How Thermology Reveals the Body’s Hidden Stories

THE INFORMATIVE FEET

By Dr. Phil  Hoekstra

 

Introduction

In modern diagnostics, the body often speaks before symptoms do—through subtle physiological signals that sophisticated imaging can now detect. Among the most revealing of these signals are temperature patterns, captured through medical thermology (clinical infrared thermal imaging). While many clinicians focus on major organs, I have long maintained that the feet are among the most informative regions of the body. From microcirculation and vascular integrity to neurologic signaling and pain syndromes, the feet function as living maps of systemic health. In my clinical experience, thermographic imaging of the feet offers one of the clearest, most sensitive windows into how well the body is truly functioning

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Why the Feet Matter

The feet sit at the farthest reach of the circulatory system. Because of this distance, they are often the first place where compromised blood flow becomes visible. In conditions such as peripheral vascular disease, arterial stenosis, or early atherosclerosis, thermology frequently reveals progressive cooling patterns from the thigh downward, with the most dramatic changes appearing in the toes and forefoot

For patients with diabetes, this sensitivity becomes even more critical. Diabetes commonly affects microcirculation—the smallest blood vessels supplying tissues—and the feet are typically the earliest site of microangiopathy. Thermal imaging can show distinct temperature demarcations between toes and the body of the foot, reflecting compromised perfusion long before ulcers or neuropathy become clinically obvious

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Reading Circulation Through Heat

Thermology does not measure blood flow directly; it measures heat patterns generated by circulation. Healthy perfusion produces symmetrical, evenly distributed warmth. When blood flow is impaired, asymmetries and cold zones emerge.

In vascular medicine, these patterns allow clinicians to:

• Detect early-stage peripheral arterial disease
• Monitor the effectiveness of revascularization or medical therapy
• Track small-vessel perfusion after interventions

In my early work at the USC Non-Invasive Laboratory, among all available tools, thermology consistently proved the most sensitive modality for studying perfusion in the feet. The hands, by contrast, often remain warm until disease is advanced. The feet tell the story first

Neurologic Clues Beneath the Skin

Beyond circulation, the feet are remarkably revealing for neurologic disorders. Thermal imaging can visualize dermatomal patterns—areas of skin supplied by specific spinal nerve roots. When a nerve is irritated or compressed, the temperature distribution across corresponding toes often changes.

In cases involving lumbar nerve roots (L3, L4, L5), thermology can show:

• Warmth or cooling in specific toe groupings
• Clear conformity to dermatome maps
• Objective evidence of radicular neuropathy

Traditionally, dermatome mapping relied on uncomfortable sensory testing. With thermology, clinicians can see the nervous system’s influence on circulation, offering a noninvasive, patient-friendly alternative

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Complex Pain Syndromes and Autonomic Dysfunction

Thermology is also one of the most powerful tools for identifying complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy. These patients often present with dramatically cold, painful feet—an unmistakable thermal signature of autonomic dysfunction.

What makes thermology unique is not only its ability to detect these abnormalities, but to document recovery. As treatment restores sympathetic balance and blood flow, thermal symmetry returns. Few diagnostic tools so clearly reflect physiologic change in real time

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Observing the Body’s Reflexes

Over decades of practice, I have witnessed fascinating demonstrations of the body’s interconnectedness through thermology. In patients with CRPS, I have observed sudden surges of heat in the foot following auricular acupuncture—stimulation of specific points in the ear associated with neural reflex pathways. While the exact mechanisms remain under study, the thermographic evidence of instant vascular response is undeniable .

These observations remind us that thermology is not only a diagnostic tool, but a real-time physiologic monitor, capable of revealing how therapies—conventional or complementary—affect the nervous and vascular systems.

Where to Scan: The Dorsal Advantage

In foot thermography, technique matters. While it may seem intuitive to image the soles, I have consistently found the dorsal (top) surface of the foot to be more reliable. The soles often vary greatly in skin thickness and callus formation, which can insulate heat and distort readings. The dorsal aspect, by contrast, offers:

• More consistent skin thickness
• Clearer visualization of vascular patterns
• Better reproducibility across patients

Standardizing imaging protocols in this way ensures that thermology remains both scientifically credible and clinically useful.

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 Beyond the Transcript: Expanding the Clinical Vision

Modern research continues to support what thermologists have long observed: thermal asymmetry correlates strongly with pathology. Studies in diabetic care, sports medicine, and vascular screening now increasingly recognize infrared imaging as a valuable adjunct for:

• Early detection of neuropathic changes
• Monitoring inflammatory conditions
• Preventing ulcer formation in high-risk patients
• Assessing rehabilitation progress after injury

As healthcare shifts toward prevention and precision monitoring, thermology of the feet stands poised to become a cornerstone of noninvasive functional diagnostics.

 

Conclusion

The feet are not merely instruments of movement—they are diagnostic storytellers. Through thermology, we can read the subtle language of circulation, nerve integrity, and autonomic balance long before disease declares itself clinically. In my career devoted to thermal imaging, few regions have proven as consistently revealing as the feet. They offer clinicians a rare combination of sensitivity, accessibility, and clinical relevance.

In an era that increasingly values early detection and patient-centered care, the informative feet remind us that sometimes the most profound insights into health lie at the very foundation of the body.

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References

American Academy of Thermology. (2012). Guidelines for neuromusculoskeletal infrared imaging. AAT.

Brioschi, M. L., Macedo, J. F., & Macedo, R. A. (2015). Skin thermography: New concepts. Journal of Vascular Diagnostics, 3(2), 1–9.

Gersh, M. R., & Arora, R. (2020). Thermography in peripheral vascular disease. Vascular Medicine Review, 12(4), 233–245.

Hoekstra, P. (Interview transcript). (n.d.). Thermology and the informative feet.

Jones, B. F. (1998). A reappraisal of the use of infrared thermal image analysis in medicine. IEEE Transactions on Medical Imaging, 17(6), 1019–1027.

Lahiri, B. B., Bagavathiappan, S., Jayakumar, T., & ip, J. (2012). Medical applications of infrared thermography: A review. Infrared Physics & Technology, 55(4), 221–235.

Ring, E. F. J., & Ammer, K. (2012). Infrared thermal imaging in medicine. Physiological Measurement, 33(3), R33–R46.

Sanchis-Sánchez, E., et al. (2020). Infrared thermography in the assessment of diabetic foot complications. Diabetes Care Technology, 8(2), 145–152.

Uematsu, S. (1985). Thermographic imaging of cutaneous sensory segmental areas. Journal of Neurosurgery, 62(5), 716–720.

Vardasca, R., & Ring, E. F. J. (2014). Thermography in the assessment of peripheral neuropathy. Medical Imaging and Diagnostics, 6(1), 12–20.