The British have suffered for their fashion for centuries, according to a new study, which suggests that a fashion for shoes with a pointed toe led to a sharp increase in the big toe hallux valgus ̵
Researchers examining remains in Cambridge, UK, found that those buried in the city center, especially in the grounds of wealthy citizens and priests, were much more likely to have had bunions – suggesting that wealthy city dwellers paid a higher price for their footwear in several ways.
A team from the University of Cambridge also found that older medieval people with hallux valgus were significantly more likely to have had a broken bone from a probable fall compared to those at a similar age with normal feet.
Hallux valgus is a minor deformity in which the largest toe is angled outward and a bony protrusion forms at the base on the inside of the foot.
While various factors can predispose someone to bunions, from genetics to muscle imbalance, by far the most common contemporary cause is constrictive boots and shoes. The condition is often associated with wearing high heels.
Archaeologists analyzed 177 skeletons from cemeteries in and around the city of Cambridge and found that only 6% of the people buried between the 11th and 13th centuries had evidence of the disorder. However, 27% of those dating from the 14th and 15th centuries had been hampered by chronic hallux valgus.
Researchers point out that shoe style changed markedly in the 14th century: shifting from a functionally rounded toe box to a longer and more elegant tip.
In a paper published today in International Journal of Paleopathology, the team from Cambridge University’s After the Plague project claims that these “poulaine” shoes drove the rise of bunions in medieval Britain.
“The 14th century brought an abundance of new styles of dress and footwear in a wide variety of fabrics and colors. Among these fashion trends were pointed shoes with long legs called poulaines,” said study author Dr. Piers Mitchell from Cambridge’s Department of Archeology.
“The remains of shoes excavated in places such as London and Cambridge suggest that by the end of the 14th century, almost all types of shoes were at least slightly pointed – a style common to both adults and children.”
“We examined the changes that occurred between the High and Late Middle Ages, and realized that the increase in hallux valgus over time must be due to the introduction of these new forms of footwear,” Mitchell said.
First author Dr. Jenna Dittmar, who performed the work while in Cambridge, said: “We think of bunions as a modern problem, but this work shows that it was actually one of the more common conditions that had affected medieval adults.”
The remains came from four separate locations around Cambridge: a charity hospital (now part of St John’s College); the grounds of a former Augustinian monastery where priests and wealthy benefactors were buried; a local parish cemetery on what was the edge of town; and a burial ground at a village 6 miles south of Cambridge.
Researchers conducted “paleopathological assessments,” including inspection of the foot bone for bumps at the big toe that are characteristic of hallux valgus.
They found a sliding scale of predicament prevalence linked to the prosperity of those buried in each location. Only 3% of the rural cemetery showed signs, 10% of the cemetery (which mainly kept the poor) crawling up to 23% of them on the hospital side.
Yet nearly half of those buried in the monastery – about 43% – including five of the eleven individuals identified as clergy by their belt buckles, had the mark for bunion.
“The rules for dressing Augustine suitors included footwear that was ‘black and fastened by a strap at the ankle’, similar to a lifestyle of worship and poverty,” Mitchell said.
“In the 13th and 14th centuries, however, it became more and more common for those in clerical orders in Britain to wear stylish clothing – a cause for concern among high-ranking ecclesiastical officials.”
In 1215, the church forbade priests to wear pointed shoes. This may have done little to stem the trend, as several additional decrees on indiscretions in dress had to be adopted, especially in 1281 and 1342.
“Priests’ adoption of fashionable garments was so common that it spurred criticism in contemporary literature, as is evident from Chaucer’s depiction of the monk in the Canterbury Tales,” Mitchell said.
Across late medieval society, the pointedness of the shoe became so extreme that in 1463 King Edward IV passed a law limiting the tip of the toe to less than two inches in London.
The majority of remnants with signs of hallux valgus across all sites and eras within the study were men (20 of the 31 total bunion patients). The study also suggests that health costs of footwear were not limited to bunions.
Dr. Jenna Dittmar found that skeletal residues with hallux valgus were also more likely to show signs of fracture usually due to a fall, e.g. Them to the upper limbs, indicating that a person tumbled forward on outstretched arms.
This association was only found to be significant among those who died over the age of 45, suggesting that youthful fashion choices came back to haunt the middle-aged, even in the Middle Ages.
“Modern clinical research on patients with hallux valgus has shown that the deformity makes it harder to balance and increases the risk of falls in older people,” Dittmar said. “This would explain the greater number of healed bones we found in medieval skeletons with this condition.”
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International Journal of Paleopathology, DOI: 10.1016 / j.ijpp.2021.04.012
Provided by the University of Cambridge
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