Skip to content

8. Making a Visual Assessment

In the previous chapter, I looked at the knowledge we could gain from looking at the feet and asking the right reflexology questions. In the following two chapters, I will look at the best way to record what you see to provide a guide to refer back to as part of your treatment notes.

In the rest of the book, I will look at how you can use this knowledge to improve your treatments. 

Methods Of Record Keeping

Templates & Notes

Of course, you can keep visual records by adding a section in existing treatment notes to record how the feet look. Many people use pre-designed templates supplied by their professional association. These usually have blank outlines of feet, which can easily be used to mark visual information in the same way as textures felt in the feet.

The NRRI (National Register of Reflexologists in Ireland) has a template that includes a section to make a written record of the appearance of the feet, including the nails. It also includes a section to record reactions during treatment, which is a very important part of Visual Reflexology and is covered in a later chapter. (see chart at the end of this section). Maybe more professional bodies could be persuaded to add this to their templates if their members asked for it. 

Photographic Records

Some reflexologists like to make a photographic record of the feet occasionally or regularly. The chapter following this one gives full guidelines on taking foot photos and the correct etiquette to use with clients when doing so.

Before You Start

Position And Support Your Client Properly

This is always important, but especially so when making a visual assessment. As I will explain later in the book, how the feet and ankles lie naturally tells us a lot about the pelvic reflexes. We can also do a quick body scan to see how the rest of the body is lying to get further information about the client’s gait and postureSo we need to be sure they are not presenting in a certain way because they aren’t adequately supported.

The guidelines below are mainly for when the client is lying on a massage couch, lengthways on a sofa, a bed, or a chair and stool etc., as a Lafuma is designed to correctly support a client. When not working with a Lafuma, a lot of pillows etc. should be at hand to try to mimic its ergonomically correct shape as much as possible. However, even on a Lafuma, the neck support is usually inadequate to properly support the head, so take note of the first point below. 

  • Provide proper support, such as a soft pillow or rolled-up towel that is a comfortable thickness to cushion both sides of the neck. This prevents the head from lolling badly to one side as the client relaxes, as this compresses the vertebrae and neck muscles on that side. (Even with support, their head will still tend to slump slightly to one side, and this tells you about its habitual misalignment and how to work on its reflexes.)
  • There is a lot of emphasis on supporting the ankles, but it is actually even more important to put pillows or bolsters under the client’s knees. Insist on doing this even if they say they don’t need it, as it will ease pressure on the knee joints. It is bad for these joints to lie unsupported as they will be completely straight and rigid for an hour. It also prevents a proper assessment of hip and pelvic alignments. You can raise the ankles along with the knees.
  • As an extension of the point above, when supporting the knees, try to raise them as much as possible to aid lymph and blood flow. This also gently stretches out the upper legs and thighs, alleviating pressure on the lower spine and gluteal muscles, which is especially important for clients with lower back and pelvic problems. (in effect, mimicking the shape of the Lafuma in the way it supports the legs)
  • If using a couch, ensure the upper section bend is aligned with the base of the client’s spine and don’t leave a gap under the small of their back. If there is a gap because the raised end of the couch is too short, put plenty of support, such as a folded blanket or pillows, to fill it.

How To Record

Be sure the feet are fully relaxed when you read them. Don’t ask the client to pull them back or raise them up so you can get a better view, as this will distort how they normally hold tension. If necessary, bend down to look, or if there is no other option, gently raise or rotate the foot yourself to look at it.

With practice, you should be able to absorb a quick, efficient assessment seamlessly into the start of a treatment, and it shouldn’t take long to make your initial observations. You will gradually work out your own shorthand methods and optimum way of noting their appearance, similar to how you record what you feel in them. Assessing a client’s health in terms of the appearance of their feet will become second nature, a natural and integral part of your treatment that doesn’t require any special effort. 

But always do this before you ask any questions of your client. This is so you can use what you see to help you decide what to ask them. And also because their initial appearance can alter as an emotional response to your questions, such as becoming flushed or tensing up for example. And Visual Reflexology note keeping also includes any movements in the feet and body that occur during a treatment, as I outline in a section below. So you should include these changes in your visual records as well.

What To Record

It may seem difficult at first to know what to take note of visually, but like everything (including, as I said, palpation), the more you practise, the better you will get. But bear in mind that a person’s entire life history is recorded on their feet. And the more you practice foot reading, the more sensitive your eyes will become to their various textures and differences in their energy. So, just as it is impossible to keep a register of everything you feel on the feet, you cannot note everything you see, especially in older people

The following list 1., of things to look out for is quite extensive and it won’t be possible to take note of everything. But always take note of anything that really jumps out (such as the red raw area on the ball of the right foot in photo 1. following, for example). Work with whatever grabs your attention visually on that particular day, as that is what the client’s energy is communicating to you most strongly. And if it is a follow up treatment, check how the foot conditions you made a note of at the last appointment appear this time.

photo 1. The red raw area on the ball of the right foot zone 1 is immediately obvious and should be noted.

Visual Markers

The significance of all the things in list 1. following are considered in great detail in chapters in the second part of the book. The list just gives a quick summary of what to look out for and what to potentially include in your visual records.

list 1.

  • Differences in size and shape between the two feet
  • Alignment of the ankles
  • The shape of the three arches of the foot
  • Tension in the muscles
  • Torsion in the joints
  • The shape of the toes
  • The spacing of the toes 
  • Different types of lines
  • Variations in underlying skin tone
  • Corns, callouses, bunions, and verrucas
  • Other types of skin textures
  • Scarring
  • Areas of lymphodema
  • Other kinds of swelling or dips 
  • Marks, moles, and freckles
  • Broken capillaries 
  • Swollen veins
  • Movements in the feet or body
  • Resistance in tone and texture

The Body Language Of The Feet

But before using these markers looking for specific foot conditions at the reflexes, spend time studying the overall body language of the feet as a single entity. As I mentioned in the introduction, this is very important and the first thing to consider in any visual assessment. Look at both feet together and use their appearance to get an idea of the kind of personality you are dealing with. Are the ankles too close and pulled together, are the feet inverted and tense, or loose and relaxed? These things can tell whether the person is shy and retiring, relaxed and open, uptight and scared to let go, and so on. 

This will also give clues about how the client feels on that day. Because even though they may tell you that they are not stressed and appear to be relaxing, the feet will tell the true story. It will also give you an idea of how ready the client is for their treatment, whether they are fully engaged and open to an exchange of energy. Make notes during subsequent treatments as to whether the feet appear more relaxed, better aligned, etc., as this will tell you how well your treatments are working regarding improving gait and posture and how this also reflects the emotions through body language.

The Four Aspects Of The Feet

Then use all the markers in list 1. firstly to consider the overall appearance of all four aspects and the difference between them on each foot, as this instantly gives you information about the imbalances of energy between the two sides of the body. Then consider each foot separately using the markers to look for problems at individual reflexes as well as areas of the feet in terms of the physiological health of each of the body’s systems.

Plantar and Dorsal Aspects

First look at the dorsal aspects as this represents the face the person shows to the outer world. If they aren’t visible at the height you are sitting, stand up to get a good look at them before you begin the treatment and again at the end. This aspect of the feet represents the client just as much as the plantar, which represents the private side of person. Compare and contrast the appearance of the plantar aspects. Gently lift up the foot to look at the sole if it is not visible because the Achilles tendon is very tight and the foot is at a very acute angle. 

Medial and Lateral Aspects

Now check the medial and lateral aspects and compare and contrast their appearance between the feet in the same way. If you cannot see either aspect properly because of the way the feet are lying, support the leg at the calf with one hand, then with the other, gently rotate the ankle until you can get a good look at it. Then do the same with the other leg. Particularly pay attention if there are problems with the limbs or spine or reflexes found on the lateral or medial zones of the body, such as the testes, bladder, or oesophagus. 

Trust Your Eyes

As with palpation, don’t feel that you must find evidence of something just because of what you already know about a client – the feet have their own way of giving us messages. Also don’t jump to conclusions regarding what a visual indicator may be the cause of. It is essential to start from as broad a perspective as possible regarding what health conditions it may relate to and then narrow its significance down to how it is affecting that particular individual. 

Visual indicators will vary because of the uniqueness of every human being, even though they may be suffering from issues with the same organ or medical problem, how the condition presents visually in one client may be completely different from how it appears in another. This is because the contributing causes to the problem will vary due to the complexities of each person’s genes, medical history and personality

Photos 2a. b .& c. following give examples of how problems with the same organ, the heart, manifest visually in different ways with three clients. The accompanying readings assess the markers that the reflex, and those around it are showing that may be contributing to the problem and how they vary depending on the condition and the individual. (I look in much more depth at these markers in the relevant chapters later in the book.) 

(As a side note: Despite the fact that all the clients have different clinical problems with the heart, the primary visual indicators are all found in the same heart reflex: zone 2 on the left foot. Interestingly, I find this is a very common place for the markers of physical problems with the heart to appear, regardless of what they are. Whereas emotional problems often appear in heart zone 1 of both feet, but that’s just an observation of mine, not a rule.)

rorys heart inked

photo 2a.

This client was recovering from a recent quadruple bypass. Note how stress lines form a 5 pointed star on heart reflex zone 2.

Other contributing factors: 
the dramatic squashing of toes 2-4 in a medial direction which roughly follows the angle of the diagonal stress line of the star. This shows extreme and chronic muscular hunching up of the whole left shoulder girdle area. And the alignment of the toes is an indicator of stress carrying down their zones into the left chest.
There are callouses on the armpit/axillary lymph node and at the chest area on the ball of the foot, which indicates poor moisture/lymph flow in these areas. 
InkedInked jeanette_LI

photo 2b.

This client was about to have her second heart surgery for Mitral stenosis. Note the verruca on heart zone 2. reflecting a long term deeply ingrained problem there.

Other contributing factors: vertical rippling grooves running up through the whole diaphragm area, showing lateral tension across the chest area due to chronic compression of the muscles. This is caused by the client continuously holding/pressing her left arm too tightly into this side of the body

There is also general redness over the area, which indicates tissue inflammation.

photo 2c.

This client suffered from atrial fibrillation (irregular heartbeat, a major contributing factor to strokes). Note the callous on heart zone 2. 

Other contributing factors: stress lines going up either side of the callous and one coming in horizontally from the medial foot/spine reflex.            

Also, toe 3 is being squeezed out dorsally by the medial shift of toes 4 & 5, which indicates compression of the shoulder girdle & clavicle muscles, contributing to tension in the chest area. (Although affecting different toes, this is a similar misalignment to that of client no.1, just not as extreme).  

Energetic Changes During A Treatment

It is also very important to register things that happen in the feet whilst you are actually working on themas well as reactions in the rest of the body. (But don’t take your hands off your client to write things down during a treatment, make a mental note only and then include it in your records when you finish.) These things are covered in much more detail in the chapter on ‘Other Visible Reactions, but here is an overview:

Resistance In Tone And Texture

Note temporary changes in appearance, primarily in underlying texture or colour. If, after pressing on a reflex, an indent or a change in colour – typically a white or red patch remains, the longer it takes to ‘spring back’ to how it was before, the greater the lack of resilience and disturbance at this reflex. 

Movements In The Feet

Movements in the feet during a treatment, are not random occurrences but a physical or emotional response to energy changes caused by your work and are a valuable source of information. So it is very important to look out for them and to note when they happened and what you were doing or talking about at that time. 

Record when a client moves their feet, wriggles their toes or adjusts their ankles. And autonomous movements such as twitching and jerking are nerve responses, whichever foot they occur in. Cramping tells what is happening to those muscles in the foot and, therefore, the muscles in the related reflex area of the body. Emotional responses in the ‘body language’ of the feet are also very informative. For example, if the client moves their feet by curling their toes away from you or inverting their ankles, this may mean you are encroaching on their personal space, and they are pulling back, or in the latter case, closing up from communicating freely with you.

The following video from Yvonne Owen Reflexology is very short but shows beautifully how sometimes we can see quite profound energetic reactions in the feet.

Movements In The Body

Look out for, and note changes not just in the feet but also in the body itself.

Clients often move their bodies during a treatment, and again this is due one way or another to the energetic exchange between you, so these movements are all relevant and important to recordFirstly, note the person’s body language while talking about their life – seeing when they are folding their arms defensively, clenching their fists and so on. While this is not foot reading, it all contributes to the bigger goal of understanding our clients and giving the best treatment we can.

Otherwise, some body movements are clearly directly attributable to your work; readjusting a misaligned joint in the body, such as the neck or hips, after you have focused on that reflex area is very common. Other things, like yawning and stretching, show the relaxing and balancing effect of reflexology. Some things are less obviously connected; scratching (both in the body and at a reflex) can relate to a reaction of the nervous system or pancreas. And watch how deep or shallow the client’s breathing is, as this can be a clue to focus on the lungs and other relevant reflexes. 

At The End Of The Treatment

At the end of the treatment, make a brief record of any changes that have occurred since you started. Even after one session, you may be able to discern some, such as a reduction in lymphoedema and a change in skin tone due to improved circulation and/or reduced inflammation. The feet will likely also look much more relaxed and possibly better aligned as tension is reduced. And other things may have changed, such as veins becoming less distended, for example. 

And don’t forget to take note of any temporary activity during the treatment itself in both the body and feet and which techniques you were using, as you can apply these again if necessary another time. Whether or not you get the same reaction can help you evaluate how successful your treatments have been. If the response is reduced or no longer happens, it can mean that the situation is improving or has been resolved. 

Follow Up Treatments

At follow-up treatments, refer to previous foot reading notes (and any photos you may have taken) and look for alterations in the appearance of the client’s feet. This is an invaluable addition to your record keeping of their health during the time between appointments and is especially useful if it has been a long while since you have seen them. And if you see the client regularly or they are having a course, visual records will help track how effective your work is over time. 

Some conditions will improve quickly, but naturally, it is to be expected that chronic or recurrent issues will take longer. This will be reflected in the appearance of their feet, so things such as hard skin or joint tension will only change gradually. But after a few treatments, if their health is improving, you will start to see lasting changes both overall and at individual reflexes, and this should be added to your records. 

Of course, there may be regression at times, but hopefully, it will be temporary. Even if the client has an illness that is terminal, you may be able to see the respite from some symptoms and side effects of medication on their feet. And while some things can never go back to how they should appear naturally, such as a toe with a bunion, you can still record that there has been no further visible deterioration in their condition since you started seeing the client.

This is the Q&A section, so please go ahead and comment on this chapter if you wish. If you want to ask me something privately so only I can view it, make a note and I will not make it visible to other readers. 

Unfortunately, it isn’t possible to notify you when your comment has been approved, so you will need to check, but I aim to approve them all within 48 hours. You can also scroll down to go directly to the next chapter.

6 thoughts on “8. Making a Visual Assessment”

  1. This is resonating with me so much!
    I took photos of my pregnant daughter’s feet to chart the ‘baby bump’ she had on her feet – it felt natural but also important to do so. I hadn’t thought about doing it on all my clients but I will start doing that now.
    I also have clients whose feet twitch and move a lot during treatments and I have been trying to figure out why!
    Thank you for validating my feelings but also encouraging me.


      Thank you Karenjade, that’s great to hear. You’ve probably seen, but there are whole chapters on both foot reading for maternity and ‘other things to look out for’ later on in the book.

  2. Hi – having watched your talk in Love Reflexology I became very interested in the way you read the feet (like you say other readers specifically look at the emotional side) but the way you read is more physical. As a massage therapist too this resonated with me.

    I am working my way slowly through each chapter but I have a growing thought that I want to incorporate this into what I teach my students. (I am a tutor at Phoenix in Essex – Level 3 Reflexology and massage City & Guilds).

    What are your thoughts on ways to do this? I really feel that it would be an additional benefit to the students and should certainly be included in the core curriculum – but alas I suppose it is ‘too new’ and also it would entail more time.

    Anyway, loving the book – only on chapter 3 at the mo – but its fascinating.




      Hi Michelle, thank you for your comment.
      I am very keen that visual reflexology should be included in the core curriculum not seen as an advanced or additional skill.
      There is a limit to what I can suggest as to how to do this as I dont teach reflexology per se, Im not trained as a teacher and know the curriculum is very different from when I was a student. However, I have run workshops for reflexology students and they have grasped it very easily. Often I think at times more easily than more experienced therapists who are ‘set in their ways’. Rather like how languages are most easily taught to very young children as they have fewer ingrained thought patterns
      I imagine that there would be two ways of teaching it as part of the basic qualification: 1. as a module in itself or 2. to incorporate it into the existing modules which I think for time reasons would be preferable and also would be more cohesive, seeing as it’s purpose is definitely to be complementary to palpation and listening to clients rather than developed as a separate skill or specialism within reflexology.

      I think it is important for the teachers hoping to do so to agree with the concept of the feet as a 3d microcosm of the body, not just 2d charts, but I think most do so nowadays anyway? And an approach that includes teaching that we can read the health of all the systems in the body, and how they all affect areas of the body, rather than only reading the health of individual reflexes is important too.

      I think teaching how the appearance of the reflex/body area corresponds to how the texture feels in those places feels could be one interesting way to teach reading, which would could be easily be incorporated into the existing curriculum.

      I’m sure there are many other ways. Certainly teaching how to add a visual record of outstanding features of the feets’ appearance to the record-keeping notes also is easily included in treatment.

      Anyway it’s an interesting and very worthwhile challenge, I’ll continue to think about it, and I’d be very interested to hear your opinions after you have read more of the book.



      Thanks Colleen! and there is a lot more on the subject in chapter 23 (due online very soon) on ‘reading other energies’ during a treatment.

Leave a Reply

Your email address will not be published. Required fields are marked *