thoracic area or
the thumb is placed on the dollar plexus reflex
and pressure applied to open up the metatarsals
on the dorsal surface and the fingers of this
hand are placed on the edge of the dorsal
surface.
Working hand working from medial to lateral
use reinforced index finger to walk from the toe
webs to the end of the metatarsals. Do three
passes and then repeat lateral to medial.
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Reflexology
F1BD 34
Reflex
Surface
Zone
Lymphatic
drainage
Dorsal
surface of
both feet
1-5
Treatment
Location the same area as the breast
dorsal reflex.
Supporting hand form a fist and place this
on the plantar surface over the ball of the
foot.
Working hand work from lateral to medial
edge and using all 4 fingertips march across
the breast reflex three times.
Sinus
Plantar
surface of
the toes
2-5
Location toes 2-5

Supporting hand hold fingers against the
dorsum of the toes to provide support.
Working hand work from medial to lateral
on each toe using the flat of the thumb.
Cover the toes in strips from the bottom of
the toe to the tip. Cover toes 2-5 then repeat
from lateral to medial toes 5-2.
Sinus
Medial/
lateral
surfaces
of the toes
2-5
Location toes 2-5

Supporting hand place this flat against
the dorsum of the toes to support the
working hand.
Woking hand use the flat of the thumb
and index finger to work in strips down the
medial and lateral edge of each toe in turn
each toe will only need 2 or 3 strips to cover
this area.
Sinus
Dorsal
surface of
the toes
2-5
Location toes 2-5

Supporting hand the thumb should
provide support against the plantar surface
of each toe being treated.
Working hand rest the thumb against that
of the holding hand and use the index finger
to cover the dorsal surface of each toe in
strips.
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Reflexology
Reflex
Thyroid
F1BD 34
Surface
Zone
Treatment
Plantar
surface of
both feet
Location this reflex is located between the

base of the big toe and the interphalangeal
joint.
Supporting hand use the index finger and
thumb to separate the toes.
Working hand use the medial edge of the
thumb to cross hatch this area vertically,
horizontally and diagonally. As this is such a
small area the wiggle will need to be very
slow and small.
Great toe
Plantar
As per sinus reflexes
Great toe
Dorsal
As per sinus reflexes
Eyes, ears
and
thymus
Plantar
surface of
both feet
1- 5
Location along the ridge at the bottom of

the toes where they meet the foot.
Holding hand hold the foot across the
metatarsals on the dorsal surface and place
the thumb on the plantar surface.
Working hand this hand adds support to
the supporting hand by resting on top of it on
the dorsum. The index finger is used to
wiggle along this reflex from medial to lateral
then lateral to medial three times.
Reinforced finger can also be used if
preferred.
Upper GI
Plantar
surface of
both feet
1-5
Supporting hand support the foot by

placing the fingers on the dorsum and the
thumb on the plantar thoracic area. The foot
may be gently hyper extended to allow
access to the reflex area.
Working hand using the medial hand, work
from medial to lateral edge using the fingers
to support the medial edge of the foot while
cross-hatching the reflex area using the
medial edge of the thumb. Work in vertical,
horizontal and diagonal strips.
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Reflexology
Reflex
F1BD 34
Surface
Zone
Treatment
Organs of
the upper
GI
Spleen
Left foot
plantar
4/5
Location below the diaphragm line

between zones 4 and 5.
Stomach
Left foot
plantar
1-4
Location lies below the waistline in zone 1

and between the waistline and the diaphragm
line in zones 2-4.
Left foot
plantar
1-3
Location this lies behind the stomach

reflex above the waistline on the medial edge
in zones 1-3.
Pancreas
Left foot
plantar
2-3
Location lies above and below the

waistline towards the medial edge in zones 2
and 3.
Kidney
Left foot
plantar
1-2
Location directly above the kidney towards

the medial edge in zones 1 and 2.
Adrenal
Right foot
plantar
1-5
Location covers the whole area between

the diaphragm and waistline in zones 1-5.
Liver
Left Foot
1-2
Location lies between the diaphragm line

and waistline towards the lateral edge in
zone 4.
Gall
bladder
Right foot
plantar
Location lies between the diaphragm line

and waistline towards the lateral edge in
zone 4.
Kidney
Right foot
plantar
2-3
Location Lies above and below the

waistline towards the medial edge in zones 2
and 3.
Adrenal
Right foot
plantar
1-2
Location directly above the kidney towards

the medial edge in zones 1 and 2.
Pancreas
Right foot
plantar
Location a small section is located on the

medial edge of zone 1 immediately above
and below the waistline.
Stomach
Right foot
plantar
Location a small section of the stomach is

located in zone 1 above and below the
waistline on the lateral edge of the pancreas.
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Reflexology
Reflex
Lower GI
F1BD 34
Surface
Plantar
surface
of both
feet
Zone
Treatment
1-5
Supporting hand support the foot by

placing the fingers on the dorsum and the
thumb on the waistline. The foot may be
gently hyper extended to allow access to the
reflex area.
Working hand using the medial hand work
from medial to lateral edge using the fingers
to support the medial edge of the foot at the
malleolus while cross-hatching the reflex area
using the medial edge of the thumb. Work in
vertical, horizontal and diagonal strips. When
doing diagonal strips the flat of the thumb can
be used.
Organs of
the lower
GI
Descending Left foot
colon
plantar
Location lies in zone 5 between the pelvic

line and the waistline.
Sigmoid
colon
Left foot
plantar
Location directly above the pelvic line in

zone 4 (a hooking technique is used here
which is described earlier in the pack).
Rectum/
anus
Left foot
plantar
1-2
Location above the pelvic line in zones 1

and 2 and onto medial border of the foot
below the bladder reflex.
Ileocaecal
valve
Right foot
plantar
Location lies above the pelvic line towards

the lateral edge in zone 5 (a hooking
technique is used here which is described
earlier in the pack).
Ascending
colon
Right foot
plantar
Location lies in zone 5 from the ileocaecal

valve upwards to the waistline.
Transverse
colon
Both feet
plantar
1-5
Location runs across all five zones from

the lateral edge of the right foot to the lateral
edge of the left foot (connects to ascending
colon on right foot and descending colon on
left foot).
Small
intestine
Both feet
plantar
2-4
Location lies within the boundaries of the

ascending, transverse and descending colon
in zones 2 to 4 of both feet and cover a
significant part of the lower GI area.
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Reflexology
Reflex
Pelvic
F1BD 34
Surface
Zone
Treatment
Both feet
medial
Location the lower part of the foot to

anterior the malleolus and inferior to the
Achilles tendon.
Lateral
both feet
Supporting hand support the foot placing

the fingers of this hand over the dorsum
and the thumb on the plantar at waistline
level.
Plantar
both feet
1-5
Working hand cross-hatch this area in

vertical, horizontal and diagonal strips using
the medial edge of the thumb to wiggle.
Work immediately inferior to the malleolus
and inferior to the achilles tendon, using
fingers to support the heel.
Use the same technique on the lateral
surface swapping supporting and working
hand for comfort.
These areas are worked as part of the
lower GI reflex.
Lymph,
groin,
fallopian
tube
Medial,
lateral and
dorsal of
both feet
1-5
Location inferior to the malleoli up

towards the dorsal of the foot at the head of
the tibia and fibula.
Supporting hand these reflexes are
treated together on all surfaces using both
hands. Place the fingers of each working
hand on the lateral and medial side of the
foot while using the thumb to treat. When
using the fingers it may be more
comfortable to form a fist and rest this on
the lateral and medial surface of the foot to
offer support.
Working hand with both thumbs use the
medial edge to start palpation immediately
inferior to the malleoli and work upwards
onto the dorsum in a wiggle movement
three times. Pressure should be upwards
towards the leg. Repeat the move using
the lateral edge of both index fingers from
the dorsum downwards to the malleoli.
Pressure should be downwards towards the
toes.
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Reflexology
Reflex
Chronic
pelvic
Spinal
COLEG
F1BD 34
Surface
Zone
Treatment
Anterior of
leg
1-5
Location from the apex of the tibia to the

approximate line of the sock (usually one
hand width up the leg).
Supporting hand the fingers of the
supporting hand can rest on the medial and
lateral edges of the leg to guide and
support the thumb and finger while working.
Working hand using the medial edge of
the thumb wiggle up in strips to the top of
the reflex and then using thumb or
reinforced index finger come back down the
leg in strips.
Posterior
of the leg
1-5
Location one hand width up the leg from

the Achilles tendon.
Supporting hand this should be the
medial hand and is used to support the heel
during treatment.
Working hand starting at the top of the
reflex area (on the leg) work down towards
the heel massaging the area with the thumb
and index finger in a milking action.
Repeat three times.
Medial
edge of
both feet
Location cervical spine starts proximal

phalanx of the big toe on the medial edge of
the foot. The thoracic runs the length of the
first metatarsal, the lumbar along the
cuneiform and navicular bones to the distal
margins of the talus. The sacrum
descends from the distal end of the talus to
the calcaneum. The coccyx is at the base
of the calcaneum.
Supporting hand supporting the forefoot
on the dorsal, the hand will move down the
foot to ensure support at the reflex is
worked.
Working hand starting at the cervical
spine on the medial edge of the thumb,
wiggle to the 7th vertebrae then move onto
flat of thumb and continue down the rest of
the spinal reflex in a wiggle three times.
Repeat the move from the coccyx starting
on flat of thumb and changing to medial
edge at the 7th vertebrae.
83
Reflexology
Reflex
F1BD 34
Surface
Musculature Medial
of the spine border
onto
dorsal of
each foot
Zone
Treatment
1-2
Location from the medial arch of both

feet up to the dorsal surface up to the edge
of zone 2.
Supporting hand this should be placed
on the plantar of the foot and used to
support and absorb any pressure from the
working hand through the foot.
Working hand use the flat of the thumb
to treat this area on the medial edge of the
foot from thoracic to lumbar vertebrae
working from the lower margins of the
medial arch upwards towards the dorsal
surface of the foot. This will usually allow
three or four passes depending on the size
of the foot. Treat in a downward move only
and from medial to lateral.
Leg/hip/
knee
Lateral
surface of
both feet
2-5
Location on the lateral surface of the foot

from the proximal metatarsal heads to the
anterior of the malleolus and extend from
the lateral edge of the foot to the highest
point on the arch formed by the
intermediate cuneiform and navicular
bones.
Supporting hand use the medial hand
and place the fingers on the dorsal surface
of the foot and the thumb on the plantar
surface and secure the foot.
Working hand using the medial edge of
the thumb, wiggle in vertical and diagonal
strips over the reflex three times. Change
hands and walk the flat tips of the fingers
down the reflex from zone 2 to 5.
Pituitary
Plantar
surface of
big toes
Location located in the centre of the

whorl pattern on the big toes of each foot.
Supporting hand either place this flat
against the dorsal of the big toe or grip
medial and lateral sides of the big toe with
the thumb and index finger.
Working hand using the tip of the toe
hook the pituitary three times to the midline
and turn and hook three times to the tip of
the big toe.
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F1BD 34
Physiology of the body and possible effects

It is important to understand how the body works from a reflexology point of view as it
will enable you to give informed advice to the client about their body and any symptoms
they may be concerned with. It will allow an understanding of how the organs and
systems work together and it will allow you to give a safe and effective treatment. This
knowledge is essential to ensure that the therapist has an understanding of why some
conditions are contraindicated and the effects that reflexology may have on the
systems of the body during or after treatment. Good health depends on balance/
equilibrium of the natural functioning of all the body systems and reflexology causes all
systems of the body to work efficiently and effectively
Brief overview of the systems
The following table shows, for each body system, the related organs, functions of the
system and the effects reflexology has on the body system:
Body system
Organs
Functions of the
system
Effects of
reflexology
Skeletal
All bones and

joints
Support and protection,

movement, storage of
calcium and
phosphorous, formation
of blood cells
Assists with effective

movement patterns
and skeletal
alignment, relaxation,
to assist pain
management and
repair to damaged
bones
Muscular
All muscles
and tendons
Muscle tissue shortens

or contracts resulting in
movement (a by-product
of movement is
generation of heat),
gives body posture
Relax muscles,
increase blood flow
to muscles and
encourage
elimination of toxins
that have built up,
removes blocked
energy
Respiratory
Nasal cavity,
oral cavity,
pharynx,
larynx,
trachea,
bronchi, lungs
To warm clean air,

alveoli in the lungs
absorb oxygen into the
blood, remove carbon
dioxide and excess
water vapour from the
blood, helps maintain
acid base balance of the
body, helps produce
vocal sounds
Enhance respiratory
rhythm, assist
breathing difficulties,
to help eliminate
mucous build up,
support function,
support emotional
conditions of the
system
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Reflexology
Body system
F1BD 34
Organs
Functions of the
system
Effects of
reflexology
Nervous
Brain, spinal
cord, nerves
Speedy communication
within the body, control
of body functions, eg
gut movements and
secretions, recognition
and communication of
changes in the internal
and external
environment, eg sight
Supports functioning
of the system,
encourages
relaxation, removal of
toxins in the system,
restores energy flow,
supports mental
functions of the
system
Circulatory
Heart, veins,
artery
Transportation of
nutrients and oxygen to
cells, removal of waste
and carbon dioxide from
cells, maintenance of
acid base balance in the
body, helps regulate
body temperature, helps
fight infection
Improved flow of
blood and oxygen in
the body, regulates
function of the
system, removal of
blockages or toxins
within the system,
assists emotional
disturbances
Lymphatic
Thymus,
lymph nodes,
spleen, lymph
vessels
Return of tissue fluid to

blood, immunity against
disease, eg by
production of antibodies
Increased efficiency
of lymph drainage,
increased removal of
infection and toxins,
supports immunity
Endocrine
Pineal,
hypothalamus,
pituitary,
thyroid,
parathyroid,
thymus,
adrenals,
pancreas,
testes, ovaries
Slower but longer lasting

communication within
the body, stimulation of
target organs, control of
body function, eg growth
and reproduction,
control of changes in the
internal environment, eg
water balance,
testosterone
Stimulation of the
immune system, aids
production of lymph,
to promote the
functions of the
systems, supports
hormone function,
balances menstrual
cycle, calms and
balances the
emotional and mental
state
Integumentary
Skin, hair,
nails
Protection of underlying
structures, sense organ
of touch, body
temperature regulator,
eliminates some wastes,
helps with production of
Vitamin D
Assists with skin

complaints,
toxins and allergens,
supports functions of
system, regulates
body temperature
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Reflexology
Body system
F1BD 34
Organs
Functions of the
system
Effects of
reflexology
Digestive
Mouth,
tongue,
salivary
glands,
pharynx,
oesophagus,
liver, gall
bladder,
stomach,
pancreas,
small
intestine, large
intestine,
appendix,
rectum, anus
To mechanically and
chemically digest
complex chemicals of
food so that they may be
absorbed into the body.
The liver is involved in
heat production
Increased functioning
of the system,
removal of toxins or
allergens, regulates
body temperature,
supports emotional
elements of the
system, aids
digestion, assists
with recovery from
digestive conditions,
removes blocks in
waste removal and
energy in the system,
altered bowel habits
Urinary
Kidney, ureter,
urinary
bladder,
urethra
Removal of metabolic
waste, maintenance of
water and acid base
balance, production,
storage and excretion of
urine
Supports functions of
the system,
increased urination,
metabolic waste,
supports emotional
elements of the
system
Reproductive
Male: penis,
scrotum,
testes, vas
deferens,
prostate
gland, urethra
Production, storage and

ejaculation of sperm
Increased functioning
of the system,
support of hormonal
and menstrual
activity, elimination of
toxins, supports
emotions of system,
support of developing
foetus
Female: vulva, Production of ova,

vagina,
protection, development
uterus, uterine and birth of offspring
tube, ovary
COLEG
87
Reflexology
F1BD 34
3.1
1. Name two of the reflexology techniques used when treating a client and which
reflex areas you might use them on.
2. How many bones are there in the feet? Please list them by name.
3. There are 4 transverse zone lines on the foot please draw and name them on the
following foot chart.
COLEG
88
Reflexology
F1BD 34
4. Explain how reflexology treatment might affect the following body systems:
a) The Lymphatic System
b) The Cardiovascular System
c) The Digestive System
COLEG
89
Reflexology
F1BD 34
5. On the following blank foot chart please map and label the location of the following
reflexes:
a) The solar plexus
b) The thyroid
c) The bladder
d) The fallopian tubes
e) The chronic areas
f)
The ileocaecal valve
g) The sigmoid colon (flexure)

h) The spine clearly label cervical/thoracic/lumbar and sacral
i)
The pancreas
j)
The shoulder
COLEG
90
Reflexology
COLEG
F1BD 34
91
Reflexology
F1BD 34
submitted work.
COLEG
92
Reflexology
F1BD 34

This section has dealt with the practical elements of working with clients, setting up the
clinical environment and how to carry out a treatment. Introduction to the feet, support
and leverage were outlined along with the relaxation techniques employed by you as a
therapist. The physical structure of the foot and lower leg were described as well as
basic physiology of the body systems and organ locations. How these are affected by
the reflexology treatment has been described as well as how to ensure the treatments
are safe and effective. The reflex areas and their clinical application were laid out in
order to allow the therapist to perfect their application.
COLEG
93
Reflexology
F1BD 34

Answer to SAQ 3.1
Once proficient the average time for a consultation and treatment will be 1 hour.
Answer to SAQ 3.2
Relaxation techniques are important as they maximise the treatment by allowing the
therapist to introduce their touch to the feet and the treatment that is about to
commence. It also allows the therapist to assess the structure and tone of the feet.
Answer to SAQ 3.3
The main technique used is the wiggle and is used in the following reflexes:
diaphragm
plantar thoracic
heart
upper GI
lower GI
pelvic
chronic areas
spinal
leg/hip/knee
COLEG
94
Reflexology
F1BD 34
1. There are 26 bones in the feet
2. The big toe has 2 phalange bones
3. The 3 cuneiform are called medial, intermediate and lateral
4. The heel bone is called the calcaneum
5. The group of 5 long bones are called the metatarsals
COLEG
Tibia
Fibula
peroneus longus
extensor digitorum longus
Achilles tendon
peroneus brevis
flexor hallucus longus
tibialis posterior
95
Reflexology
COLEG
F1BD 34
96
Reflexology
F1BD 34
Section 4: Evaluation
COLEG
97
Reflexology
COLEG
F1BD 34
98
Reflexology
F1BD 34

short term effects after a single treatment
long term effects after multiple regular treatments
position and degree of tenderness in a reflex
advice on after care and possible after effects of treatment
tenderness and textural changes in the feet
client feedback
a record of the session.
Objectives
By the end of this section you should be able to:
evaluate knowledge and skills of the reflexology treatment
describe the effects of long and short term treatments
give home care and after care advice to clients
receive feedback from clients and reflect on how to use this information.

In addition to the text in this section you will require the Reflex Sensitivity Chart,
supplied in the appendix.
COLEG
99
Reflexology
F1BD 34

information.
You have to achieve 70% pass marks in on each of the two exam papers and produce
4 client consultation documents that show the process and treatments of 4 clients for 6
opportunity.
COLEG
100
Reflexology
F1BD 34
Possible reactions to reflexology treatment

Clients may incur a reaction to reflexology treatment. Some common possible
reactions include:
more frequent desire to pass water, as the kidneys react to secrete more urine
increased bowel activity
the mucous membranes of the nose, throat and lungs increase their secretion
skin rashes may be aggravated in cases where medication has suppressed

symptoms. There may be an increase in sweat production and elimination
in women, vaginal discharge may change and increase
suppressed conditions may flare up
sleep patterns may alter temporarily, this can result in deeper sleep but can also
result in difficulty sleeping.
All of these factors are regarded as positive reactions to the treatment and will be
short-lived, lasting no more than 24 48 hours on average.
When treatment courses are longer, some of the following reactions may follow one or
more treatments and again can be assessed as a positive reaction:
diarrhoea
extreme fatigue and/or its opposite, restlessness
cramps
headache (believed to be caused by build up of toxins in the blood)
aches, pains
arthritic flair up
insomnia
nausea
sinus congestion
fever (usually low grade) and/or chills
frequent urination and/or urinary tract discharges
drop in blood pressure
skin eruptions, including boils, hives and rashes
cold or flu-like symptoms
COLEG
101
Reflexology
F1BD 34
strong emotions such as anger, despair, sadness, fear, etc.
suppressed memories arise
anxiety
mood swings
new phobias develop.
This list is not exhaustive and should only be shared with the client where necessary.
There is no expectation that a client will suffer from any or all of these symptoms.
Healing crisis
A healing crisis may occur after a treatment and is most often evident after the initial
treatment is given. A healing crisis may include some or many of the signs and
symptoms listed but can be distinguished by the fact that the symptoms last longer
than 48 hours and have a significant impact on clients ability to carry out their normal
routine.
There is no expectation for a healing crisis to occur and many clients never experience
them. It can also be true that a client has no reaction until several treatments in and
then a healing crisis occurs. This can be a positive sign that some chronic condition
has been relived or some long held beliefs or emotions have been unblocked.
How to deal with a healing crisis
Reassure the client that although the signs and symptoms appear somewhat severe
they are a positive sign that the reflexology treatments are working and they are
temporary and will clear within approximately 72 hours.
The client should be advised to drink plenty of water some of the symptoms listed
may actually indicate that toxins are being released from the body and the most
effective way to assist this process is to drink water. Lie down if lightheaded or
headaches are present and advise the client to walk in the fresh air if the client feels up
to it.
If the client is anxious that there is a recurrence or flair up of a medical condition they
should be advised to seek advice and help from their GP or other appropriate health
professional.
COLEG
102
Reflexology
F1BD 34
Reflex sensitivity
It is important to note the sensitivity and changes in a reflex so that you have a
measurable marker for the changes that occur due to treatment and as an aid to
subsequent treatment strategies. It is good practice to mark these on the consultation
sheet and one of the easiest ways to do that is by completing a sensitivity chart like
the one which follows on the next page.
After care and home care
A client may need to be given after care advice or home care advice. The client should
always be advised to increase their water intake for the next 24 hours to help flush
toxins out the body and to ensure that the lymphatic system is not overloaded from
treatment resulting in a headache for the client. You may also advise a client to go for
a walk before driving home if they have been feeling particularly relaxed or light headed
following treatment.
Home care advice is useful if the client has mobility problems in the foot and is able to
do some exercises between treatments. You may also want to show the client some
points on the feet they can work themselves if it would be beneficial.
The client should always be given your contact number and advised to call if they are
at all worried about any reaction they experience. In this way you can put their mind at
rest or advise the best course of action for them.
COLEG
103
Reflexology
F1BD 34
Sensitivity chart
Date:
Reflex Area
Diaphragm
Heart
Thyroid/bronchial
Secondary
Oesophagus
Bronchus
Lung
Shoulder/arm/elbow/wrist
Trapezius
Neck
Cervical lymph
Thoracic lymph
Facial
Dental
Sinus reflexes
Occipital
Pituitary
Thyroid primary
Ears
Eyes
Breast
Dorsal lymph
Rib cage
Thoracic musculature
Stomach
Duodenum
Spleen
Pancreas
COLEG
104
R L R L R L R L R L R
Reflexology
Reflex Area
F1BD 34
L R L R L R L R L R L R
Liver
Gall bladder
Adrenals
Kidney
Ureter
Bladder
Ileo caecal valve
Ascending colon
Hepatic flexure
Transverse colon
Splenic flexure
Descending colon
Sigmoid flexure
Sigmoid colon
Rectum
Uterus/prostate
Pelvic floor
Uterine tube
Vas deferens
Ovaries/testes
Sacrum
Hip-joint
Chronic medial
Chronic lateral
Spine:
Cervical
Thoracic
Lumbar
Sacral
Coccyx
Spinal musculature
COLEG
105
Reflexology
Reflex Area
F1BD 34
L R L R L R L R L R L
Knee/hip/lower back
Sciatic nerve tract
* This is also supplied in the appendix for use by you in your treatments
Table of reflex responses
1 = no sensitivity
2 = slight sensitivity
3 = moderate sensitivity
4 = marked sensitivity
5 = acute sensitivity
COLEG
106
Reflexology
F1BD 34
Evaluation
It is important to discuss with your client their opinion on the effectiveness of the
treatment both during the course of treatments and at the end of the course in order to:
determine the degree of client satisfaction
monitor treatment progress improvement or worsening of the clients condition
ensure that the treatment aims have been met
establish if any changes are needed to future treatments
provide a chance for the therapist to reflect on their performance as a therapist.
A record of all treatments should be kept by the therapist in a locked filing cabinet or
drawer. If possible, the record of each treatment should be kept on the same client
card or sheet so that there is a consequential record of the treatments that take place.
This can help the therapist to see any emerging patterns and benefits as well as any
worsening of present conditions or changes. It is also a record of treatment for your
accounting purposes if you are self employed and will act as a double check for the
amount of treatments you carried out and income earned.
It would also be useful for the student therapist to keep a diary of their experiences
throughout the treatments. This would be an account of how you felt at each stage of
the treatment, from welcoming the client right through to them leaving the clinic room.
You may also want to include any further reading or referencing you had to do about
any medication or conditions that were presented.
Things to include would be what went well, what didnt go well; did the treatments meet
your expectations? If not why not? What would you do differently and why? What
would you keep the same and why? Were you surprised about the things you liked
and those you didnt? Use this process of reflection to evaluate your performance as a
therapist and the outcomes of the treatments. The act of reflection has been used in
healthcare for many years and should be built into the evaluation of yourself and the
ongoing treatments. This allows you to contribute to your own continued professional
development.
COLEG
107
Reflexology
F1BD 34
4.1
1. What after care advice would you give a client at the end of a treatment?
2. Name 2 reasons for asking for client feedback at the end of treatments.
3. What distinguishes a healing crisis from the normal reactions clients may
experience after a treatment and what advice would you give the client?
4. Describe some of the benefits of keeping a therapy diary throughout treatments.
submitted work.
COLEG
108
Reflexology
F1BD 34

This section has outlined the effects that reflexology treatment can have on clients
physically, emotionally and mentally. The difference between short term and long term
treatment effects were discussed and how to handle these with the client. After care
and home care advice was given so that you may be able to advise the client between
treatments. A chart showing the sensitivity is provided in the appendix to record when
and where this occurs on the feet as well as any textural changes. Evaluating the
treatments has been explained and why there is a need to undertake evaluation and
use the information received.
COLEG
109
Reflexology
COLEG
F1BD 34
110
Reflexology
F1BD 34
Glossary
Anterior
front of the body
Posterior
back of the body
Medial
toward the midline
Lateral
away from the midline
Proximal
closer to the midpoint
Distal
farther from the midpoint
Dorsal
top of the foot
Plantar
sole of the foot
COLEG
111
Reflexology
COLEG
F1BD 34
112
Reflexology
F1BD 34
Appendices
Appendix 1
Client consultation notes
Client ID
Number
Address
Telephone
No
Age
Occupation
Occupational
factors
Reasons for
seeking
reflexology
GPs Name
and address
Treatment
plan agreed:
COLEG
113
Reflexology
F1BD 34
Lifestyle, (fluid
intake, exercise,
sleep)
General statement
of wellbeing
Contraindications
Special care
conditions
Current medical
conditions
Current medication
(prescription, OTC,
recreational)
After consultation with the therapist:
I have read and understood the information provided on reflexology
The information given to the therapist during the consultation is correct, to the best
of my knowledge.
We have agreed on the aims and objectives of my treatment.
I consent to reflexology treatment.
Clients initials: _____________________________________________________

Date: _____________________________________________________________
Therapists signature: ________________________________________________
Date: _____________________________________________________________
COLEG
114
Reflexology
F1BD 34
Body systems
System
Disorder/imbalance
Circulatory
Respiratory
Lymphatic/immunity
(including allergies)
Nervous
Digestive
Endocrine/menstrual
Musculo-skeletal
COLEG
115
Duration
Reflexology
F1BD 34
Foot analysis
Assessment
Left foot
Tissue and ligaments

dry/damaged/broken
skin/infections
Markings on the feet

Hard skin/corns/verrucas/
prominent marks
Oedema
areas present/moisture
Temperature
Structural
Include angle of feet at rest
Odour
Note any changes during
treatment
COLEG
116
Right foot
Reflexology
COLEG
F1BD 34
117
Reflexology
COLEG
F1BD 34
118
Reflexology
F1BD 34
Appendix 2
Treatment record
Treatment 1
Date
COLEG
Notes on treatment
119
Reflexology
F1BD 34
Treatment 2
Date
COLEG
Notes on treatment
120
Reflexology
F1BD 34
Treatment 3
Date
COLEG
Notes on treatment
121
Reflexology
F1BD 34
Treatment 4
Date
COLEG
Notes on treatment
122
Reflexology
F1BD 34
Treatment 5
Date
COLEG
Notes on treatment
123
Reflexology
F1BD 34
Treatment 6
Date
COLEG
Notes on treatment
124
Reflexology
COLEG
F1BD 34
125
Reflexology
COLEG
F1BD 34
126
Reflexology
F1BD 34
Appendix 3
Reflexology sensitivity record
Date:
Reflex Area
Diaphragm
Heart
Thyroid/bronchial
Secondary
Oesophagus
Bronchus
Lung
Shoulder/arm/elbow/wrist
Trapezius
Neck
Cervical lymph
Thoracic lymph
Facial
Dental
Sinus reflexes
Occipital
Pituitary
Thyroid primary
Ears
Eyes
Breast
Dorsal lymph
Rib cage
Thoracic musculature
Stomach
Duodenum
Spleen
COLEG
127
R L R L R L R L R L R
Reflexology
Reflex Area
F1BD 34
L R L R L R L R L R L R
Pancreas
Liver
Gall bladder
Adrenals
Kidney
Ureter
Bladder
Ileo caecal valve
Ascending colon
Hepatic flexure
Transverse colon
Splenic flexure
Descending colon
Sigmoid flexure
Sigmoid colon
Rectum
Uterus/prostate
Pelvic floor
Uterine tube
Vas deferens
Ovaries/testes
Sacrum
Hip-joint
Chronic medial
Chronic lateral
Spine:
Cervical
Thoracic
Lumbar
Sacral
Coccyx
COLEG
128
Reflexology
Reflex Area
F1BD 34
L R L R L R L R L R L
Spinal musculature
Knee/hip/lower back
Sciatic nerve tract
Table of reflex responses
1 = no sensitivity
2 = slight sensitivity
3 = moderate sensitivity
4 = marked sensitivity
5 = acute sensitivity
COLEG
129
Reflexology
COLEG
F1BD 34
130

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LEARNING SOLUTIONS FOR SCOTLANDS COLLEGES

Introduction to the unit

What this unit is about

How to use these learning materials

Symbols used in this unit

Other resources required

How you will be assessed

When and where you will be assessed

What you have to achieve

Opportunities for reassessment

Section 1: Consultation and development

Introduction to this section

Assessment information for this section

Purposes and processes of reflexology

History and philosophy of reflexology

Special care conditions for reflexology

Treatment objectives and limitations

Comparison of subsequent treatments

Summary of this section

Answers to self assessed questions

Section 2: Preparation for treatments

Introduction to this section

Assessment information for this section

Preparation for reflexology treatment

Position and comfort of the client

Health and safety

Summary of this section

Answers to self assessed questions

Section 3: Performing treatments

Introduction to this section

Assessment information for this section

Timing, sequence and duration of treatment

Structure of the foot

Structure of the lower leg

Physiology of the body and possible effects

Summary of this section

Answers to self assessed questions

Introduction to this section

Assessment information for this section

Possible reactions to reflexology treatment

Summary of this section

Introduction to the unit

Consultation and development

Preparation for treatment

How to use these learning materials

Symbols used in this unit

you are set SAQs throughout the study section

Other resources required

Therapy bed or reflexology chair

Consultation sheet supplied as student file in the appendix

Blank foot charts supplied as student file in the appendix

Reflex sensitivity sheet supplied as student file in the appendix

Arnold, M, 1999, Chi-Reflexology Guidelines For The Middle Way, Hazlebrook,

Byers, D C, 2001, Better Health with Foot Reflexology, St Petersburg, Ingham

Crane, B, 2005, Reflexology Therapies and Techniques for Well-being, London,

Crane, B, 1997, Reflexology The Definitive Practitioners Manual, London, Element

Cross, J R, 2001, Acupressure & Reflextherapy in the Treatment of Medical

Dougans, I, 2005, Reflexology the 5 elements and their 12 meridians a unique

Dougans, I, Ellis, S, 1992, The Art of Reflexology, Shaftesbury, Element

Hall, N, 1994, Reflexology for Women, London, Thorsons

Kunz, B. Kunz, K, 2003, Reflexology health at your fingertips, London, Dorling

Mackereth, P, Tiran, D, 2002, Clinical Reflexology A Guide For Health

Norman, L, Cowan, T, 1988, The Reflexology Handbook A Complete Guide,

Oxenford, R, 2002, Healing with Reflexology, Hong Kong, Hermes House