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13. Musculoskeletal System (Part 2)

Reading The Shape Of The Feet

In the previous chapter, I looked at the rotation of ankles and the distance between the heels. In this chapter, I will continue to look at the ankles and heels and the many ways in which misalignment and structural problems in the lower back, hips,and pelvic girdle are shown in their appearance.

I will also look at the significance of the three arches of the feet. And some other common musculoskeletal misalignments and what they tell us about emotional body language as reflected in the feet. The shape and alignment of the toes will be covered in the next two chapters.

The guidelines and cautions for working on the musculoskeletal system, as well as suggestions for potential referrals given in the previous chapter, also apply here.


If you were taught with mainly organ-based charts and you don’t know where all the muscle group and skeletal reflex areas are, it is important to learn them. It is worth investing in charts that show both these systems on the feet, as this is the best way to connect the two. If your own association does not provide one, I would recommend Balancing Touch or a book such as Podycharts, or the ones from the Stone Institute following. 

These charts show not just the musculoskeletal but also the other body systems placed on the feet in anatomically accurate positions and are an invaluable addition to your practice. Then when there are back problems, you can see how to work the local muscles, not just the spine reflex. And also how to work the pelvic and shoulder girdles and their associated muscle groups. 

Purely for quick reference whilst reading this post, I have put images directly below of anatomy charts for the anterior and posterior muscles, so you can mentally envisage them placed on the feet. (The reflex areas to the deeper placed muscles are reached if you work more firmly on the feet.) It is not so important to remember the names of the muscles, rather to have an awareness of the shape, connections, and interactions of the relevant muscle groups as you work their corresponding reflex area on the feet.

Stone Institute muscle reflexes chart
Dorsal foot
Stone Institiute skeletal reflexes chart
Plantar foot

The Heels and Ankles

In addition to the things I covered in the previous chapter, the presentation of the heels and, specifically, the appearance of the Achilles tendon/sciatic reflex will give further clues to other lower back and pelvic issues. Amongst other things, we can see whether there is horizontal misalignment, rotational misalignment, or a pelvic tilt (anterior/posterior), or in fact, a combination of more than one of these. 

There are also multiple ways the internal pelvis and groin alignment can be shown to have problems. These include the heels/feet being inverted showing tension in the tendons and ligaments of the groin, and a difference between the size and shape of the medial heels reflecting a bilateral structural difference in the two sides of the pelvis.

(Note: now is a good time to have another look at the kinetic chain video in the previous chapter to see the pink chain that goes up the Achilles tendon and up the rear of the leg.)

Types Of Pelvic Misalignment

1. Horizontal 

If one heel appears further away from you than the other, this means that the pelvis is not correctly aligned horizontally (photo 1a. following) and is lying diagonally rather than straight. It is easy to feel this in your own body simply by pulling one of your own feet up off the floor whilst standing; you will notice that the whole pelvis shifts. 

The diagonal pelvic alignment may be caused by the difference between the length of the client’s legs, as the skeleton is never completely symmetrical. And sometimes, this is great enough to cause problems with the lower back and/or in at least one hip, especially as the person ages. In some cases, the client has had an accident, typically a broken bone, and this compounds any leg length difference that they were born with.

Other contributing factors can be poor posture and gait – regularly leaning down into or carrying a heavy bag or a small child on one side, for example. But whatever factor or combination of factors causes the misalignment, reflexology can help either to realign the associated muscle groups and/or do a lot to alleviate any problems associated with it. 

So when the feet appear this way, we need to work on the mid to lower back, gluteal muscles, hips, and legs, using techniques described in the last chapter, plus stretching out of the leg that appears further away from you. With time the heels may appear more equidistant to you, which means the alignment is improving and your treatment is working. 

2. Rotational

If there is a pelvic rotation, there will be a forward pull on one side of the hips. And when the person is lying down, this will show as one foot presenting a little higher up than the other (photo 1b. following), as opposed to horizontal misalignment, which shows as one foot further away from you (photo 1a. following). (But do make certain that one foot isn’t only appearing higher because of uneven support due to pillow stuffing etc.) As well as reading the alignment of the feet, you can look up at the pelvis itself, as one hip may be visibly higher. 

This torsion in the pelvis is often caused by the ‘lead’ side of the body – i.e. the side of their writing hand – becoming overly dominant. It tends to be caused by posture, especially in people who sit a lot, whether because they are elderly or desk-bound at work, but can also be found in people who play certain sports. And the pull forward on this side may continue all the way up the body to include the diaphragm and shoulder girdle.  

But often (depending on the causes of the pelvic torsion), the upper body does not pull forward, and this causes a twist in the mid spine. Sometimes it even pulls forward on the opposite side (typically, for example, due to using the computer mouse). So when the ankles show pelvic rotation, pay attention to the mid-spine reflexes, as there may be tension due to a spinal twist.

When the feet show a pelvic rotation, stretching both ankles is good to help loosen the pelvis generally, as well as turning the distal part of the foot in the opposite direction to the proximal in a ‘wringing’ type movement.

Horizontal and rotational misalignments of the pelvis, as presented in the feet, may look quite similar when you first look at photo sets 1a. & 1b. following but actually, especially when you are faced with them in real life, it is quite easy to differentiate between them. Do bear in mind though some people may have both!

It may be hard to envisage these how these ankle alignments reflect the chronic pelvic misalignments from the photos, especially the second. But if you try moving your own hips and feet when standing it might make it easier to follow.

1a. Horizontal misalignment of the pelvis

Here the left foot is further away from us, which indicates the pelvis is not lying straight (horizontally) but at an angle. 

The figure shows how this misalignment appears in the body when the person is standing with the pelvis and hips misaligned at a sloping angle.

1b. Rotational misalignment of the pelvis

Because of pelvic rotation both the heels and toes on the left foot are presenting higher than the right. The yellow dots show how the feet would lie without this rotation.

The figure shows how this presents when standing. The left leg is pulling forward causing torsion up the body with the pelvis and even shoulder girdle pulled slightly forward on that side.

3. Pelvic Tilt (anterior/posterior)

When we look straight at the soles of the feet, if they are either coming forwards towards us or pulling away from us, it tells us about how tension is manifesting in the Achilles tendon. This in turn shows tension and inflexibility in the reflexes of the muscles of the lumbar/sacral/sciatic/abdominal area, causing the pelvis to tilt backwards or forward.

When the foot comes towards us at an acute angle, this means the heel is being pulled back very tightly, as seen in photo 2a. & 2b. following. As a result, we can see a lot of curving and tightness in the sciatic reflex. But in photo 3a. & 3b. following we see the opposite, whereby the tension is most noticeable in the dorsal tendons of the ankle which are pulling the foot away from us, and back towards the body. This flattens the curve of the lower back and pulls the sciatic reflex very straight so it loses flexibility. It also shows that there is a lot of tension held in the abdominal muscle reflexes.

To treat the tension that is causing both of the above problems, we need to hold the heel in one hand and flex the foot backwards and forwards with the other to loosen the tightness. But to balance more effectively, in the first case, focus on pushing the foot away from yourself quite firmly towards the client in order to stretch the out Achilles/lower back. And in the latter, focus on pulling the foot gently towards yourself and away from the client to stretch out the top of the ankle and the abdominal reflexes/dorsal tendons.

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2a. Feet coming towards you

These feet do not need annotating as it is so obvious the acute angle at which they are coming towards you. Because of the angle it will actually be quite difficult to work on these feet.

In terms of body language this person is presenting themselves on the surface very confidently and self assertively. But underneath this front, we see the tension that it is creating to keep up this facade. 

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2b. The same feet from the side

Here it is easy to see the extreme tightness pulling the Achilles tendon/sciatic reflex, and this is causing the acute angle at the heels. The sacral/lumbar region of the spine is very arched and pulls the rest of the spine back with it.

We can see the flatness of the dorsal ankle and foot, which reflects corresponding tightness in the abdominal area reflexes. The green dots show roughly the angle at which the feet would present if not for the tightness in the Achilles/sciatic reflex.

(There is also tension in these metatarsals which will be covered further on in this chapter.)

Compare the previous feet above with those following, and observe the opposite extremes of alignment reflecting the different ways that tension is occurring in their abdominal and sciatic reflexes.

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3a. Feet pulling away from us

It is most evident that the feet are pulling away from us because of the metatarsals curling back so much that the necks of the toes are not visible. 

Emotionally, this posture is more of a defensive one, pulling away and retreating from the observer.

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3b. Same problem from the lateral aspect

Although these are a different pair of feet, they show the same problem from a sideways perspective. From the side, we can see great tension in the dorsal tendons reflecting the same in the abdominal muscle reflexes. 

The Achilles tendon is completely straightened because it is so taut. This means that in the body the curve of the lower back is pulled flat as the pelvis is pulled forward. The purple dots show roughly the angle at which the feet would present if not for this.

The following video shows the straightforward stretching back & forth technique recommended for both these kinds of presentations shown directly above. But note it is given added potency by separating the toes with fingers whilst doing it. Check the client is comfortable with this separation, especially if there have been toe breaks or arthritis is present. Another way of working whilst separating the toes is shown in video no.3. towards the end of this chapter.

N.B. The shape of the medial longitudinal arch of the foot can be a contributing factor to the tension involved in these kind of presentations and I look at this further down in the page.

Spinal stretch video 1.

Other Types of Pelvic Misalignment

4. Pelvic shift

Sometimes a whole weight bearing shift away from the medial line of the body and over to one side of the body can be seen through the alignment of the ankles. This is often more evident from above and gives a good example of why it is so important to pay attention to the dorsal aspect.

In the next photo 4a., we can see from the prominence of the left lateral ankle how both in the body, and the pelvic reflex area, there is a very definite shift over to the left. And there is more of the right groin reflex/medial heel area visible which also indicates that the pelvis is being pulled to the left. 

Although it is not seen on many charts,  some so show this dip in the ankle where the talus the fibula, and the calcaneus join, is the reflex to the sacroiliac joint. While this would not be an exact anatomical fit with respect to zones etc., this dip is often very responsive in clients with lower back pain. 

Due to the shift over to this side of the foot, this reflex/area of the body will certainly be bearing a disproportionate amount of weight. 

photo 4a.

5. Pelvic inversion

With this misalignment the heels are inverting towards the medial line, so to balance you need to work on stretching them out in a lateral direction. Pelvic floor work is very good for this (see pelvic floor video no 2. following).

In the next photo 5a., there is supination (under pronation/high arch) on both feet. But sometimes this will be seen only, or more pronounced on one foot. The dotted green line shows roughly the angle at which a correctly aligned medial heel should lie. 

It means that the feet are rotating in a way that is putting excess weight onto the outer edges. The inversion is causing disproportionate weight bearing on the lateral edge of the foot and pressure onto zones 4-5. 

Reflex wise we can see the inversion of the medial Achilles/groin reflex and the pressure at the very base of the spine onto where the sciatic nerve exits and impacting its function. 

This type of inversion is typical of high medial arched feet (image 3. following).

photo 5a.

6. Bilateral size difference in the pelvis

Always check for differences in the length and shape of the medial heels, as it will show structural weaknesses caused by a bilateral difference in the shape of the pelvis. (Incidentally, the heels in photos 6a. & 6b. following are inverting as well, as you can see – they do not run straight down from the ankle but pull inwards in a similar way to those in earlier photo 5a.) These feet were shown before in a previous chapter where the different sizes of the medial heels, i.e. medial pelvic area, were one of the visual indicators of problems in the groin. 

photo 6a.

photo 6b.

The Pelvic Floor Reflex

In all the above cases, and also those in the previous chapter, where the groin and abdominal muscles are involved, it is very helpful to work the pelvic floor reflex. Unfortunately, considering its importance generally, and to the reproductive organs of women in particular, many charts do not show a reflex for the pelvic floor. 

It is actually found on the medial side of the heel running from just beneath the ankle bone down to the spine, just proximal to the base of the bladder swell. It is musculature in the body, so it will also be the same in the foot, and you may well be able to feel it running vertically from just beneath the centre of the medial malleolus to the sole. 

This is a great reflex to work for clients with issues in this area, not just lower back problems, but also with the bladder and uterus, etc. Like muscle reflexes generally, clients will tend to find it painful but say it is a ‘good’ pain. (But do go easy here during the latter stages of pregnancy, when the pelvis ligaments have loosened.)

 In case it is not clear from the following video, the pelvic floor reflex is right between the base of the bladder and the sciatic loop (not actually on the sciatic loop).

Pelvic floor reflex video 2.

The Three Foot Arches

Although the ‘arch of the foot’ generally refers to its medial edge, there are actually three arches in the foot. The appearance of each of these three arches gives us a wealth of information about problems in the body at the equivalent reflex areas of the musculoskeletal (msk) system . And obviously the function of all the arches interact, so the structural weaknesses of one will influence the shape, strength and flexibility of another.

image 1.

The three arches of the foot

1. The Medial Longitudinal Arch relates to the strength and flexibility of the vertebrae and supporting muscles. 

2. The Lateral Longitudinal Arch tells us about the health of the msk system of the limbs and lateral edge of the body. 

3. The Transverse Arch tells us about the health of the msk system in the diaphragm and the chest and lung areas. (On the plantar foot this is called the Anterior Transverse arch and on the plantar aspect the Posterior Transverse arch.)

As energy flows not just from the body down to the feet, but the feet up to the body as well, it can get blocked as it moves in either direction. So  after the section on the arches, I will look at some of the more common structural foot issues and what they mean to the health of the reflexes in which they occur.

1.The Medial Longitudinal Arch

There are broadly speaking, one of three shapes this arch will have: high, neutral, or flat (image 3. following). A neutral arch is considered the optimum, however, it is important to note that the shape of the arch is due to genetics, and as we grow the body can naturally adapt to whichever arch we are born with. It is possible for all arch shapes to be accommodated without causing too many problems. 

In fact, it is mostly lifestyle factors, such as footwear, accidents, and poor muscle tone that cause problems, not the shape of the arch itself. But when problems do occur, they will tend to develop along specific lines of weakness depending on the shape of each arch. And as the spinal reflexes run down the medial edge of the foot, reflexologists know that we cannot separate the functioning of this arch from that of the spine.

image 2.

The reddish brown area shows the long abductor hallucis muscle which runs down the medial edge of the foot and relates to the Medial Latitudinal Arch reflex.

This muscle runs the length of the spine reflex in the foot and is equivalent to the muscles found at the sides of the spine. So, whenever there is tension in these muscles, we will feel tension precisely at the same point(s) in this muscle in the foot.

It is important to pay attention to which type of Medial Longitudinal arch the client has, as this will tell us about the shape of their spine. And it will therefore give us clues when problems occur in the back as to what the cause is likely to be and what form they will take. Then which vertebral reflexes we will need to work on the most and how. (image 3. following)

It is also important because the vertebrae enclose the spinal cord. This means that the reflex for this is also found in the arch, as well as the reflexes to all the nerves that exit from it to supply the organs in the body. Therefore weakness related to arch shape will also affect the vertebrae and the functioning of the nerves.

And thirdly, depending on the shape of the arch, we can see which parts of the spine and back tend to be affected by excessive weight bearing and how the organs found in the parts of the body they support will be impacted by this.

The Three Types of Medial Longitudinal Arches

image 3.

a. flat                    b. neutral                    c. high

foot arch types

If the arch is abnormally high or flat, it can be due to certain medical conditions, so be sure to ask about this when taking a client’s history. However, usually the shape is due to genes and it is normally adapted to and accommodated by the body from childhood onwards. But when musculoskeletal problems do develop, we can see the different ways they will tend to affect  each arch type, and therefore how this will relate to the health of the spine reflex.  

We can also see from the middle row of the diagram, that weight bearing will be distributed on the feet depending on the arch shape, which will also influence how the reflexes might be affected. As the bottom row shows the heels it is clear the different ways in which each arch will put pressure on the pelvis, hip and sciatic reflexes. 

Bear in mind none of the arches, or the personality types associated with them, are inherently ‘bad’ or ‘good’ in themselves. They are all completely natural and as such have their strengths and their weaknesses. We are only looking at what happens when things become imbalanced energetically – in any way – and how weakness will be prone to manifesting depending on the arch type.

      a. Low/Flat when there are problems with these arches, it will usually be because they have a lack of strength in the muscles and tendons and can become overly flexible and weak. So the spine and back itself will also be potentially affected by problems for the same reason. 

There are many reasons for adult acquired flat feet (fallen arches). But because they are overpronating there is a disproportionate amount of weight being carried on zones 1-2 than is structurally ideal, so consider reflex health here. There can be balance issues with these arches due to their flatness so consider this with clients who have them.

Work the arch by bending and plantar flexing the whole foot including the toes, and massage the muscles alongside the spine reflex as deeply as possible to help build up strength in the vertebrae, but do so carefully so as to avoid cramping. The client can also do exercises for their feet to strengthen the arch.

Emotionally, the flexibility of this arch means the person tends to be solid and easygoing, and work very well as a team player as they benefit from the support of others. When weakness occurs it is that they find it hard to work independently or manage without structure in their life.

     b. Neutral this arch can still lack cushioning in the joints and be painful when walking, standing, or running for long periods. These arches are prone to ankle sprains, and therefore can still be connected to pelvic and lower back problems. And they often descend with age or weight gain to become flat or ‘dropped’ arches.

But in reality, no foot is truly totally neutral and will always tend slightly towards having either a higher or lower arch, so try to assess this. Also watch out for one foot having a flatter or higher arch than the other, as this will be a cause of structural and therefore spinal imbalance.  

     c. High this arch tends to be overly rigid and lacks flexibility, and when back problems develop they also tend to be associated with this. Higher arched feet tend to underpronate, and so may weight bear disproportionately on the lateral edges. So look out for problems in reflex areas zones 4 & 5 and consider this arch in conjunction with the Lateral Latitudinal arch which I cover a little further down. Also, because of the height of the arch, there will be disproportionate weight put on the heels and ball of the foot, so pay extra attention to the reflexes there.  

To help with flexibility, whether there are existing spinal problems or to work preventatively, do a lot of stretching of the foot to loosen the vertebrae, and also twist the foot in alternate directions on either side of the mid arch. And massage the muscles at the side of the spine on the plantar foot to keep them (and hence the equivalent muscles alongside the spine in the body), as flexible as possible. 

Emotionally, the high inflexible arch tends to be seen in more of an independent thinker and personality. But when this gets out of balance, it can be seen as inflexibility and emotional rigidity, not wishing to work with others or take their thoughts and feelings into account.

Medial Arch Shapes & Scoliosis

It is possible for there to be a great difference to develop between the two medial arches of the feet. This indicates very different curvatures in the two sides of the spine which will likely reflect back problems. When the differences are extreme can be seen in clients who suffer from scoliosis

Potentially this difference can occur when one arch drops, but the other doesn’t. As a result, one foot can be a whole shoe size longer, while the other, shorter foot is wider, especially across the metatarsal area. As the proximal ends of those bones form the transverse arch this is one example of how the structure of the arches affects each other. The differences in length and width in themselves can lead to difficulties in finding suitable footwear which then exacerbates the problem.

So work according to what you see to try to balance the two sides of the spine as much as possibleAs well as helping with back problems, this will help with physical balance as the greater the difference in foot shape the more potential for the person to have falls. Emotionally and mentally of course, it will also help balance the two sides of the person, but I will leave the significance of the left and right foot to these things for a later chapter in the book.

photo 7a.

These are two very different shaped and sized feet. It is noticeable that the right foot is wider across the reflexes of the shoulders and pelvis and especially at the diaphragm, than the left. 

The left hallux/chest reflex area is thrust more prominently plantar wise. But this is not the case in the right chest area.

photo 7b.

In this foot the shape of the two arches is quite different – the right foot is much straighter. The left spine reflex is very curved mostly due to the diaphragm/transverse having a hallux valgus (bunion).

2. The Lateral Longitudinal Arch

The lateral and medial longitudinal arches work very much in tandem and if the medial arch is high, this can lead to problems with the lateral arch, as the foot will most likely underpronate (prior image 3c.). This will put a disproportionate amount of weight onto the lateral arch along the outer edge of the foot (photo 4a. following). This will impact the reflexes to zones 4-5, including the arms and legs and shoulder, knee, and elbow joints. It can also affect the ascending and horizontal colons and their flexures.

A high medial arch also puts a lot of weight-bearing pressure directly on the ball and heel of the foot. But sometimes the lateral arch is also high, and then there will be even more pressure on the ball and the heel of the foot (photo 4b. following)This will also affect the reflexes found in the heel and metatarsals, so therefore the chest and the gluteal areas of the body. 

If someone with these types of arches wears high heels this will further exacerbate problems with the upper body reflexes as this will make them thrust their weight even further onto the balls of the feet.


photo 8a.  

Here the high Medial Longitudinal arches are causing the feet to invert, putting pressure on the Lateral Longitudinal arches and therefore the reflexes in zones 4 and particularly zone 5. 

In this quite extreme case, the shoulder and knee joint reflexes are very impacted as well as the colonic flexures.

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photo 8b.  

In this case, we can see very curved Medial and very curved Lateral Longitudinal arches. They both appear high so there will be a lot of weight put on the balls and heels of the feet, and not quite so much on the lateral edges as in the previous photo. 

So, this is not impacting in the same way on the lateral edges and reflexes of zones 4-5. This shape can be caused by a person with high arches wearing heels a lot.

3. The Transverse Arch

The shape of this arch is very relevant to the functioning of the diaphragm muscle and tells us about the shape of the ribcage. Because of the continuous movement of the diaphragm, the arch is important for the whole chest area and all the organs in it, including those of the thyroid, heart, lung, and also upper lymph nodes. Visually and structurally this arch is interdependent with the distal Medial Latitudinal Arch, so also involved with the function of the reflexes of the upper thoracic spine. 

The origins of tension can be physical, such as when the client is slumped over a computer all day. But it is very commonly an emotional response, as people will tend to ‘make themselves small’ and hunch over protecting and folding in on themselves when feeling vulnerable. 

This area is also very important because of the positioning of the heart and the need to ‘get things off our chest’. And also because of the significance of breathing, which symbolically and psychologically relates to taking in new experiences and welcoming the future as we inhale, and letting go of past experiences and emotions as we exhale.

Tension in the transverse arch

One very easy and very accurate way to check how tension is manifesting in the upper body is to see if any of the metatarsal extensor tendons are tight, and therefore dorsiflexing. When this is seen (photos 9. & 10. following), then it shows quite clearly which zones are holding tension in the upper body, and where. 

How far the tightness extends, shows the areas of the zone that are affected. It frequently goes up into the neck and face reflexes, and may also go further down the body towards the waist. And the tighter the tendon the more tension there is in the corresponding muscles. This tension in the dorsal foot will mean the chest is hunching/being pulled forward to the same degree in that zone, which also means that the connected back muscles are being pulled out of alignment as well. 

photo 9.

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Tension in the upper body 

Tightness can be seen in the tendons coming up from the transverse arch particularly in the left side of the body in zone 2 in photo 9.. The extent of this tells us that the tension is going far down the body even carrying on below the waist

Zone 3 is also tense and zone 4 to a lesser extent. There is also tension in zone 1. coming from the chest which goes all the way up through the neck and into the lower face. On the right foot, it is only zone 2 that shows any tightness, apart from some slight tension in the throat area of the big toe.

Working on the dorsal reflexes to the shoulder girdle and shoulder joints in addition to those on the plantar foot is often overlooked, but it is always beneficial for upper back problems and is especially important when we see this kind of tightness. Covering both aspects of the feet is a much more balanced way to work as it also includes the collarbone and all the muscles in the front of the chest, shoulders, and arm as well as the interconnected muscles and fascia of the front and back of the body.

Working up and down the zones from this arch to the toes using firm finger walking and massaging and flexing this third of the foot backwards and forwards. followed by lymphatic drainage is a good way to release tension from the area,  (video 3. following).  But when there is chronic dorsiflexion, in order to counterbalance it put the focus on working the foot backwards i.e. stretching firmly plantar-wise. 

Diaphragm rocking and getting the client to do simple deep breathing exercises are also very useful for this arch especially because it is so connected to the heart and solar plexus/vagus nerve area.

Too Curved

In photo 10. all the distal metatarsal tendons are dorsiflexing very tightly, and there is a lot of tension, especially in both zones 1 going right up into the neck and face reflexes. 

It is clear that the tension is pulling the thoracic area of the spine forward, so it is too curved and this will be pulling the muscles of the back out of alignment as well. This is also connected to the all toes 2-5 bunching up. (I will cover the significance of this in the next chapter, ‘Toes & the Musculoskeletal System part 1’)

photo 10.


Weakness in the Transverse Arch

The opposite extreme is when the metatarsals and toes are too flat. They should both have a slight curvature indicating that they have flexibility. A flat transverse arch is typically associated with chest and lung problems and is often seen in asthmatic clients especially when it has been present since very early childhood. It would seem likely in this situation that the asthma is connected to structural weakness in the rib area, which is impacting the functioning of the diaphragm and efficient breathing. 

When making a visual assessment of the metatarsal area (assuming there is no puffiness due to swollen lymph), you should be able to see the slight dips between the bones but not tightness in the tendons. In the second photo 11. following, because of the lack of curve and flexibility in the arch, we cannot see the tendons at all. Whereas in photo 10. they are far too visible because of the tightness of the tendons.

Too Flat

The entire distal third of the feet in photo 11. is too flat so will be rigid and inflexible. The purple dots on the left dorsal foot show where there should be a slight upward curve to the transverse arch to provide flexibility and resistance. But this and the corresponding arch on the right foot are too flat. 

The upper thoracic spine reflexes on both feet also lack curve and flexibility. And the toes are too flat and straight as they should have slight dorsal flex. This means that the neck reflex is too rigid. There is also the start of hallux rigidus type of bunion in the breast bone reflex adding to the lack of flexibility.

photo 11.

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Metatarsal Stretch (video no.3)

The following video shows a good way to work the metatarsal area, for both the dorsal and plantar muscles simultaneously as well as supporting the organs in the area. It is still possible to use this technique if there is any arthritis or history of broken joints just go very gently between the affected toed while paying close attention to the client’s response, and ease up or stop if there is any pain. The same guidelines apply if there are bunions present. Many people love this technique, but if your client doesn’t enjoy it, don’t force it on them.

Common Foot Conditions

The following are all examples of clinical conditions that affect the musculoskeletal system that are often thought of as having no direct relationship to reflexology, but this is not the case. They are all telling us something about the reflexes of the musculoskeletal system on which they are found and, therefore, about the equivalent areas of the body.

Cramping and twitching in the muscles during a treatment are also of great interest from the perspective of Visual Reflexology, and I cover both in depth later on in the book in the chapter ‘Other Visible Reactions’.

Do not use this guide for diagnosing. And if you are unsure as to what you are seeing, or after taking a client’s history, feel that clinical attention is needed, refer to a medical practitioner. (Use your general reflexology training to decide when to refer.)


Bunions involve the metatarsals and toes so they are also relevant to reading musculoskeletal health on their joints. But because they are caused by structural problems in the foot arches, I will cover them in this chapter. I look at other problems related to the hallux that are not bunions in the following chapter, ‘reading the toes#1’

They can be an inherited problem, and I often find when a client says her mother also suffered, then they are less troublesome than when they have developed from poor footwear and other lifestyle choices. But even if the bunion does not cause pain, still consider its impact on the reflex areas in which it forms.

Hallux valgus is the most common type of bunion, and it develops because of structural issues with the feet. In reflexology terms, they relate to a problem with the thoracic spine as they impact the function of this area of the latitudinal arch. But they also affect the transverse arch and therefore impact the diaphragm and the reflexes of the whole chest area as well. 

When this type of bunion is present, it is necessary to consider the health of the vertebrae of the affected region of the thoracic and cervical spine (which will depend on the size of the bunion), the sternum, the oesophagus, the nerves that come out from those vertebrae, and also all organs and muscles in the chest area, particularly of zones 1-3.

Because it is formed by a dislocation of the hallux, it is also very relevant to thyroid function.  The joint dislocation always directly impacts the plantar thyroid reflex (see photo 11a. following). Additionally, if it is large, then the deformity goes into the throat area, which is where the dorsal anatomical reflex to the thyroid is sited. 

There is another connection between a bunion and a common symptom of hypothyroidism to bear in mind, which is weight gain. This in itself can put pressure on the arches of the feet and lead to the formation or worsening of a bunion, which in turn will have a negative impact on the functioning of the thyroid reflexes.

The client may be aware they have thyroid issues. But even if they aren’t, bear in mind, that thyroid function is often poorly diagnosed, so it may not have been recognised. And while we must never openly dispute a medical diagnosis, reflexology can offer a lot of support to clients who feel they are not being properly helped by orthodox medicine.

It is essential to work around the bunion to help the thyroid and other reflexes of the area. Use as much pressure as you can without causing pain or discomfort to your client to work around (not over) the joint using finger walking and massaging to boost the circulation of blood and lymph, and if possible, gently flex and stretch the joint to help retain flexibility. 

In addition to helping the reflexes, the massaging effect of this will help alleviate symptoms and prevent further deterioration of the joint. Although this is not reflexology as such, it is a welcome side effect, and it is great to be able to help in any way we can, so we should stress this additional benefit to clients.   

In emotional terms, bunions tend to be associated with carrying the problems of others on your back and shoulders, particularly of your family and those closest to you. This would fit with the typical profile of the bunion sufferer, who is a middle-aged to elderly female.

Hallux rigidus is also a bunion, but develops when the hallux loses dorsal-plantar flexibility, gradually stiffens, and can become arthritic (photo 11b. following). It is more visible on the dorsal foot, so is another good example of always checking this aspect. To help to keep it flexible and prevent further deterioration, work it in a similar way to a hallux valgus. 

Reflex wise, as it is affecting the hallux joint, it also relates to the upper thoracic area, but mostly the dorsal reflexes in zone 1, particularly the sternum and oesophagus. Because of the lack of movement in the joint the client’s breathing may be affected, as the rise and fall of the diaphragm will be impacted. If it is comfortable for the client, use the diaphragm rocking technique as shown in this post.

Emotionally it can show a person who has suffered a long standing hurt. But they have responded to the hurt with pride and inflexibility in contrast to those with hallux valgus who show their vulnerability and weakness to the world, 

Tailor’s bunions are found at the distal 5th metatarsal, and tend to manifest on feet that are already prone to hallux valgus (photo 11c. following). Because of their position, they tend to reflect problems with the arm, and especially the shoulder joint and also the functioning of the axillary lymph nodes in the armpit. 


11a. Hallux Valgus

The bunions are pulling the cervical spine and thoracic spine reflexes out of alignment. In these feet, the misalignment goes as far as the neck, which affects the throat, including the dorsal thyroid reflex. 

It is also impacting the whole hallux area, and organs found there, including the plantar thyroid reflex. 


11b. Hallux Rigidus

This type of bunion shows dorsally. So consider the anterior bodyall of zone 1. and the sternum and oesophagus in particular.

Focus on the diaphragm and bronchial tubes and centre of the chest. It affects breathing as it inhibits the rising and falling of the chest.

11c. Tailor’s Bunion

A tailor’s bunion puts pressure into the shoulder joint, so work to keep this joint flexible. And also be aware of lymph flow in the area, especially the axillary nodes in the armpit. 

This, in combination with the hallux bunion, is putting pressure all the way across the muscles of the clavicle and diaphragm. It also affects the alignment of the toes, and I will look at the impact of this in the next chapter

Some Other Common Foot Conditions

Morton’s Neuroma. This is often found in clients with bunions, as it is caused by the toes in zone 3/4 being squeezed together. Consider the same area over the shoulder girdle, especially if there is neck and shoulder pain, particularly that originates between the shoulder blade. 

If you work deep into the musculature of the feet in the zone the neuroma is found, you will find a small area of great tightness in the tendon there. So try to work this out to relieve pressure on the nerve and ease the pain in the foot and any neck and shoulder pain. Use the technique shown in the video above for metatarsal stretch work, as this can help (if the client is comfortable with it). Emotionally it is connected with a feeling of restriction, being held in.

Tendonitis should be diagnosed and treated clinically, but to work preventatively, we should keep the lower back and sciatic region as flexible as possible. So we would work the Achilles and also all over the heel on the reflex area to the gluteal muscles. 

Plantar Fasciitis is caused by an inflamed tendon, and depending on where the symptoms are in the foot, the equivalent muscle area in the body will also be affected. So as usual, when the problem is connected with musculature in the body, work the musculoskeletal system in the foot with the techniques described in the previous post, and use the techniques in video 4. following. This shows a trained massage therapist at work, and the client is prone, but we can include any of the techniques she uses during a reflex session. This therapist is also working the muscle reflexes to the back, but she (maybe) just doesn’t know it! 

Plantar Fasciitis video 4.

I wish that more reflexologists and their clients realised the benefits to the feet purely from the massaging effects of reflexology. Other than by reflexologists who are also trained in massage, this side benefit of the therapy is often greatly underestimated. As I continually stress in this chapter, working the muscles of the foot is working the muscle reflexes to the body; there is no separation – we are benefiting the foot itself as well as the reflexes.

photo 12.


Plantar fibromas are fibrous nodules that grow on the large tendon and quite common in the elderly especially. It is not always visible but when it is it looks like a small bump on the sole, usually in the midfoot. 

They can appear similar to a cyst (covered in a later chapter) but will feel harder. They can also be painful and confused with plantar fasciitis. So should be medically diagnosed.

There will be chronic tension in the muscle area of the body at the equivalent reflex area to where it appears on the tendon.

photo 13.

Metatarsalgia, where one or more of the metatarsal/sesamoid joints is disproportionately weight bearing, which causes them to appear more prominently. It has many causes and tends to be found in those with high arches, so refer to the section above on arches. 

In terms of the reflexes, we would focus on working the same area in the body and the lungs and upper back especially and use the techniques shown in the metatarsal technique video if possible


Out of interest – see if you can see these classic spinal shapes reflected on the medial arch of any of the feet on this page, or in any of your clients!

posture spine

A preview

The following photo 14. is a preview of how different visual elements can be combined to read the bigger picture of the client’s health. In the photo we can use what has been covered so far to read the shape of the feet and get a good idea of what is happening with the musculoskeletal system. But once we can read the appearance of spinal lines, which I cover in an upcoming chapter, we get a lot more information. Reading the shape of the toes, skin textures, and colouring would add further dimensions. So, I will read a different pair of feet at the end of each chapter, gradually adding each of these aspects (and more) to the readings as they are covered in the book. 

Combining musculoskeletal structural reflex reading with spinal lines.

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photo 14.

These feet (photo 14.) have very different medial longitudinal arch shapes. Because these arch shapes reflect how the person tends to lean down into the spine on either side, their differing shapes would indicate there are back problems present.

But there are additional markers as to why there are back problems and precisely where their origins may be.

The left foot arch has a very sharp curve beneath the ball of the hallux showing the muscle is very tight here in the foot. This is caused by tightness in the muscles alongside the spine in this area, probably due to chronic poor posture. The tightness reflected in this acute curve means that the lower thoracic vertebrae reflexes especially, are being compressed. And the lines exiting from the foot arch correspond to exactly where the vertebrae are under pressure and tell us where to focus our work to help the back. The continuation of these lines down the vertebrae of the lumbar spine to the base shows that the compression of the vertebrae carries on this far. 

The right foot has a gentler curve to the arch and therefore this tells us there is less compression on the vertebrae on this side of the spine. The person does not lean down so much into this side. As a result, the foot has a smaller area of lines concentrated in the mid-spine. This shows that the main compression of the muscles of this side of the spine is here.

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.

7 thoughts on “13. Musculoskeletal System (Part 2)”

  1. Hello Angela Telford!
    Do you advice any particular technique to work plantar fibroma? Thanks, Raquel Dora

      Hi there, I would say with these kind of muscle/tendon type problems its a good idea to follow guidelines on foot massage techniques to use and also cautions on how to proceed. This article above shows massage techniques that you can incorporate into a reflex treatment safely.
      However just to follow protocol, do not claim to be giving a foot massage if you are not insured in massage therapy, just explain that you are using techniques on the reflexes that relate to the relevant areas of the body, ie the muscles in the length of the back.

  2. Hi Angela
    Just a note that you have spelt Judith’s name wrong – it’s Whatley, not Whately. I did her Advanced Spinal Reflexology training when it was a one day online with the AOR. Like you I can’t currently find anything online about her knowledge in this area. I have a handout from her from the course which nicely adds to the excellent information you have on this page. For example, you can see when the pelvis is twisted, making it seem like one leg is shorter than the other, because one foot is closer to the body than the other on the client. I have been looking for some more info in this area, which I think is fascinating, so thanks very much for pulling this together x

  3. Hi Angela, what an interesting blog, thank you. The pictures and explanations are so useful and I love the video on how to relieve tension in the pelvic floor.
    Do you have any other videos which you can show to help with the other issues eg how to relieve upper back tension?
    Can reflexology really help to reduce the tension in the tendons through correct massage of the foot?
    Also, at what stage should you refer a client to a chiropractor or physio?

    I look forward to hearing from you. Best wishes, Andrea


      Hi Andrea, I have added the metatarsal separation video at your suggestion. Thank you.
      Reflexology actually is basically a form of massage – only with the enormous added benefit of being able to work much more profoundly on the body because we can apply the pressure with the knowledge of the reflexes. So absolutely yes it can help any form of tension just like any type of massage.

      As far as when to refer to another practitioner, this is something that you should refer to your initial reflexology training for as it is an additional different skill to foot reading. But it will depend on severity of symptoms, client concerns etc. but as a general rule I don’t find GPs are the best people to refer to when there are any musculoskeletal problems. If the client can afford it I would suggest a body worker such as an osteopath (or physio if there has been an accident) and if they can’t afford it then to a GP.

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