“HEART IN THE FEET TECHNIQUE” – PLANTAR VENOUS PLEXUS AND THE VENOUS RETURN

Arteries supply blood to the feet and nourish them. Veins return blood to the heart. Have you ever imagined carrying blood from your feet back to the heart, overriding the existing pressure?
There are anatomical and biomechanical characteristics that contribute to the blood return to the heart, namely:
·      the existence of numerous valves (which prevent backflow) (Figure 1);
·      the contraction of the muscles in the legs (allowing blood to pass from the perforating veins to the deep veins, continuing its journey at high speed to the heart);
             We must mention here the wonderful soleus muscle, considered the "peripheral heart" and its           venous sinuses - the main pumping system;
·      the help of the arteries pulsations near the deep veins.

Scientific studies also indicate a set of veins in the foot – plantar venous plexus (Figure 2) – which also acts as an important return pump, sending blood back to the heart.
Every time the foot hits the ground while walking or running, the plantar venous plexus is flattened, stretched and compressed. This is the first mechanism for venous return from the lower extremity to the heart, followed by the calf pumping mechanism, through the contraction of the gastrocnemius and soleus muscles.
We have a truly and a perfect pumping system!
Interestingly, a 25 ml venous reservoir of blood is sent upward in each step during walking (UHL and GILLOT, 2012).

Let's try to understand this system, based on the available scientific information. There is a lower limb pumping system that drains blood toward the heart, composed by the following mechanisms (RICCI, 2015) (Figure 3):
·      Dorsiflexion – distal calf pump emptying;
·      Weight bearing – foot emptying (Figure 4);
·      Plantar flexion - upper calf emptying.

The plantar venous plexus consists of: the lateral plantar vein, the medial plantar vein and the deep plantar arch (Figure 2). The deep plantar arch and the dorsal venous arch drain blood from the marginal, digital and metatarsal veins of the foot. There is a connection between the dorsal and plantar veins.
The lateral plantar vein, which has a larger diameter than the medial plantar vein, is the most responsible for the pumping action and the main plantar venous “reservoir”.

On the sole of the foot, blood is drained through two possible mechanisms: 1) weight exerted by stretching and compressing the plantar veins and 2) contraction of the muscles surrounding the veins. From here, it drains through the posterior tibial veins.

The diameter of the main veins of the plantar venous plexus is larger than the posterior tibial veins in the calf, creating a "bellows" effect. This rapidly increases the speed of blood flow from the plantar venous plexus to the posterior tibial veins during the plantar vein’s compression.

In situations of venous insufficiency, functional obstruction or hypertension, some problems may arise in this venous return system and/or vice versa. Dilated veins around the ankle ("corona phlebectasia") may be a visible symptom. But others may occur. If the valves of the perforating veins become inefficient (blood flows backward, i.e., to the superficial system) or if the deep veins are blocked, pressure in the superficial veins increases and the veins swell and become tortuous – varicose veins.

FOOT REFLEXOLOGY contributes to an efficient pumping system and a balanced blood circulation system. How?
·      It contributes to a fluid and an unobstructed venous circulation.
·      It provides movement to the muscles, toning them so they can do the necessary contraction.
·      It stimulates the plantar venous plexus.
·      It mobilizes the ankle, pumping through dorsiflexion and plantar flexion.
·      It ensures good surface drainage.
·      It helps blood flow from superficial veins to deep veins.
·      It helps with hypertension.

Although more research is needed, the available scientific information about plantar venous plexus is very important and useful when working with feet. The “Heart in the Feet Technique” that I apply in my FOOT REFLEXOLOGY sessions is a suitable set of movements and pressure on foot based on the pumping system of the plantar venous plexus, helping to stimulate its functioning and consequently the entire venous circulation.

It is unquestionable how FOOT REFLEXOLOGY is important in blood circulation and how it integrates science evolution.

 REFERENCES
CORLEY Gavin J. et al, 2020, “The Anatomy and Physiology of the Venous Foot Pump” The Anatomical Record 293: 370-378 (https://anatomypubs.onlinelibrary.wiley.com/doi/full/10.1002/ar.21085)
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HORWOOD, Andy, 2021, “The Venous Foot Pump: Modelling its function in gait”, Podiatry Review, Summer Issue 2021(https://issuu.com/iocp/docs/pod_rev_summer_21)

RICCI, Stefano, 2015, “The venous system of the foot: anatomy, physiology and clinical aspects”, Phlebolymphology. 2015; Vol 22. Nº 2 (https://www.phlebolymphology.org/the-venous-system-of-the-foot-anatomy-physiology-and-clinical-aspects/)

UHL, Jean-François and GILLOT, Claude, 2010, “The plantar venous pump: Anatomy and physiological hypotheses”, Phlebolymphology. 2012; Vol 17. Nº 3 (https://www.phlebolymphology.org/the-plantar-venous-pump-anatomy-and-physiological-hypotheses/)

UHL, Jean-François and GILLOT, Claude, 2012, “Anatomy of the foot venous pump: physiology and influence on chronic venous disease”, Phlebology. 2012; Vol 27(5): 219-230 (https://doi.org/10.1258/phleb.2012.012b01)

Raquel Dora Pinho, Setembro 2025