The Larderello geothermal field is located in the inner Northern Apennines (southern Tuscany), an area which has been affected by extensional tectonics since the Early–Middle Miocene. The structure of the Larderello field is characterised by NW-trending, NE-dipping Pliocene to Present normal faults. Their geometry down to depths of 4–5 km is constrained by field, borehole, and reflection seismic data. An association between extensional structures and heat flow maxima (up to 1000 mW/m 2) is recognisable from detailed surface heat flow mapping. In order to investigate the relationships among extensional structures and heat flow, subsurface isotherms were traced, subject to borehole control, along variously oriented geological cross-sections. The isotherms show vertical displacements associated with the recent normal faults and related deformation zones, which reach the brittle/ductile transition. Estimates of the relative importance of convective and conductive components of heat flow suggest that fluid circulation is particularly important in correspondence with the normal faults, accounting for the correlation between isotherm perturbations and extensional structures. In this view, extensional shear zones are interpreted as the main structural pathways for the flow of hot geothermal fluids.