The British have suffered from their fashions for centuries, according to a new study suggesting that a vogue for point-toe shoes led to a sharp increase in hallux valgus of the big toe – often referred to as bunions – at the end of the period medieval.
Researchers investigating remains in Cambridge, UK, found that those buried in the city center, especially in plots intended for wealthier citizens and clergy, were much more likely to have had onions – suggesting that the wealthy city dwellers paid a higher price for their shoes in more ways than one.
A team from the University of Cambridge also found that medieval elderly people with hallux valgus were significantly more likely to have suffered a fracture from a probable fall compared to those of a similar age with normal feet.
Hallux valgus is a minor deformity in which the larger toe becomes tilted outward and a bony protrusion forms at its base, on the inside of the foot.
While a variety of factors can predispose someone to bunions, from genetics to muscle imbalance, by far the most common contemporary cause is constricting boots and shoes. The condition is often associated with wearing high heels.
Archaeologists analyzed 177 cemetery skeletons in and around the city of Cambridge and found that only 6% of those buried between the 11th and 13th centuries had evidence of the affliction. However, 27% of those dating from the 14th and 15th centuries had been hampered by long-standing hallux valgus.
Researchers point out that the style of shoes changed dramatically during the 14th century: from a functional rounded-toe box to a longer, more elegant pointed toe.
In an article published today in the International journal of paleopathology, the Cambridge University After the Plague project team argues that these “foal” shoes led to the rise of bunions in medieval Britain.
“The 14th century brought an abundance of new styles of clothing and footwear in a wide range of fabrics and colors. Among these fashion trends were point-toe shoes called foals,” said the co-author of the study, Dr Piers Mitchell of the Cambridge Archeology Department. .
“Shoe remains unearthed in places like 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 among adults and children.”
“We studied the changes that took place between the early and late Middle Ages and realized that the increase in hallux valgus over time must have been due to the introduction of these new styles of shoes,” Mitchell said. .
The first author, Dr Jenna Dittmar, who led the work at Cambridge, said: “We think onions are a modern problem, but this work shows that it was actually one of the most common conditions for have affected medieval adults. “
The remains came from four separate sites around Cambridge: a charity hospital (now part of St John’s College); the grounds of a former Augustinian convent, where the clergy and wealthy benefactors were buried; a local parish cemetery on what was the edge of town; and a rural burial site near a village 4 miles south of Cambridge.
The researchers performed “paleopathological evaluations,” including inspecting the bones of the foot for the big toe lump which is the hallmark of hallux valgus.
They found a sliding scale of onion prevalence related to the wealth of people buried at each site. Only 3% of the rural cemetery showed signs, 10% of the parish cemetery (which mainly housed poor workers), climbing to 23% of those at the hospital site.
Yet nearly half of those buried in the convent – around 43% – including five of the eleven people identified as clergy by their belt buckles, bore the onion mark.
“The Augustine brothers’ dress code included shoes that were ‘black and tied with an ankle strap’, consistent with a lifestyle of worship and poverty,” Mitchell said.
“However, by the 13th and 14th centuries it was increasingly common for members of religious orders in Britain to wear elegant clothing – a source of concern among senior church officials.”
In 1215, the church forbade the clergy to wear pointed-toed shoes. This may have done little to curb the trend, as many additional decrees on indiscretions in office dress had to be passed, most notably in 1281 and 1342.
“The adoption of fashionable clothing by the clergy was so common that it drew criticism in contemporary literature, as evidenced by Chaucer’s portrayal of the monk in The Canterbury Tales,” Mitchell said.
Throughout late medieval society, the toe point became so extreme that in 1463 King Edward IV passed a law limiting the length of the toe point to less than two inches inside London.
The majority of the remains showing signs of hallux valgus at all sites and at all times of the study were males (20 of 31 people with bunions in total). Research also suggests that the health costs of foot fashion weren’t limited to bunions.
Dr Jenna Dittmar found that skeletal remains with hallux valgus were also more likely to show signs of fractures which usually result from a fall, for example those of the upper limbs indicating that an individual has fallen forward on outstretched arms. .
This association was only found to be significant in those who died over the age of 45, suggesting that young fashion choices returned to haunt middle-aged people, even in medieval times.
“Modern clinical research in patients with hallux valgus has shown that the deformity makes balance more difficult and increases the risk of falls in the elderly,” said Dittmar. “This would explain the higher number of healed broken bones that we found in medieval skeletons with this disease.”