This is a case study to show the effectiveness of reflexology in the progression of healing a diabetic wound over the course of one year.

1. Client: Casey Lee (anonymous name)
REFLEXOLOGY CASE STUDY
by Connie S. Young, Certified Reflexologist

2. Client History
 Diabetic neuropathy;
 Compliant diabetic who eats well and takes care of
herself;
 Normal weight, but swollen neck;
 Open wound on great toe (ongoing condition for two
years—started 5 Dec. 2006);
 Callused feet on medial side—both feet—open wound
on left great toe only;

3. History of Wound Treatment
 Client treatment prior to reflexology:
 Used expensive cream application prescribed by doctors
(client said there was no visible healing);
 Soaked feet in hydrogen peroxide every day;
 Wrapped wound when it was seeping blood.
 Client pursued many types of conventional medical
healing and alternative healing modalities before
trying reflexology as a “last resort.”

4. Reflexology Treatment/Study
 Client treatment—once a week sessions for first six weeks
 Sometimes treatments were more than one week apart out of necessity.
 Assessment with client would determine further treatment at
the end of six treatments.
 Client /Practitioner chose to continue treatments every two weeks.
 Client was requested to stop hydrogen peroxide soaking and
only clean the wound dabbing it with hydrogen peroxide
using cotton balls.
 Client chose to discontinue using hydrogen peroxide completely.
 Client was asked not to change any other element of her
routine concerning the wound during reflexology treatments
for the duration of the case study.

5. Sinus Reflexes Sinus Reflexes
Pituitary
Eye Reflexes Hypothalamus Eye Reflexes
Pineal
Esophagus
Thyroid
Parathyroid
Trigeminal Nerve
Ear Reflexes Ear Reflexes
Chronic eyes
Chronic ears
Pericardium
Shoulder Reflex Heart Shoulder Reflex
Lungs
Lung Reflexes Lung Reflexes
Adrenals
Stomach
Liver Pancreas
Gall Bladder Kidneys
Spleen Reflex
Duodenum
Reflexes
Knee
Knee Ureter
Ileocaecal Valve Small Intestines
Sigmoid Reflex
Appendix
Colon Reflexes Colon Reflexes

6. Session One
Session One: Client’s feet are both callused and the pad of the
right foot is quite swollen compared to the left foot. Notice the
toes against the pad itself. Compare to Session Three.

7. Progression of Healing
 Session One: Pictures were taken following
the first reflexology treatment.
 These pictures show the wound, but do not
show the seeping of blood,
 The photos show the swelling in the foot and
the pad of the foot.
 The right foot also had calluses that showed
cracking and some roughness of skin.
 Feet: Session One

8. Session One
Note the size of the toe and the swollen
pad of the foot and great toe.

9. Session One
The picture is the same
size as in session one. So
is the circle—this is to
help the eye see the
difference in the wound.
Note the size of the toe and the swollen
pad of the foot and great toe.

10. Dorsal Side: Session One
Note the swelling of the
great toe on the left
foot—client complained
that she could not “feel”
her feet.

11. Client Reaction
 Following the first treatment, the client
wrote:
 “Just wanted to let you know, that while I cannot
pinpoint exactly what, I can tell that my feet feel
most decidedly different since the session
yesterday. I know this is going to be a worthwhile
venture for me” (Casey Lee).
 “P.S. In the meantime, I am trying to get more in
touch with ‘feet’ things that are unfamiliar for me .
. . I am excited, and will be in contact.”

12. Session Two

13. Progression of Healing
 Session Two: Pictures were taken after the foot was soaked in
clear water for five minutes prior to the reflexology treatment;
 The photo shows the yellowing underneath the skin showing the
depth of the wound;
 EPCs explained: “Diabetic?”;
 In an article entitled “Endothelial Progenitor Cell [EPC] Release
into Circulation is Triggered by Hyperoxia-Induced Increases in
Bone Marrow Nitric Oxide [NO],” researchers at the University of
Pennsylvania Medical Center in Philadelphia believe “EPC
mobilization into circulation is triggered by hyperoxia through
induction of bone marrow NO with resulting enhancement in
ischemic limb perfusion and wound healing” (3); (see Abstract);
 Stimulating the reflexes of the feet may induce this healing
process naturally. Further study needs to be pursued in this area;
 Compare Session One with Session Two as the treatment given
has improved circulation to the wound and allowed the body to
begin the healing process without injections or other treatments.
 Feet: Session Two;

14. Graphic Representation
Found in the article “Cellular and Molecular Basis of Wound Healing
in Diabetes” by Harold Brem and Margana Tomic-Canic

15. Abstract
Endothelial progenitor cells (EPC) are known to contribute to wound healing but the physiologic
triggers for their mobilization are often insufficient to induce complete wound healing in the
presence of severe ischemia. EPC trafficking is known to be regulated by hypoxic gradients and
induced by VEGF-mediated increases in bone marrow nitric oxide (NO). Hyperbaric oxygen
(HBO) enhances wound healing though the mechanisms for its therapeutic effects are
incompletely understood. It is known that HBO increases nitric oxide levels in perivascular
tissues via stimulation of nitric oxide synthase (NOS). Here we show that HBO increases bone
marrow NO in vivo thereby increasing release of EPC into circulation. These effects are inhibited
by pretreatment with the NOS inhibitor L-nitroarginine methyl ester (L-NAME). HBO-mediated
mobilization of EPC is associated with increased lower limb spontaneous circulatory recovery
after femoral ligation and enhanced closure of ischemic wounds and these effects on limb
perfusion and wound healing are also inhibited by L-NAME pretreatment. These data show that
EPC mobilization into circulation is triggered by hyperoxia through induction of bone marrow
NO with resulting enhancement in ischemic limb perfusion and wound healing. (Goldstein et. al 1)

16. Sessions One and Two
Session One: Note the size Session Two: Here the swelling has
of the toe and the swollen receded and the skin is beginning
pad of the foot and great to heal around the wound.
toe.

17. Client Reaction
 Following the second treatment, the client shared:
 “Usually my feet feel like shapeless stumps that just ‘thud’
[on] the ground . . . sometimes with sharp knife-like pain that
stabs, though I cannot really pin-point the exact location.
This manifests itself in different degrees of precarious
balance.
 Immediately after the session yesterday, my feet felt much
more in touch with the ground. A vein in my left toe was
visible to the knuckle right before the end of my big toe.
 My balance today is pretty good, and, while sometimes, I
limp, or my right foot drags a bit, there was none of that thus
far today. The sensation of having had a ‘deep tissue’
massage only in the feet (including toes, heels, and middle
of foot) was not extremely strong, but very definitely
present.”

18. Session Three
Session Three: The callused right foot was healing remarkably, while
the left foot was definitely improved. Swelling was down and the
client’s toes on the left foot were looking more normal in size.
Compare to Session One. Back to Session Four.

19. Progression of Healing
 Session Three: Pictures were taken prior to treatment.
Indications:
 The wound was healing very slowly.
 The left foot was definitely less swollen.
 The client felt more ability to balance herself when walking.
 She started to “feel” the treatment as if it were a “deep tissue
massage.”
 Hypothesis: Stimulating the reflexes of the feet may induce
EPC healing process naturally.
 Compare Session One with Session Two as the treatment
given has improved circulation to the wound and allowed
the body to begin the healing process without injections
or other treatments.
 Feet: Session Three

20. Session Three
The picture is the same
length (see green line) as
in session one. So is the
circle—this is to help the
eye see the difference in
the wound.

21. Session One and Three
The toe and pad of foot look less swollen
and the wound is coming to the surface.
There is also new, healthy skin forming at
the edges of the wound.

22. Client Reaction
 Following the third treatment the client shared:
 “The day after my appt. I noticed obvious foot veins,
reaching at the highest, to the space between toes 2 & 3
(the big toe being #1) on my left side. Veins were clearly
seen on the right side to the 1st joint below the toe nail on
my big toe.
 Balance seems more grounded . . . and, it was tested as I
worked a lot in my yard today, which has many sharp
inclines and uneven surfaces. The sore looks good, and
seems to be ‘bonding’ some. My feet felt sore, but in a
healthy way . . . like they had been subject to a ‘deep
tissue’ massage.
 Also, I am noticing a little less pain/discomfort on the
outside of my right knee and into my right hip” (Casey
Lee).

23. Session Four
Session Four: The callused left foot was healing slowly, while the right
foot was definitely improved. Swelling was down and the client’s toes
were looking more normal in size. Compare to Session One, Session
Three.

24. Progression of Healing
 Session Four: Pictures were taken after the
foot reflexology treatment.
 Compare the pictures of the feet taken in
Sessions one, three, and four. If you look
closely at the left foot’s toes, you will see the
swelling and its regression from Session to
Session.
 Feet: Session Four

25. Dorsal Side: Session Four

26. Session Four

27. Session Four

29. Sessions One and Four

30. Session One
Comparisons
Session Three
Session Four

31. Session Five Before Treatment
After Treatment

32. Progression of Healing
 Session Five: Pictures were taken before the
treatment and after the treatment to
compare how the treatment affects the feet.
It was interesting to note that the wound
looked more dry after the treatment.
 The client expressed concern that there was a
new piece to the wound.
 Feet: Session Five Before Treatment
 Feet: Session Five After Treatment

33. Before Treatment
After Treatment

34. Client Reaction: Session
Fivethe fifth treatment the client shared:
 After
 “More good news! My sore looks good, and my feet are
back to feeling more ‘grounded,’ thus . . . better balance! I
can feel a little more sensation in them, as well.
 Thanks for working on the part of the right foot that affects
my knee and hip. I have noticed less discomfort in the knee,
in particular.
 Finally, I am so glad you called my attention to my neck. I
have really been taking note of my mirrored reflection (for a
change) . . . you are right again! There IS a difference. There
is more definition in the neck, especially right at the jaw
line. PLEASE keep working on that!
 I believe your efforts on my behalf are paying off . . . thank
you so much.”
~~Casey Lee

35. Dorsal Side: Session Five

37. The wound shows a
definite change in
appearance from before
the session to after the
session, which might
support the theory that
EPC stimulus is evident
through reflex
stimulation of the foot.
Before Treatment
After Treatment

38. Session One
Comparisons
Session Three
Session Four

39. Session Five
Session Five

40. Session Six
Session Six

41. Progression of Healing
 Session Six: Pictures were taken before the
client’s treatment and just following the
treatment as well.
 The toe also diminished in size, which makes
it difficult to see with the eye what has
happened to the wound.
 Feet: Session Six Before Treatment
 Feet: Session Six After Treatment

42. Session Five
Session Six

43. Right
Foot
Progress

44. Session Six
 One tablespoon of baking soda and one
tablespoon of sea salt added to the footbath.
 Everything else was the same.

45. Left
Foot
Progress

46. Client Reaction Session Six
 Wound looked like it was coming toward the
surface and opening up more.
 Swelling decreased.
 Client was still encouraged and hopeful to see
full and complete healing of this wound.

47. Dorsal Side: Session Six

48. Session Seven
Session
Seven

49. Progression of Healing
 Session Seven: Pictures were taken before
the client’s treatment and just following the
treatment as well.
 Feet: Session Seven Before Treatment
 Feet: Session Seven After Treatment

50. Dorsal Side: Session Seven

51. Client Reaction Session Seven
 Client is still encouraged and hopeful to see full
and complete healing of this wound.
 On Session seven the client also shared that she
had realized a side benefit of the treatments.
She had decided to trim her toenails. Her third
toe nail was prone to detach from the skin and
fall off three times a year. When she started
trimming, she felt she would need to be cautious
of that toenail. She discovered that the toenail
was now fully attached and just like her other
toenails again. She was surprised and delighted!

52. Session Seven
Session Six

53. Session Seven
Session Six

54. The wound looks
Session Five as if it is getting
larger, but the skin
underneath is
healing—the
Session Seven surface is now
creating healthy
skin. The wound is
less deep.

55. Session One Session Seven
Session Five

56. Session One
Comparisons:
Session Seven

57. Session Eight

58. Progression of Healing
 Session Eight: Pictures were taken before
the client’s treatment and just following the
treatment as well.
 Feet: Session Eight Before Treatment
 Feet: Session Eight After Treatment

59. Session One
Session Eight

60. Comparisons
Session One Session Four Session Eight

61. Session Nine

62. Session One

63. Progression of Healing (continued)
 Session Nine: Pictures were taken after the
client’s treatment.
 Feet: Session Nine After Treatment

64. Session One Session Nine

65. Session One
Session Five
Session Nine

66. Session Five
Session Seven
The wound is
knitting together
and the skin is
definitely healing.
Session Nine

67. Progression of Healing
 Session Ten: Pictures were taken after the
client’s treatment.
 Feet: Session Ten After Treatment

68. Comparisons: Sessions One to Nine

70. Session One Session Eight
Comparisons
Session Four Session Nine

72. Comparisons: Sessions One to Nine

73. Session Ten

74. 30 July 2008

75. 20 August 2008

76. 27 August 2008

77. 5 November 2008

78. 1 September 2008

79. 10 September 2008

80. 24 September 2008

81. 8 October 2008

82. 24 October 2008

83. 5 November 2008

84. 19 November 2008

85. Client Reaction Session Ten
 Client is still discouraged to see the wound
looks somewhat larger, but encouraged to
know that it is not as deep as before and that
healing is still visibly taking place.
 The client also experienced a bit of a setback
in that she realized she had developed an
infection in a particular area of the wound,
but nursed it back to health before coming to
her tenth session for reflexology.

86. Session Eleven

87. Composite of Wound Inverted

88. Composite of Wound Inverted
30 July2008 3 December 2008

89. Composite of Wound Inverted
30 July2008 3 December 2008

90. 30 July2008 11 February 2009

91. Comparisons
Session Eleven
Session Nine

92. Comparisons
Session Eleven
Session Sixteen
Session Nine

93. Comparison of Wound
3
2 4
1
9
5
16
11
10
8 6
7

94. Comparison of Wound
3
2 4
1
9
5
11
16
8
7 6
10

95. Conclusions
 Reflexology can help the body’s processes to improve
blood flow of the circulatory system, increase the
efficiency of the nervous system, and allow the body’s
environment to return to homeostasis.
 Healing is enhanced and encouraged with reflexology
treatments, even in diabetic wounds, so it would be
appropriate to believe that health is also enhanced and
encouraged in those who are already healthy, or in
situations where people need healing of any chronic or
symptomatic issue.
 To assume reflexology is only a complimentary or
alternative method of healing would be an
understatement.
 Reflexology is a necessary and vital treatment for
preventative health, repairing health, and equipping the
body to fight disease more efficiently.

96. Seeing is believing . . .
First Session
Tenth Session
Can you live without reflexology?
Sure, but after seeing this, do you
want to live without it?

97. Seeing is believing . . .
First Session Eleventh Session
Twelfth Session
Can you live without reflexology?
Sure, but after seeing this, do you
want to live without it?
Sixteenth Session

99. Session Sixteen

100. Healing 12 August 2009. . .

101. If the body can visibly heal its own wounds
through this kind of hands on consistent
working of the reflexes of the feet, what
does it do to help the internal wounds,
issues, organs, and systems of the body?
We can’t visibly watch those changes.
However, this evidence suggests to me
that what reflexology can do to help the
internal health and exterior health is
palpable and worth our understanding and
patience to wait for these results.

103. See why you need reflexology?!
Thanks so much!
CyReflexology
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