Purpose <p>Hiesho (cold hypersensitivity) is a common condition in Japan and other Asian countries, particularly among females, and has substantial health implications. Despite the high prevalence of Hiesho, the existing screening methods for this condition remain controversial and largely subjective. This study aimed to explore the potential of using the foot skin temperature–recovery rate after a cooling test as a quantitative biomarker for Hiesho.</p> Methods <p>Sixty–two young females underwent a cooling test, which was followed by foot–temperature measurements. The participants also completed the Terasawa Hiesho Questionnaire. Data analysis included receiver operating characteristic (ROC) curve evaluation and statistical tests to determine biomarker efficacy.</p> Results <p>Hiesho was identified in 31 participants. The Hiesho and non–Hiesho groups showed significant differences in temperature–recovery rates, particularly at specific foot regions and time intervals. The Aligned Rank Transform was used for post–hoc pairwise comparisons. At the medial metatarsal 15 min post–cooling, the values for the Hiesho and No–Hiesho groups differed significantly (<i>p</i> &lt; 0.01, Cohen’s <i>d</i> = 0.663, 95% confidence interval (CI), 0.231, <InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\mathrm {\infty }\)</EquationSource> </InlineEquation>). The ROC curve identified the temperature–recovery rate at the medial metatarsal at 15 min post–cooling as the most effective biomarker, with a suggested screening threshold of &lt; 44.68% (area under the curve = 0.701, 95% CI: [0.572, 0.811]).</p> Conclusion <p>This study demonstrated significant differences in foot temperature–recovery rates between individuals with and without Hiesho, indicating its potential as a reliable biomarker. Despite these limitations, this approach offers a promising quantitative method for Hiesho assessment, and warrants further investigation.</p>