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Improving Blood Flow to the Feet
The Power of Relaxation and Biofeedback

by Birgitta I. Rice, MS, RPh, CHES

When the body relaxes, it also uses carbohydrates more efficiently: Blood glucose levels may decrease 2–4 hours after relaxation. For people who use insulin, it is important to be aware of this possibility. Monitoring blood glucose levels more frequently when starting a formal relaxation program is therefore advisable.

The WarmFeet technique
WarmFeet is a standardized technique designed to take advantage of the body’s natural relaxation response, which widens the peripheral blood vessels and improves circulation in the hands and feet. Inducing relaxation is the first step of the technique: Instructions on an audiotape prompt the user to release tension through conscious muscle relaxation and breath work.

The second step involves visualization, in which a person imagines comfort or warmth around his feet. Visualization, or forming a mental image, is often used in stress reduction and self-healing and has played a successful role in the treatment of various illnesses. It is particularly helpful when the body is in a relaxed state. As a component of the WarmFeet technique, visualization permits the feet to feel even warmer or more at ease. Healthy outcomes or desired healing can also be visualized, and remembering the beauty and strength of the legs and feet at an earlier age is another very encouraging and powerful image. The WarmFeet audiotape suggests various images that can be used during the visualization portion of the relaxation session.

The third key component of the WarmFeet technique is called assisted thermal biofeedback. Biofeedback is a method in which people use measured information about changes in bodily processes to gain conscious control over normally unconscious physiological functions (such as skin temperature). In this case, assisted thermal biofeedback means measuring skin temperature at a specific site (such as a finger or the big toe) before relaxation and then again afterward. This before-and-after setup allows the relaxation time to be spent relaxing rather than worrying about a temperature change. A temperature increase recorded at the end of practicing the WarmFeet technique indicates that a more relaxed state has been achieved. Remembering how this relaxed state feels and then aiming for that sensation the next time the technique is practiced strengthens and improves a person’s ability to achieve the desired outcome of skin temperature increase. Keeping a log of temperature changes also reinforces the development of this new skill.

Research findings
At the University of Wisconsin, research was conducted to test the effectiveness of this biofeedback-assisted relaxation technique. A randomized, controlled, multisite clinical trial was performed on a group of people who had had chronic, nonhealing ulcers on the feet for at least 8 weeks to see if the relaxation therapy would improve the healing process. Half of the study participants had diabetes, and all were under the treatment of a podiatrist. The medical outcomes were highly significant for increased wound healing and increased sensation. Fourteen of 16 participants who practiced the relaxation technique (for 16 minutes 5–7 days a week) completely healed their chronic ulcers within the 12-week study time. Only 7 out of 16 in the control group that didn’t use the technique healed their ulcers. After the study was over, four of the people from the control group who had unhealed ulcers learned the relaxation technique. Although their ulcers were now three months older than those in the first part of the study, with the relaxation technique they all healed within 13 weeks. This study and other research findings have been presented nationally and published in the medical journals Diabetes Care, Diabetes, and Journal of the American Podiatric Medical Association.

In clinical applications of the WarmFeet technique, pain relief has been the most common and significant result. For example, one man had such excruciating pain in his feet that he could neither eat nor sleep. His physician suggested he learn the WarmFeet relaxation technique and practice it daily. After two weeks he was almost pain-free. His vascular surgeon, who had been considering an amputation because of impending gangrene in his toes, saw improvement in his tissues and put the surgery off for the time being. The man, delighted to be free of pain and grateful for the improved circulation, was able to continue with his plan to go south for the winter. He continued to practice the technique nearly every day while away, and when he returned home in the spring he was still doing well.

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