Medieval trend for pointy shoes led to bunions explosion, study shows

A rise in toe-joint dislocations coincided with the rise in popularity of a pointy-toed shoe called a poulaine.
Medieval trend for pointy shoes led to bunions explosion, study shows

L-R: excavated bones showing signs of hallux valgus; part of a period picture of a poulaine sole

A medieval trend for pointy shoes led to a sharp increase in bunions, a study of skeletons has suggested.

Cambridge University researchers analysed 177 skeletons from four cemeteries in and around the city.

Their study indicated that 6% of individuals buried between the 11th and 13th century showed evidence of hallux valgus, better known as bunions, rising to 27% of those from the 14th and 15th centuries.

This coincided with the rise in popularity of a pointy-toed shoe called a poulaine.

Dr Piers Mitchell from Cambridge’s Department of Archaeology said: “The 14th century brought an abundance of new styles of dress and footwear in a wide range of fabrics and colours.

“Among these fashion trends were pointed long-toed shoes called poulaines.

“The remains of shoes excavated in places like London and Cambridge suggest that by the late 14th century almost every type of shoe was at least slightly pointed – a style common among both adults and children alike.

“We investigated the changes that occurred between the high and late medieval periods, and realised that the increase in hallux valgus over time must have been due to the introduction of these new footwear styles.”

The sole of an adults shoe from the late 14th century in Cambridge, showing a pointed shape.
The sole of an adults shoe from the late 14th century in Cambridge, showing a pointed shape.

The study identified that 31 of the 177 skeletons displayed changes at the metatarsophalangeal toe joint consistent with long-standing hallux valgus.

Hallux valgus is a minor deformity in which the largest toe becomes angled outward and a bony protrusion forms at its base, on the inside of the foot.

While various factors can predispose someone to bunions, from genetics to muscle imbalance, the most common contemporary cause is constrictive boots and shoes.

Radiocarbon dating and records of when burial grounds were in use helped to date the skeletons, indicating the apparent increase in cases of bunions over time.

Those buried in the city centre, particularly in plots for wealthier citizens and clergy, were more likely to have had bunions, according to the research.

The study indicated that 3% of skeletons at a rural cemetery 6km south of Cambridge showed signs of bunions, compared with 10% of those at a parish graveyard on what was the edge of town which mainly held the working poor.

This rose to 23% of those at a charitable hospital site, and 43% of those in the grounds of a former Augustinian friary where clergy and wealthy benefactors were buried – including five of the 11 individuals identified as clergy by their belt buckles.

Excavated medieval foot bones showing hallux valgus, with lateral deviation of the great toe. A medieval trend for pointy shoes led to a sharp increase in bunions, a study of skeletons has suggested.
Excavated medieval foot bones showing hallux valgus, with lateral deviation of the great toe. A medieval trend for pointy shoes led to a sharp increase in bunions, a study of skeletons has suggested.

“Rules for the attire of Augustinian friars included footwear that was ‘black and fastened by a thong at the ankle’, commensurate with a lifestyle of worship and poverty,” said Dr Mitchell.

“However, in the 13th and 14th centuries it was increasingly common for those in clerical orders in Britain to wear stylish clothes – a cause for concern among high-ranking church officials.” In 1215, the church banned clergy from wearing pointed-toed shoes.

This may have done little to curb the trend, as numerous further decrees on indiscretions in clerical dress had to be passed, most notably in 1281 and 1342.

“The adoption of fashionable garments by the clergy was so common it spurred criticism in contemporary literature, as seen in Chaucer’s depiction of the monk in the Canterbury Tales,” said Dr Mitchell.

Across late medieval society the pointiness of shoes became so extreme that in 1463 King Edward IV passed a law limiting toe-point length to less than two inches within London.

First author Dr Jenna Dittmar found that skeletal remains with bunions, a condition that makes it harder to balance, were also more likely to show signs of fractures that usually result from a fall, such as to upper limbs, indicating an individual tumbled forward onto outstretched arms.

This association was only found to be significant among those who died aged over 45.

The study is published in the International Journal of Paleopathology.

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