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Int J MS Care. 2024 Mar-Apr; 26(2): 43–48.
Effect of Foot Reflexology on Patients With Multiple Sclerosis: A Systematic Review of Current Evidence

Boopalan Deenadayalan, MD, Vijayakumar Venugopal, PhD, Ravi Poornima, BNYS, Vanamoorthy Mahesh Kannan, MSc, Anandhan Akila, MD, Chidambaram Yogapriya, BNYS, and Kuppusamy Maheshkumar, PhDcorresponding author

From the Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India (BD)
Department of Naturopathy (CY)
Department of Yoga (VV)
Department of Acupuncture & Energy Medicine (VMK, AA), and Department of Physiology (KM)
Government Yoga and Naturopathy Medical College and Hospital, Tamil Nadu Dr MGR Medical University, Chennai, India;
Department of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (RP) Chennai, India.

ABSTRACT

BACKGROUND:
Individuals with multiple sclerosis (MS) commonly experience fatigue, discomfort, sleep problems, anxiety, and reduced quality of life. Studies have shown that foot reflexology can help relieve these symptoms. The objective of this current study is to systematically review the effects of foot reflexology on patients with MS.

METHODS:
We conducted a systematic review of published literature in many databases, including PubMed, EMBASE, and Cochrane Library, from January 1, 2000, to January 27, 2022. With language restrictions, we included randomized controlled trials of foot reflexology interventions for MS that had any clinical or psychological symptom measurements as outcomes. The Cochrane risk-of-bias tool was used to assess evidence quality. Two authors independently screened titles and abstracts. Potential eligible articles were retrieved for full-text review. A third author checked for excluded records. All discrepancies were resolved through a discussion among the 4 reviewing authors.

RESULTS:
A total of 154 studies were identified; 9 studies with 545 MS patients were included in this review. The most frequently reported findings of foot reflexology intervention in individuals with MS were reductions in fatigue, pain, muscle spasms, stiffness, and psychological symptoms and improvement in bowel and bladder functions and quality of life.

CONCLUSIONS:
The findings suggest that foot reflexology could be a safe and effective modality to reduce the physical and psychological symptoms and also improve the quality of life for individuals with MS; however, well-designed, large-scale trials are required to confirm the effect.

Free full text:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10930811/

Excerpts:

"Reflexology is a common therapy from complementary and alternative medicine.5 It works on the theory that certain reflex points on the palms and soles correspond to internal organs and glands.6 Previous studies have found that foot reflexology is effectively used in the management of various symptoms, including fatigue, stress, bowel and bladder dysfunction, and pain, and also improved sleep and quality of life in individuals with MS.6,7"

"DISCUSSION

"Reflexology is the application of moderate pressure on the feet using a series of thumb and finger movements. Every physical area of the body is represented in a reflex area, from the head at the distal phalanx of the great toe to the pelvis at the calcaneum.16 Stimulating these areas enhances blood and energy circulation, promotes relaxation, and preserves balance,17 although the precise mechanism is unknown. We have 3 theories on why foot reflexology helps individuals with MS. (1) Reflexology creates electrochemical signals by activating neural pathways via the sensory stimuli, aiding analgesic effects with a release of endorphins.18 (2) Reflexology is believed to remove toxins from the body and impact the endocrine, immune, and neuropeptide systems. This positively affects the physiological and psychological parameters by stimulating the autonomous nervous system.7 (3) Significant improvement in quality of life could be attributed to the proprioceptors in the feet that correspond to parts of the body.19 Pressure is easily felt on the feet as they have a variety of sensory nerve receptors with unique anatomical and physiological characteristics.20

"In general, touch and foot reflexology generate pressure and trigger the sensory nerve endings (corpuscles). In the dermis and epidermis, corpuscles, tactile cutaneous mechanoreceptors (ie, Meissner, Ruffini, and Pacinian corpuscles), react to increased pressure and rapid vibration. They trigger action potential in the cells, discharging electrical current that gets transmitted via the sensory nerves to the brain for interpretation and resultant response via the motor nerves.21 Analgesic effects are achieved by pressure on specific reflex points, which effectively intercepts pain neural pathways via the gate control theory of pain mechanism.

"In the 9 studies included in this review, foot reflexology had a positive effect on the physical and mental health and quality of life of individuals with MS. None of the interventions had treatment-related significant adverse events."

"CONCLUSIONS

"Foot reflexology may be a safe and cost-effective intervention for individuals with MS as it has shown potential effectiveness in managing a range of physical and psychological symptoms experienced by individuals with MS. This systematic review aimed to provide a comprehensive summary of the effects of foot reflexology on the population. Drawing from the existing scientific literature, foot reflexology can effectively alleviate symptoms such as fatigue, stress, muscle spasms, depression, and anxiety. As a result, it contributes to improved sleep quality and overall quality of life. Thus, improvement was seen in both subjective and objective parameters; however, large-scale randomized studies with long-term follow-up are necessary to validate these effects."

"PRACTICE POINTS

"The minimal electrical activity along the sensory nerves generated during reflexology might be beneficial in reducing the symptoms associated with multiple sclerosis.
Foot reflexology is a noninvasive, economical, nonpharmacologic treatment option that may be beneficial for individuals with multiple sclerosis."

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Comments:

There is no discussion of the fact that reflexology is rejected by the scientific community, and that its principles are inconsistent with understanding of anatomy and physiology. Therefore it is likely that any alleged benefits are placebo effects.

There is no discussion of how the results were affected by the type of control group. Only one of the nine studies used a sham control group ("The intervention group was given foot reflexology with pressure massage; the control group was given sham reflexology (ie, standard foot massage with little pressure) using grapeseed oil."). In this study, "Significant reduction in pain was observed in both groups when compared to baseline. No statistically significant difference was observed between groups."