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

Abstract

Objective Hallux 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. Materials 177 adult individuals from four cemeteries located in Cambridge, England. Methods Human remains were macroscopically and radiographically assessed. Results Hallux 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. Conclusion The 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. Significance This is the first study to explore the relationship between foot problems and functional ability by studying hallux valgus in archaeological assemblages. Limitations Falls are complex and determining the mechanism of injury in human skeletal remains is not always possible. Further research Fracture prevalence rates may have been affected by biological factors and underlying pathological conditions.

Using paleopathology to provide a deep-time perspective that improves our understanding of one health challenges: Exploring urbanization

“…A study of different groups of people living in and around Cambridge during this period showed that 10%-45% of those living in the town had hallux valgus, compared with just 3% of those who lived in a rural farming community outside Cambridge. It was also found that fractures were significantly more common in those with hallux valgus than those without, which matches what we know about the increased risk of falls (Dittmar et al, 2021). This highlights how human behavior associated with urbanization, mediated by variation in income between rural and urban areas and coupled with access to the latest fashions, can lead to adverse health consequences in the past.…”

Global prevalence and incidence of hallux valgus: a systematic review and meta‐analysis

“…1). A total of 44 papers [9–52] were included ( n= 186,262,669). These epidemiological studies came from five continents and 17 different national regions (Table 1).…”