Bunions rife in medieval Britain thanks to fashion for pointy shoes, study suggests

·5-min read
woman removed shoes to massage painful foot
Bunions may mistakenly be considered a 'modern problem'. (Stock, Getty Images)

Suffering for our fashion is apparently nothing new.

While modern women may endure blisters while hobbling in stilettos, pointed shoes were in vogue in late medieval Britain, making bunions rife.

Scientists from the University of Cambridge analysed 177 skeletons buried in or around the city.

The medieval period spanned the 6th to 16th centuries. Among the skeletons dating from the 14th to 15th centuries, more than one quarter (27%) had a so-called hallux valgus, more commonly known as a bunion.

This is compared to just 6% of those buried between the 11th and 13th centuries.

Read more: Up to 14% died of cancer in medieval Britain

Shoe styles are said to have shifted during the 14th century, from a rounded toe to a more elegant point.

Being on trend came at a price, however, with constrictive shoes now known to be the most common form of bunions – painful bony lumps on the side of feet.

The excavated medieval foot bones show a bunion. (Supplied: Dr Jenna Dittmar)
The excavated medieval foot bones show a bunion. (Supplied: Dr Jenna Dittmar)

"The 14th century brought an abundance of new styles of dress and footwear in a wide range of fabrics and colours," said study author Dr Piers Mitchell. 

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

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

Read more: WFH may have unexpected benefits for foot health

A person's genetics may also make them more prone to bunions, however, the most common cause are "constrictive" shoes, which often "exert a force" against the big toe.

The skeletons were taken from four sites around Cambridge. The first site was a charitable hospital were the elite would have been buried, now part of St John's College.

Remains were also lifted from the grounds of a former friary, a burial site for clergy and wealthy people who gave to charity.

The last two sites were a parish graveyard on the former edge of Cambridge and a rural burial ground 6km (3.7 miles) south of the city.

Read more: Baby's feet turn purple after developing inflammatory syndrome with coronavirus

The scientists inspected the bones in the skeletons' feet for a bump on their big toe, a hallmark of a bunion.

"We think of bunions as being a modern problem but this work shows it was actually one of the more common conditions to have affected medieval adults," said co-author Dr Jenna Dittmar.

Watch: How to ease painful bunions

Perhaps unsurprisingly, bunions were more common among the wealthy, gauged by where the skeletons were buried. 

Just 3% of the remains taken from the rural cemetery showed signs of a hallux valgus. This rose to 10% among the skeletons taken from the parish graveyard, which mainly housed the working poor.

Bunions affected just under one quarter (23%) of those on the hospital site, the results – published in the International Journal of Paleopathology show.

More than two in five (43%) of those buried in the friary had bunions. Of the 11 skeletons that were identified as clergies – based on the belt buckles they were buried with – five showed signs of a hallux valgus.

In 1215, clergy were forbidden from wearing pointed shoes. This likely did little to protect against bunions, however, with further rules on clerical dress being passed over the next hundred years or so.

In late medieval society, the points on shoes had become so extreme that King Edward IV passed a law that limited the length of toe points to less than two inches (5cm) among London residents.

High heels may make bunions more of a female issue in this day and age, however, 20 of the overall 31 skeletons with the bony protrusion were men.

Bunions may have been just the start of people's foot troubles in medieval Britain.

The skeletons with a hallux valgus were more likely to show signs of fractures that usually occur after a fall.

"Modern clinical research on patients with hallux valgus has shown the deformity makes it harder to balance and increases the risk of falls in older people," said Dr Dittmar. 

Different types of Cracowes (Poulaines) - medieval shoe fashion with long toes: 1) Crakow with a chain attached to the leg (France, 1360); 2) Crakow with a small bell in front (Germany); 3-4) Crakowes with pattens and lashing straps (15th century). Wood engravings from the book
Poulaines, pointy shoes with a long toe, were popular in late medieval Britain. (Stock, Getty Images)

How to treat bunions

Bunions are not always avoidable, however, wearing correctly-sized shoes with room for the toes to move may help ward off the condition. High-heeled shoes and those with pointy toes should also be avoided.

Bunions can only be removed via surgery.

For less severe cases, ease pain by wearing wide shoes with a low heel and soft sole.

Holding an ice pack or bag of frozen peas against the area for up to five minutes at time may also reduce discomfort.

Bunion pads, cushions you put in shoes to stop them rubbing, can be effective.

Painkillers and losing weight, if required, can also help.

See a GP if the pain has not eased within several weeks or if it stops you from doing your normal activities.

If the bunion gets worse or you have diabetes, which can make foot problems more serious, seek medical advice.

Watch: Less invasive procedure could treat bunions

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