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Research · Therapies

Reflexology

Against usual care or no treatment, pooled trials found reflexology lowered anxiety, improved sleep and eased labor pain. Against plain foot massage or sham reflexology, trials in multiple sclerosis, Parkinson's disease, menopause and breast cancer found no difference in pain, anxiety or mood. Reviews found no condition it convincingly treats. No adverse events were reported in trials.

Checked 2026-11-13
Status
Not a federally regulated health profession. A 2018 Nebraska State Board of Health report records that reflexology is exempt from massage laws in more than 30 states and the District of Columbia, that four states with no massage law do not regulate it, and that four states (North Dakota, Tennessee, New Hampshire and Washington) have reflexology-specific laws [1]. National certification is voluntary in most states [1].
Also called
reflexology, foot reflexology, hand reflexology, reflexologist, zone therapy, foot reflexology massage, reflex zone therapy, precision reflexology, plantar reflexology
Used for
pain, anxiety, stress, relaxation, sleep, insomnia, labor pain, menopause symptoms, cancer symptoms, multiple sclerosis, high blood pressure, constipation, premenstrual syndrome, fatigue, diagnosing illness from the feet, general wellness

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help5

Reported risks0

No risks sourced yet.

What it is used for, and what was found

Shown to help5

Strong

Anxiety, compared with usual care or no intervention

Shown to lower anxiety around heart procedures and in other adults in pooled trials, mostly against usual care or no intervention, with large and varied effects.

Compared with control groups the source abstracts do not describe [8][9]; nonactive controls: sham intervention, usual care, waiting list or psychoeducation [10]

The numbers and sources
Effect
In 10 trials of patients having cardiovascular procedures, reflexology lowered anxiety more than control [8]. In patients having coronary angiography, anxiety fell immediately after reflexology (Hedges' g -1.78, 95% CI -2.94 to -0.63) and 30 minutes later (g -1.16) [9]. Across adults with a range of conditions, anxiety fell (g -1.237, 95% CI -1.682 to -0.791) and depression fell (g -0.921, 95% CI -1.246 to -0.595) [10].
Population
760 patients with a mean age of 59 in 10 trials [8]. 913 patients in 10 studies [9]. 2,366 adults in 26 trials [10].
Sources
[8], [9], [10]
Caveats
Most control groups had no touch, so attention and touch are part of the effect. Two of the angiography studies were not randomized [9]. The sham-controlled results are in the blocks above.
Strong

Sleep quality

Shown to improve sleep quality scores in pooled trials, mostly against usual care or no intervention, with large effects.

Compared with control groups the source abstract does not describe [11]; nonactive controls: sham intervention, usual care, waiting list or psychoeducation [10]; control groups the source abstract does not describe [12]

The numbers and sources
Effect
Across 42 trials, sleep quality scores improved more than with controls (Hedges' g -1.37, 95% CI -1.81 to -0.94), and people given reflexology were less likely to still have sleep problems (OR 0.25, 95% CI 0.19 to 0.31) [11]. A second meta-analysis found improved sleep quality (g -1.665, 95% CI -2.361 to -0.970), larger with longer and more total reflexology time [10]. An earlier review found a weighted effect of 1.19 for sleep [12].
Population
3,928 adults in 42 trials [11]. 2,366 adults in 26 trials [10]. 18 studies on sleep [12].
Sources
[11], [10], [12]
Caveats
Trials were heterogeneous and mostly unblinded. The 42-trial review included studies in English and Chinese only [11].
ModerateStudied in pregnancy

Pain and anxiety in labor

Shown to lower labor pain by about 1.9 points on a 0 to 10 scale and reduce anxiety, against placebo, usual care or no intervention.

Compared with placebo, usual care or no intervention [13]

The numbers and sources
Effect
Foot reflexology lowered pain (mean difference -1.89 on a 0 to 10 scale, 95% CI -2.34 to -1.45) and anxiety (SMD -0.88, 95% CI -1.41 to -0.34), shortened the stages of labor and raised birth satisfaction. It lowered pulse and breathing rate and did not change blood pressure. The reviewers rated the evidence moderate for pain [13].
Population
1,189 pregnant women in 13 trials [13].
Sources
[13]
Caveats
Heterogeneity was very high (I² 92% for pain). Some trials had high risk of bias in how women were assigned to groups [13].
Moderate

Blood pressure and heart rate

Shown to lower systolic blood pressure by about 4.6 mm Hg and heart rate by about 5 beats a minute in the short term, in pooled trials.

Compared with control groups the source abstract does not describe [14]

The numbers and sources
Effect
Foot reflexology lowered systolic blood pressure (mean difference -4.62 mm Hg, 95% CI -5.58 to -3.66), diastolic blood pressure (-3.32 mm Hg), heart rate (-4.76 beats a minute) and breathing rate, and raised oxygen saturation (0.95%) [14].
Population
819 patients in 13 trials [14].
Sources
[14]
Caveats
Short-term measurements only. A pooled analysis in pregnant women found no change in blood pressure [13].
LimitedStudied in women

Breathlessness and physical function in advanced breast cancer

One trial of 385 women found less breathlessness with reflexology than with lay foot manipulation or conventional care, and better physical functioning than conventional care.

Compared with lay foot manipulation [6]; conventional care [6]

The numbers and sources
Effect
Shortness of breath was less severe with reflexology than with conventional care (P < 0.01) and lay foot manipulation (P = 0.02). Physical functioning improved more than with conventional care (P = 0.04). Breast cancer quality of life, depression, anxiety, pain and nausea did not differ [6].
Population
385 women with advanced breast cancer receiving chemotherapy or hormone therapy [6].
Sources
[6]
Caveats
One trial with several outcomes, most of which did not differ.

Not shown to help3

Strong

Any medical condition, systematic reviews

Not shown to treat any medical condition in two reviews of randomized trials, where most higher-quality trials found no benefit.

Compared with control conditions in randomized trials, which the source abstracts do not describe [2][3]

The numbers and sources
Effect
A 2009 review of 18 trials in conditions from asthma and back pain to cancer, menopause and multiple sclerosis found five with positive results, and most higher-quality trials were negative [2]. Its 2011 update of 23 trials found nine high-quality trials with negative findings and five with positive findings, and concluded that "the best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition" [3].
Population
18 trials of reflexology given by trained reflexologists [2]. 23 trials across a wide range of conditions [3].
Sources
[2], [3]
Caveats
The update shares its lead author and many trials with the earlier review. Trial quality was often poor and samples small [2][3].
Moderate

Pain, compared with sham reflexology or plain foot massage

Not shown to ease pain more than sham reflexology or plain foot massage in three trials, in multiple sclerosis, Parkinson's disease and advanced breast cancer.

Compared with sham reflexology [4]; sham massage [5]; lay foot manipulation, and conventional care [6]

The numbers and sources
Effect
In 73 people with multiple sclerosis, pain fell by a median of 50% in both the reflexology and sham reflexology groups over 10 weeks, and reflexology was not superior to sham [4]. In 30 people with Parkinson's disease and chronic pain, pain fell 12.3 mm on a 100-mm scale with reflexology and 17.9 mm with sham massage, with no difference between groups (P = 0.88) [5]. In 385 women with advanced breast cancer, pain did not differ between reflexology, lay foot manipulation and conventional care [6].
Population
73 people with multiple sclerosis [4]. 30 adults with Parkinson's disease in France [5]. 385 women with advanced breast cancer at 13 US oncology clinics [6].
Sources
[4], [5], [6]
Caveats
Pain improved substantially in both arms of the sham-controlled trials, so touch and attention may account for much of the effect [4][5].
LimitedStudied in women

Anxiety and mood, compared with plain foot massage

Limited evidence: two trials in women found anxiety and depression fell as much with plain foot massage or lay foot manipulation as with reflexology.

Compared with nonspecific foot massage [7]; lay foot manipulation, and conventional care [6]

The numbers and sources
Effect
In 76 women with menopausal symptoms, anxiety scores fell from 0.43 to 0.22 with reflexology and from 0.37 to 0.27 with foot massage, and depression scores fell from 0.37 to 0.20 and from 0.36 to 0.20, with no difference between groups. Hot flushes and night sweats changed similarly [7]. In 385 women with advanced breast cancer, state anxiety and depressive symptoms did not differ between groups [6].
Population
76 women aged 45 to 60 [7]. 385 women with advanced breast cancer [6].
Sources
[7], [6]
Caveats
In the menopause trial, 14 of 37 women given foot massage believed they had not received true reflexology [7].

Protocols studied

The sham-controlled multiple sclerosis trial gave precision or sham reflexology weekly for 10 weeks [4], and the Parkinson's trial gave four 1-hour sessions three weeks apart [5]. The menopause trial gave nine sessions over 19 weeks from qualified reflexologists [7]. The breast cancer trial compared reflexology with lay foot manipulation and with conventional care [6]. Several labor trials gave a single session [13]. Longer sessions and more total time were linked to larger sleep effects [10].

Risks

Checked, no increase found1

Limited

Adverse events in trials

Not found in the trials that checked: no adverse events were reported in a 385-woman breast cancer trial or a sham-controlled Parkinson's trial.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
No adverse events were reported among 385 women with advanced breast cancer [6] or among 30 people with Parkinson's disease [5].
Population
385 women [6]. 30 adults [5].
Sources
[6], [5]
Caveats
Most reflexology trials did not report on harms, so rare events cannot be ruled out.

Claims tested and not found

  1. That reflexologists can diagnose illness from the feet. Blinded reflexologists examining 18 patients did not distinguish people with and without six conditions, and did not agree with each other [15].
  2. That reflexology eases menopausal symptoms more than plain foot massage. Anxiety, depression and hot flushes changed equally in 76 women [7].
  3. That precision reflexology eases multiple sclerosis pain more than sham. Pain fell equally in 73 people [4].
  4. That reflexology eases chronic pain in Parkinson's disease more than sham massage. Pain did not differ in 30 people [5].

Sources

  1. Nebraska State Board of Health. Report of Recommendations and Findings on the Proposal to License Reflexologists. 2018. https://dhhs.ne.gov/licensure/Credentialing%20Review%20Docs/BoHReportReflex2018.pdf
  2. Ernst E. Is reflexology an effective intervention? A systematic review of randomised controlled trials. Medical Journal of Australia. 2009. https://doi.org/10.5694/j.1326-5377.2009.tb02780.x
  3. Ernst E, Posadzki P, Lee MS. Reflexology: an update of a systematic review of randomised clinical trials. Maturitas. 2011. https://doi.org/10.1016/j.maturitas.2010.10.011
  4. Hughes CM, Smyth S, Lowe-Strong AS. Reflexology for the treatment of pain in people with multiple sclerosis: a double-blind randomised sham-controlled clinical trial. Multiple Sclerosis. 2009. https://doi.org/10.1177/1352458509345916
  5. Joineau K, Harroch E, Boussac M, et al. Effect of foot reflexology on chronic pain in Parkinson's disease: a randomized controlled trial. PLOS ONE. 2025. https://doi.org/10.1371/journal.pone.0327865
  6. Wyatt G, Sikorskii A, Rahbar MH, et al. Health-related quality-of-life outcomes: a reflexology trial with patients with advanced-stage breast cancer. Oncology Nursing Forum. 2012. https://doi.org/10.1188/12.onf.568-577
  7. Williamson J, White A, Hart A, Ernst E. Randomised controlled trial of reflexology for menopausal symptoms. BJOG. 2002. https://doi.org/10.1111/j.1471-0528.2002.01504.x
  8. Chandrababu R, Rathinasamy EL, Suresh C, Ramesh J. Effectiveness of reflexology on anxiety of patients undergoing cardiovascular interventional procedures: a systematic review and meta-analysis of randomized controlled trials. Journal of Advanced Nursing. 2019. https://doi.org/10.1111/jan.13822
  9. Kanat C, Avcı A, Çavuşoğlu E. Reflexology for pain and anxiety in patients undergoing coronary angiography: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing. 2026. https://doi.org/10.1093/eurjcn/zvag132
  10. Wang WL, Hung HY, Chen YR, et al. Effect of Foot Reflexology Intervention on Depression, Anxiety, and Sleep Quality in Adults: A Meta-Analysis and Metaregression of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine. 2020. https://doi.org/10.1155/2020/2654353
  11. Huang HC, Chen KH, Kuo SF, Chen IH. Can foot reflexology be a complementary therapy for sleep disturbances? Evidence appraisal through a meta-analysis of randomized controlled trials. Journal of Advanced Nursing. 2021. https://doi.org/10.1111/jan.14699
  12. Lee J, Han M, Chung Y, et al. Effects of foot reflexology on fatigue, sleep and pain: a systematic review and meta-analysis. Journal of Korean Academy of Nursing. 2011. https://doi.org/10.4040/jkan.2011.41.6.821
  13. Yang JM, Li ZQ, Ye H, et al. Effects of foot reflexology massage on pregnant women: a systematic review and meta-analysis of randomized controlled studies. Scientific Reports. 2024. https://doi.org/10.1038/s41598-023-51107-y
  14. Jing Y, Liu S, Pan C, et al. The Effects of Foot Reflexology on Vital Signs: A Meta-Analysis of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine. 2022. https://doi.org/10.1155/2022/4182420
  15. White AR, Williamson J, Hart A, Ernst E. A blinded investigation into the accuracy of reflexology charts. Complementary Therapies in Medicine. 2000. https://doi.org/10.1054/ctim.2000.0380

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