Trigger points (TrPs), or muscle “knots,” are a common cause of stubborn & strange aches & pains, and yet they are under-diagnosed. The 14 Perfect Spots (jump to list below) are trigger points that are common & yet fairly easy to self-treat with massage — the most satisfying & useful places to apply pressure to muscle. For tough cases, see the advanced trigger point therapy guide.
If you have plantar fasciitis, you may prefer to start with this detailed tutorial.
The tenth of the Perfect Spots is one of the most popular of the lot, and right under your feet — literally. It lies in the center of the arch muscles of the foot. This is one of the Perfect Spots that everyone knows about. No massage is complete without a foot massage!
Why is the arch of the foot a Perfect Spot for a massage?
It isn't difficult to understand why the arch muscles of the foot would harbour a Perfect Spot for massage. They are, after all, the hardest working muscles in the human body. Our feet absorb an incredible amount of punishment, yet usually feel no worse than just stiff and tired. Injury here is common, but not nearly as common as you might expect.
The arch of the foot is a fascinating structure. The arch is like a bow without an arrow, and its curved shape is created by a “string” of muscles and elastic connective tissues. Every time you take a step, your weight pushes down on the arch. It doesn’t collapse because of an artful combination of bone shape, springy ligaments, long “stirrup” tendons from leg muscles … and the arch muscles. The arch muscles of the foot itself don’t actually “kick in” until you reach quite heavy loads: about 181 kilograms.1 Although that sounds like quite a lot, loading may spike that high in an average person with every step. We don’t have muscles there for nothing, of course! (The biggest arch supporter is probably the tibialis posterior, deep in the calf.2 And the tibialis anterior is another one — and it also has a perfect spot for massage, no. 3). Still, the forces on all of these structures are relentless and often very large — no wonder they get exhausted!
When these support mechanisms fail, the connective tissue in the arch may start to degenerate and fray — a kind of tendinitis3 called plantar fasciitis. However, many people just develop really significant muscle knots in the arch, and in other arch supporting muscles.
There is another reason why this spot is significant. The skin of the feet has a disproportionate number of nerve endings, like the face and the hands, yet the feet are generally abused or at least neglected. Therefore the sensations of foot massage seem particularly rich and diverse in contrast to the usual stomp, stomp, stomp of their daily stimulus.
This model shows what a man’s body would look like if each part grew in proportion to the area the cortex of the brain concerned with sensory perception hands & lips dominate — but the feet are also disproportionately large, indicating their sensory importance.
How do you find muscle knots in the arch of the foot?
Not only is this probably the most perfect of all Perfect Spots, but it is also perfectly easy to find: it is exactly in the center of the bottom of the foot, halfway between the heel and the ball, and halfway between the inside and outside edges (perhaps slightly closer to the inside).
The arch muscles generally feel best when pressed on an angle, for example towards the outside of the foot. But this is a minor point: any angle will do!
What does massaging the arch of the foot feel like?
You will know it when you feel it! Having massaged thousands of people and thousands of feet, I can tell you without hesitation that the center of the arch muscles is a popular, “feel good” spot. It usually produces a clear, sweet ache with mild to moderate thumb pressure only.
Note that despite its popularity, Perfect Spot No. 10 usually does not cause any referred sensation — that’s the satisfying, spreading ache that is often associated with other significant trigger points. Don't take the lack of referred sensation to mean that what you're doing isn't working!
All massage feels better when someone else does it, but this is especially true of foot massage. Although it is easy to massage your own foot (and highly recommended if you have no other choice), receiving a foot massage is one of life’s truly delicious experiences, the apple pie à la mode of touch.
What about reflexology?
Some believe that there is yet another reason why foot massage feels so good: there may be neurological and/or energetic connections between each part of the sole of the foot and every other region and system of the body. This is called reflexology. Reflexologists claim that foot massage can have a therapeutic effect on any part of the human body.
This claim is extraordinary, and “extraordinary claims require extraordinary evidence” (Carl Sagan, Broca’s Brain, 1972). I have certainly never seen nor heard of such evidence, although (to quote another old chestnut of skepticism) “absence of evidence is not evidence of absence.” The phenomenon may exist, whether there is clear evidence for it or not. However, it is most likely that the profound sensations of foot massage simply gave someone the idea that foot massage was unusually important.
I have no trouble with the general idea of therapeutically significant connections between body parts, or even with the particular idea that massaging the foot could affect organs and systems. That is plausible.
I doubt, however, that the average colourful reflexology “map” is 100% accurate — at least, not compared to the average textbook anatomy diagram. If the connections exist at all, they are probably subtle, and there is probably significant natural variation between individuals. Only a study of a large number of carefully compared observations by several extremely skilled and knowledgeable practitioners could hope to confirm that stimulating a certain tiny spot on the foot has a therapeutic effect on a certain organ — and even then it wouldn’t necessarily be true of every person.
My own personal experience with reflexology is that it feels as good as any other foot massage, but no better, and has no apparent additional therapeutic effect. Still, a foot massage is always a pleasant experience in and of itself.
EBM-First.com has a nice reading list about reflexology.
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.
Appendix A: Is trigger point therapy too good to be true?
Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can probably relieve some pain cheaply and safely in many cases. Good bang for buck, and little risk. In the world of pain treatments, that’s a good mix.
But pain is difficult and complex, no treatment is perfect, and there is legitimate controversy about the science of trigger points. Their nature remains somewhat puzzling, and the classic image of a tightly “contracted patch” of muscle tissue may well be wrong. What we do know is that people hurt, and it can often be helped.
The Perfect Spots are based on a decade of my own clinical experience as a massage therapist, and years of extensive science journalism on the topic. Want to know more? This is the tip of the iceberg. I’ve written a whole book about it …
Not too good to be true.
Just ordinary good. Trigger point therapy isn’t a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little & many will experience significant relief from stubborn aches & pains. The first few sections are free.
Appendix B: All the perfect spots
There’s also a more detailed index of the spots and other trigger point resources.
- Massage Therapy for Tension Headaches — Perfect Spot No. 1, in the suboccipital muscles of the neck, under the back of the skull.
- Massage Therapy for Low Back Pain — Perfect Spot No. 2, in the erector spinae and quadratus lumborum muscles in the thoracolumbar corner
- Massage Therapy for Shin Splints — Perfect Spot No. 3, in the tibialis anterior muscle of the shin
- Massage Therapy for Neck Pain, Chest Pain, Arm Pain, and Upper Back Pain — Perfect Spot No. 4, an area of common trigger points in the odd scalene muscle group in the neck
- Massage Therapy for Tennis Elbow and Wrist Pain — Perfect Spot No. 5, in the common extensor tendon of the forearm
- Massage Therapy for Back Pain, Hip Pain, and Sciatica — Perfect Spot No. 6, an area of common trigger points in the gluteus medius and minimus muscles of the hip
- Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome — Perfect Spot No. 7, the masseter muscle of the jaw
- Massage Therapy for Your Quads — Perfect Spot No. 8, another one for runners, the distal vastus lateralis of the quadriceps group
- Massage Therapy for Your Pectorals — Perfect Spot No. 9, in the pectoralis major muscle of the chest
- Spot No. 10 is this page.
- Massage Therapy for Upper Back Pain — Perfect Area No. 11, the erector spinae muscle group of the upper back
- Massage Therapy for Low Back Pain (So Low That It’s Not In the Back) — Perfect Spot No. 12, a common (almost universal) trigger point in the superolateral origin of the gluteus maximus muscle
- Massage Therapy for Low Back Pain (Again) — Perfect Spot No. 13, The Most Classic Low Back Pain Trigger Point
- Massage Therapy for Shoulder Pain — Perfect Spot No. 14, The Most Predictable Unsuspected Cause of Shoulder Pain
- Basmajian JV, Stecko G. The Role of Muscles in Arch Support of the Foot. J Bone Joint Surg Am. 1963 Sep;45:1184–90. PubMed #14077983 ❐
- Thordarson DB, Schmotzer H, Chon J, Peters J. Dynamic support of the human longitudinal arch: a biomechanical evaluation. Clin Orthop. 1995 Jul;316:165–72. PubMed #7634700 ❐
“Tendinitis” versus “tendonitis”: Both spellings are acceptable these days, but the first is the more legitimate, while the second is just an old misspelling that has become acceptable only through popular use, which is a thing that happens in English. The word is based on the Latin “tendo” which has a genitive singular form of tendinis, and a combining form that is therefore tendin. (Source: Stedmans Electronic Medical Dictionary.)
“Tendinitis” vs “tendinopathy”: Both are acceptable labels for ticked off tendons. Tendinopathy (and tendinosis) are often used to avoid the implication of inflammation that is baked into the term tendinitis, because the condition involves no signs of gross, acute inflammation. However, recent research has shown that inflammation is actually there, it’s just not obvious. So tendinitis remains a fair label, and much more familiar to patients to boot.