engraved drawings of poulainesShare on Pinterest
Scientists investigate whether a Middle Age fashion impacted foot health. Photo editing by Stephen Kelly; ZU_09/Getty Images
  • Archaeologists have examined human skeletons dating from the Middle Ages that were buried in four cemeteries in and around Cambridge in England.
  • They found evidence that bunions were significantly more common in the 14th–15th centuries than in the 11th–13th centuries and more prevalent in affluent areas.
  • The researchers speculate that a fashion for pointy shoes among the well-heeled of Medieval England may have spurred the increase in bunions.
  • They also found evidence of more fractures, likely caused by falls, among individuals who had bunions.

Fashion has inflicted many discomforts and indignities on its followers down the ages, from the wasp-like waistlines and codpieces of Tudor times, to the stiletto heels and “sagging” pants of our own.

According to research by archaeologists at the University of Cambridge in the United Kingdom, a fashion for shoes called “poulaines,” with long pointy toes, may have caused an outbreak of painful bunions in the Middle Ages.

A bunion, or hallux valgus, is a bony bump at the base of the big toe that develops after the toe deflects inwards towards the second toe.

An inherited fault in the mechanical structure of the foot is the most common cause of bunions, though constrictive footwear can worsen the underlying condition.

Hallux valgus can result in impaired mobility, poor balance, and an increased risk of falls.

To investigate the relationship between bunions and bone fractures in the Middle Ages, the archaeologists examined the skeletons of 177 adults buried in four cemeteries in the following locations:

  • a village called Cherry Hinton outside Cambridge (n=37)
  • the parish church of All Saints by the Castle on the edge of town (n=50)
  • the charitable Hospital of St. John the Evangelist, now part of St. John’s College (n=69)
  • an Augustinian friary in the town (n=21)

Overall, 18% of all the skeletons showed signs of bunions. However, the condition appeared to be significantly more common during the 14th–15th centuries (the Late Middle Ages) than the 11th–13th centuries (the High Middle Ages).

The archaeologists speculate that the popularity of poulaines among more wealthy individuals in the Late Middle Ages caused an outbreak of bunions.

They found a correlation between the prevalence of bunions in each location and the likely affluence of the people buried there.

The highest prevalence was:

  • in the friary (43%)
  • the hospital (23%)
  • the cemetery on the edge of town (10%)
  • the rural parish cemetery (3%)

Among those buried in the friary, 5 of the 11 individuals identified as clergy from their characteristic belt buckles had signs of bunions.

Overall, bone fractures likely caused by falls onto outstretched arms were significantly more common among those who had bunions compared with age-matched individuals who did not.

In modern people, research suggests that bunions can cause changes in gait that make falls more likely, especially in older age.

The archaeologists behind the new study have published their findings in the International Journal of Paleopathology.

“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,” says first author Jenna Dittmar, Ph.D., of the University of Aberdeen, who conducted the study while working at the McDonald Institute for Archaeological Research in Cambridge.

The authors write that there are several risk factors for bunions, including increasing age, obesity, and inherited variations in the bone structure of the foot. But research has found that modern women who wear shoes with a very narrow “toe box” in their 20s are at increased risk of the condition in later life.

The remains of shoes dug up in London and Cambridge show that while shoe styles with a rounded toe were common in the early 14th century, almost every type of shoe adopted the pointed style by the end of the century.

The new study authors believe that the prevalence of bunions among patients at the hospital suggests they were more likely to have followed these fashions than individuals living on the edge of town.

The team found that the highest prevalence of bunions was in the friary cemetery, which may indicate that both wealthy laypeople and friars adopted the fashion.

This was despite the Augustinian order laying down strict rules on attire, including footwear, which they specified should be “black and fastened by a thong at the ankle.”

The friars appear to have paid the price for their fashionable tastes with an increased incidence of bunions, which may have led to more bone fractures in later life.

Medical News Today wondered whether friars’ popular reputation for overindulgence, epitomized by the fictional character Friar Tuck, could explain the increased incidence of falls.

“We do know that friars and monks in monastic institutions during the medieval period were well fed and had access to plenty of alcohol,” said co-author Dr. Piers Mitchell.

“However, we have no way of knowing how [overweight] they were based on their skeletons, and they did not have records of weight in written texts,” he added. “Either way, the association between fracture risk and hallux valgus was seen across all subpopulations of Cambridge, and not just in the friars.”

Hylton B. Menz, Ph.D., a podiatrist at La Trobe University in Victoria, Australia, who was not involved in the research, told MNT it is always difficult to apply present-day observations to historical data.

Prof. Menz conducted the research, cited above, that found women who wear narrow shoes are more likely to develop bunions in later life.

He said the general principle that constrictive footwear may contribute to food deformity applies irrespective of the time period.

“Establishing causation in this study, however, is inherently difficult,” he added, “as it requires the shift to narrow-toed shoes to be chronologically correct (i.e., how certain are we of the date when these shoes started to be worn?) and widespread (i.e., did everyone adopt this type of footwear or just certain subgroups of the population?).

Regarding the proposed link between the increased incidence of bunions and fractures, he pointed out that there are multiple risk factors for falls, of which hallux valgus is only one.

In addition, he said only a small proportion of falls (10–15%) lead to fractures.

“It’s an intriguing hypothesis, but in my opinion, requires a few too many assumptions to be completely convincing,” he said.