The evaluation of skin temperature variability within the lower
extremities after bio-theramal inserts application
Małgorzata Łukowicz, Magdalena Weber-Zimmermann, Katarzyna Ciechanowska,
Paweł Zalewski, Justyna Szymańska, Agnieszka Pawlak, Jan Pawlikowski
Chair and Department of Laser therapy and Physiotherapy, The Ludwik Rydygier Collegium Medicum in
Bydgoszcz, The Nicolaus Copernicus University in Toruń, ul. M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, phone
+48 (0) 52 585 34 85, e-mail: kizterfiz@cm.umk.pl
Abstract
Thermal long term low-intensity stimulus through the thermoregulation mechanisms influences blood circulation,
causing dilatation of blood vessels; arterial capillary, arteriole, skin and sub skin veins, opening of closed in normal
circumstances capillaries. Local hyperemia of skin is observed. Metabolism and a diffusion through the capillaries
increases. Parasympathetic nervous system is stimulated, what influences internal organs and a circulatory system,
leading to body relaxation and good mood. A little amount of heat may stimulate immunological reactions,
whereas too much heat inhibits this response. The aim of this work was to evaluate the fluctuations of skin temperature
in some points of foot, shank and thigh after biothermal inlay application. This biothermal inlay has a specific
screen property. The tests were conducted in four groups of subjects: healthy, paraplegic and tetraplegic, with circulatory
problems in lower limbs and placebo. We observed the increase in skin temperature in all groups, except placebo,
however especially in the healthy subjects. "Warm leg signs", were observed, especially in patients with diabetes.
Key words: thermal stimulus, microcirculation, skin temperature measurement
Introduction
Bio-thermal inserts used as footwear inserts perform a function of screening
thermal energy of feet. By reflecting not dispersing heat they influence
thermoregulation processes in our bodies, mainly by influence of temperature on
microcirculation. The aim of these inserts is to increase body temperature and
improve blood circulation. As a result of interaction between the foot and the
screen a patient can feel a thermal effect after some time (5 to 15 minutes) and
sometimes a tingling sensation effect. The inserts give a thermal stimulus of low
intensity and a long-term effect [1].
Tests conducted in a Laboratory of Biotronics and Electro photography in
Kielce showed that, due to the material of which the inserts are made, they have
specific properties energostimulating energetic field of our organism (fig. 1).
Direction of changes of these fields depends on individual features of the examined
people; approximately 80% of the examined people positively reacted to
stimulation. It was shown by filling out of the energetic fields of their feet [2].
Fig. 1 Evaluation of energetic field of toes: a) after 15 minutes on felt, b) after 15
minutes on a rubber insert, 3)after 15 minutes on a thermal insert (by courtesy of
the PIOKAL company)
By reflected thermal energy, the inserts have positive influence on
receptors on the foot skin (fig 2).
The aim
A research team, after an analysis of literature on help and influence on
thermoregulation mechanisms of an organism with the use of physical
therapeutic agents, assumed that the research project is to give answer
to the following questions:
Fig. 2 Receptors of the left foot (with the PIOKAL company’s agreement)
Fig. 3 the Piokal thermal inserts
1. Does the application of the Piokal thermal inserts influence these changes in
lower extremities measured in particular points?
2. If thermal inserts influence thermoregulation mechanisms in lower extremities,
does the temperature change depend on a disease entity?
Material and methods
Research on influence of thermal inserts (fig. 3) on skin temperature of lower
extremities was conducted in Chair and Department of Laser therapy and
Physiotherapy, Collegium Medicum the Nicolaus Copernicus University (NCU) in
Bydgoszcz.
The research material consisted of four groups: three research groups and
one control group – placebo. The research groups had the following characteristics:
 group I (research) – consisted of only healthy people declaring no chronic
health ailments;
 group II (research) – consisted of people who were patients of the
Outpatient Rehabilitation Clinic and of Rehabilitation Teaching Hospital at
the NCU in Bydgoszcz; these people had been treated due to chronic
dysfunction in the spinal cord and lower part of the spine, of different
etiology, with dysaesthesia and circulatory disturbances in lower extremities;
 group III (research) – also consisted of people who were patients of the
Outpatient Rehabilitation Clinic and of Rehabilitation Teaching Hospital at
the NCU in Bydgoszcz with chronic peripheral circulatory failure in lower
extremities;
 control group (placebo) - consisted of only healthy people just like group I,
however, placebo inserts instead of therapeutic inserts were applied in this
group.
The research methodology based on measurement of temperature on the skin
surface in defined points of the body. They were always the same points of
measurement in each research group and in the placebo group.
The following measurement points were selected on the skin surface:
 dorsal surface of a foot, just above the dorsal artery of the foot;
 lateral and medial belly of gastrocnemius muscle;
 15 cm above the knee joint, above the straight muscle of the thigh.
The measurements were done on both sides with the use of a laser temperature
measuring instrument of the Raytek Company. The measurements were done in the
environment of permanent temperature in order to eliminate the influence of
external temperature on the thermoregulation processes. The measurements were
done before wearing of therapeutic inserts, and then the inserts were worn for
approx. 30-40 min, and after that time next measurement was done and registered
in the results table. Therapeutic inserts were applied in research groups, however,
in the placebo group identically looking inserts were used but they were made of
neutral material. All inserts were sawn up in the same fabric.
Results
Results obtained in respective groups are presented in tables 2-4. Measurements
done on healthy individuals are presented in table 1.
In the first group of healthy individuals without dysaesthesia or dysfunction
of peripheral circulation, an increase of skin temperature in all tested points was
shown, especially in the range of a foot and a shank. These people reported a
subjective feeling of warmth after about 5-10 minutes of putting on the inserts,
sometimes the tingling sensation and heaviness of feet.
Table 2 presents the results of measurements done on patients with spinal
cord injury.
The increase of temperature in all tested points was observed in the group of
patients after spinal cord injuries, with dysaesthesia and circulatory disturbances in
the lower extremities due to neurogenic disturbances, but the increase of
temperature was lower than in the group of healthy people, however, it could be
compared in the same proportion. These patients did not report subjective feelings
due to dysaesthesia.
Table 3 shows results of measurements done on patients with peripheral
circulatory disturbances in the lower extremities.
Measurements also showed increase of temperature on the skin surface in
proportion in all points, but due to disturbances in peripheral circulation which
caused disorder in thermoregulation processes; these changes of temperature were
smaller.
Table 4 presents results of temperature measurements after putting on the
placebo inserts – rubber sewn up in fabric.
Graphs show comparative analysis of the obtained temperature
measurements in individual points. The average change of temperature within an
individual measurement point in respective groups – [0C] graph 4,5,6,7.
The difference of average temperature changes in respective research groups
in comparison with the placebo group was analyzed - [0C], what is shown on
graphs 8, 9, 10.
Table 1 Results of measurements obtained in the research group I
Anatomical
location
of the
measurement
point
dorsal surface of
a foot
medial belly
lateral belly
15 cm above the
knee joint
Number of
temperature
measurements [n]
Average temp.
before
application of
inserts [0C]
Average temp. Average change
after 30- 40
of temperature
0
min [ C]
[0C]
100
32.47
33.69
1.22
100
100
100
32.82
32.76
33.03
33.50
33.46
33.35
0.68
0.70
0.32
Table 2 Results of measurements obtained in the research group II
Anatomical
location
of the
measurement
point
dorsal surface of
a foot
medial belly
lateral belly
15 cm above the
knee joint
Number of
temperature
measurements [n]
Average temp.
before
application of
inserts [0C]
Average temp.
after 30 - 40
min [0C]
Average change
of temperature
[0C]
50
31.86
32.55
0.68
50
50
50
33.77
33.72
33.28
34.31
34.26
33.50
0.53
0.54
0.22
Table 3 Results of measurements obtained in the research group III
Anatomical
location
of the
measurement
point
dorsal surface of
a foot
medial belly
lateral belly
15 cm above the
knee joint
Number of
temperature
measurements [n]
Average temp.
before
application of
inserts [0C]
Average temp.
after 30 - 40
min [0C]
Average change
of temperature
[0C]
35
29.93
30.32
0.39
35
35
35
30.02
30.14
30.37
30.61
30.59
30.48
0.41
0.46
0.11
Table 2 Results of measurements obtained in the placebo group
Anatomical
location
of the
measurement
point
dorsal surface of
a foot
medial belly
lateral belly
15 cm above the
knee joint
Number of
temperature
measurements [n]
Average temp.
before
application of
inserts [0C]
Average temp.
after 30 - 40
min [0C]
Average change
of temperature
[0C]
53
31.21
31.43
0.22
53
53
53
32.42
32.69
32.31
32.56
32.89
32.34
0.15
0.20
0.03
Discussion
As the presented measurements showed, application of thermal screening inserts
for feet for 30 – 40 minutes caused increase of temperature on the surface of the
skin on a foot, a shank and above knees. These changes were the highest among
healthy people ,obviously due to properly functioning thermoregulation
mechanisms. After only such a short time of application the temperature increased
especially within a foot, then a shank and in the lowest extent within a thigh. It is
probable that after a longer application these changes would be more visible.
Comparative increase of skin temperature was also observed in people who
could not state subjective feeling of warmth – patients after spinal cord injury with
dysaesthesia. These changes were less visible due to abnormal nerve supply of
microcirculation vessels in feet. However, application of inserts also brings effects
in this group of patients.
Most subjective sensations were reported by patients with disorders of
peripheral circulation within the lower extremities. Despite damage of
microcirculation within the lower extremities, increase of temperature was also
reported by this group of patients; it was lower within feet and higher within shanks
– it is probable that the thermoregulation mechanisms act more efficiently to the
level of a shank. The “warm feet” sensations were reported by these patients.
Graph 4 Average change of temperature in all research groups and in the
placebo group within dorsal surface of a foot
Graph 5 Average change of temperature in all research groups and in the
placebo group within lateral belly of gastrocnemius muscle
Graph 6 Average change of temperature in all research groups and in the
placebo group within medial belly of gastrocnemius muscle
Graph 7 Average change of temperature in all research groups and in the placebo
group 15 cm above the knee joint, above the straight muscle of the thigh
Graph 8 Comparison of average changes of temperature in individual
measurement points in research group I, in reference to the placebo group
Graph 9 Comparison of average changes of temperature in individual
measurement points in research group II, in reference to the placebo group
Graph 9 Comparison of average changes of temperature in individual
measurement points in research group III, in reference to the placebo group
These sensations were stronger when patients had worn the inserts longer. It is
recommended to use the inserts for a longer period of time for this group of
patients.
It is known that blood vessels: arterioles, capillary vessels, skin and
panniculs veins get expanded and capillaries inactive in normal temperature are
opened under the influence of a weak, long-lasting thermal stimulus. These changes
cause considerable increase of blood supply to skin. Diffusion through the vascular
wall of capillaries is increased and metabolism is improved. It causes stimulation of
parasympathetic part of the nervous system, which influences internal organs and
respiratory and circulatory systems and also gives the feeling of wellbeing and
relaxation. Sudden action of a large dose of warmth leads in the first moment to an
adverse reaction – contraction of blood vessels [1].
The volume of the stimulus, time of action, dynamics of its influence,
individual features, coexisting illnesses are important for these changes.
In case of thermal inserts the acting stimulus is long-lasting and of low
intensity. Influence of these inserts on foot receptors gives additional effect as foot
receptors according to the Chinese medicine are considered to be biologically
active points connected with channels in which life energy circulates. These
channels join our largest organ the skin with the interior of the body [3]. This is
probably the source, as well as the influence of the thermal stimulus through the
sympathetic system, of positive effects of thermal inserts described by Russian
researchers in different disease entities – diabetes, bronchial asthma (research done
by prof Danilow from Minsk) [4].
Results obtained by us are comparable with research by Mazanik done on
patients with circulatory disturbances within the lower extremities.
Conclusions
The following conclusions were drawn after analysis of the collected material:
1. Application of thermal inserts results in increase of skin temperature
within a foot, a shank and a thigh in comparison with the placebo group.
2. The highest increase was observed in a group of healthy volunteers,
without disturbances in blood circulation within the lower extremities.
3. Lower increase was reported in patients after spinal cord injury.
4. The increase of temperature in a shank was higher than in a foot in
patients with dysfunction of circulation within lower extremities; it was
probably due to higher intensification of changes within feet. It would
indicate that the thermoregulation mechanism after application of inserts
is of a reflex character.
5. The highest subjective effect of “warm feet” was reported by patients
with disturbed microcirculation in the course of diabetes.
6. The time of application should be longer for patients with disturbances of
peripheral circulation in order to achieve results similar to those achieved
in a group of healthy people.
Literature
1. G. Straburzyński, A. Straburzyńska-Lupa: Physical Medicine, PZWL
Medical Publishing Company, Warsaw 1997, 2000.
2. Assessment done by Laboratory of Biotronics and Electrophotography, PTP
Department in Kielce, 1994.
3. Z. Garnuszewski: A Renaissance of Acupuncture, Sport and Tourism
Publishing Company, Warszawa 1988.
4. I.P. Danilow: Issledowaniia promienienia stimuliatorow PIOKAL pri
bronchialnoj astmie, artymiach i diabeticzeskoj stopie. Science and Research
Institute of Hematology and Transfusiology, Minsk 1996.
5. L. Mazanik, A.A. Martynowicz, E.G. Slipczenko: Wlijanie
bioenergotiermiczeskich wkladisziej PIOKAL na termograficzeskie
pokazateli cton pri kosudistych zabolewaniach nizszych koniecznostiei,
Medicina, 2002, 3: pp 33-35.
received: 27.07.2007
accepted: 29.08.2007