Fancy shoes and painful feet: Hallux valgus and fracture risk in medieval Cambridge, England

Jenna M Dittmar,Piers D Mitchell,Craig Cessford,Sarah A Inskip,John E Robb

doi:10.1016/j.ijpp.2021.04.012

Jenna M Dittmar, Piers D Mitchell + Show 3 more

Open Access

https://doi.org/10.1016/j.ijpp.2021.04.012

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Abstract

ObjectiveHallux valgus, the lateral deviation of the great toe, can result in poor balance, impaired mobility and is an independent risk factor for falls. This research aims to compare the prevalence of hallux valgus in subpopulations of medieval Cambridge, England, and to examine the relationship between hallux valgus and fractures to examine the impact of impaired mobility and poor balance caused by this condition. Materials177 adult individuals from four cemeteries located in Cambridge, England. MethodsHuman remains were macroscopically and radiographically assessed. ResultsHallux valgus was identified in 18 % of individuals and was significantly more common during the 14th–15th centuries than the 11th–13th centuries. The highest prevalence was observed in the friary (43 %), followed by the Hospital (23 %), the rurban parish cemetery (10 %), and the rural parish cemetery (3%). Fractures from falls were significantly more common in those with hallux valgus than those without. ConclusionThe increased prevalence of hallux valgus identified in individuals from the 14th to 15th centuries coincided with the adoption of new footwear with pointed toes. Those that adopted this fashion trend appear to have been more likely to develop balance and mobility problems that resulted in an increased risk of falls. SignificanceThis is the first study to explore the relationship between foot problems and functional ability by studying hallux valgus in archaeological assemblages. LimitationsFalls are complex and determining the mechanism of injury in human skeletal remains is not always possible. Further researchFracture prevalence rates may have been affected by biological factors and underlying pathological conditions.

Highlights

Clothing and personal adornment played a role in the recognition and maintenance of social hierarchy during the High and Late medieval periods in England (Smith, 2009)
Hallux valgus was present in at least 18 % of the individuals exam ined within this study
There are a range of factors that can predispose an indi vidual to hallux valgus, including age, gender, obesity, and congenital structural variation, one of the most commonly cited causative factors is tight ill-fitting footwear with a pointed toe-box (Menz et al, 2016; Munteanu et al, 2017)

Summary

Introduction

Clothing and personal adornment played a role in the recognition and maintenance of social hierarchy during the High and Late medieval periods in England (Smith, 2009). A range of factors can predispose an individual to hallux valgus including genetics, congenital structural variations in the alignment of the metatarsals, and muscle imbalance, the most common cause is wearing tight, ill-fitting footwear with a pointed toe-box (Inman, 1974; Munteanu et al, 2017; Nix et al, 2012). Constrictive shoes cause this condition by exerting a laterally directed force against the medial aspect of the hallux (Menz, 2008; Menz et al, 2016)

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