It is well known that a fashion-conscious appearance can be at the expense of foot health. Archaeologists report that this was already the case in the late Middle Ages: the incidence of misalignment of the big toe increased sharply in the course of the spread of pointed shoes in the 14th century, studies of skeletons from the English city of Cambridge show. The wealthier classes in particular often suffered from a so-called bunion.
Hallux valgus is the medical term: It is a misalignment of the big toe in which it leans excessively towards the other toes and forms a bulge at the base. Depending on the severity, bunions can lead to pain and impair walking and rolling of the foot. In addition to a predisposition, unfavorable footwear is known as the cause of this deformity: Frequent wearing of pointed, narrow or high-heeled shoes promotes the development of hallux valgus due to the unnatural pressure effects on the foot.
View of medieval feet
As part of a study, a British team of researchers has now investigated the question of how common bunions were among the medieval residents of the city of Cambridge. To this end, they examined finds of foot bones that came from a total of 177 adults of various classes who had been buried in graves in the city and its surroundings from the 11th to the 15th centuries. The evaluations showed: Only six percent of the dead from the 11th to the 13th century showed signs of hallux valgus. In contrast, an average of 27 percent of people in the 14th and 15th centuries were affected by bunions. It also became apparent that, compared to the rural residents, it was more affluent citizens and the clergy who were affected by the misalignment of the big toe. “It’s amazing how many suffered from bunions back then,” says first author Jenna Dittmar of the University of Cambridge.
As the scientists explain, the increase in the frequency of misalignment reflects the emergence of distinctive shoe fashion in medieval Europe: In the 14th century, the previously rounded shape of shoes became increasingly narrow and finally tapered to a point. This culminated in the so-called sneaked shoes, which were also called poulaines. “The 14th century brought an abundance of new clothing and shoe models in a wide range of fabrics and colors. These pointed shoes were one of those fashion trends, ”says co-author Piers Mitchell. “The remains of shoes that were unearthed in places like London and Cambridge indicate that in the late 14th century almost every type of shoe there was at least slightly pointed.”
Literally exaggerated shoe fashion
Interestingly, the scientists most often found hallux valgus in the dead in a monastery cemetery. As they explain, this seems entirely plausible: “In the 13th and 14th centuries it became increasingly common for members of clerical orders in Great Britain to wear elegant clothing,” says Mitchell. “The adoption of fashionable clothing by the clergy was so widespread that it provoked criticism even in contemporary literature.” As the scientists report, the pointedness of the shoes sometimes took on such absurd forms that King Edward IV finally felt compelled to intervene in 1463: He limited the maximum length of the shoe tips to five centimeters.
In conclusion, the scientists highlight another interesting finding on the examined skeletons: The people with hallux valgus also showed signs of fractures in the upper limbs with a striking frequency, which are typically the result of falls in which the affected person moves forward onto their arms have fallen. As the researchers explain, it could have been a consequence of the misalignment of the big toe and thus ultimately also of shoe fashion: “Modern clinical research on patients with hallux valgus has shown that the misalignment of the big toe makes it difficult for those affected to keeping your balance and thereby increasing the risk of falling, ”says Dittmar.
Source: University of Cambridge, specialist article: International Journal of Paleopathology, doi: 10.1016 / j.ijpp.2021.04.012