Medieval fashion for pointy shoes linked to rise in bunions

From waist-squeezing corsets to crinoline skirts, fashion has rarely been about comfort – or safety. Now researchers have revealed that even in medieval times, men and women could become martyrs to fashion, linking a trend in pointy shoes to a rise in the prevalence of bunions.

Bunions – or hallux valgus– are bulges that appear on the side of the foot as the big toe leans in towards the other toes and the first metatarsal bone points outwards. Studies suggest factors such as genetics probably predispose some people to the condition, but it is thought high heels and pointy shoes may exacerbate the problem or speed up its development.

New research reveals that medieval fashionistas may have discovered this the hard way. “We were quite fortunate that we happened to be studying a time period where there was a clear change in shoe fashion somewhere in the middle of our sample,” said Dr Piers Mitchell, of the University of Cambridge, a co-author of the study. “People really did wear ridiculously long, pointy shoes, just like they did in Blackadder.”

The parsnip-shaped shoes, known as poulaines, became widespread in Britain in the 14th century, and ended up reaching absurd lengths. According to the Museum of London, in 1394 a monk of Evesham noted that some people wore shoes with pointed toes “half a yard in length, thus it was necessary for them to be tied to the shin with chains of silver before they could walk with them”.

But the fashion became contentious. In 1463 Edward IV restricted the length of the points for anyone below the rank of a lord to less than two inches within London “on pain of forfeiting 40d to your highness for every offence”.

Writing in the International Journal of Paleopathology, Mitchell and colleagues report how they analysed the remains of 177 adults, all of whom had at least one first metatarsal present, from four cemeteries in Cambridge, including a rural parish cemetery, an Augustinian friary inside town, and a hospital.

The team found that 31 of the individuals, 20 of them men, had skeletal signs of bunions. Analysis of remains that could be dated revealed bunions were significantly more prevalent during the 14th and 15th centuries, with 19 out of 71 individuals having the condition, compared with three out of 52 from the 11th–13th centuries.

The study cannot prove that the bunions were triggered by poulaines. However, the researchers found bunions were more common among town dwellers and in particular those buried in the friary, who would have included clergy and wealthy laypeople.

While the latter may have been expected to adopt fashion trends, Mitchell said not all clergy would have dressed soberly. “Some of them wanted to look distinctive and so they might wear velvet gloves or flashy shoes,” he said, noting the clergy were often well off.

What’s more, it seems older people afflicted by bunions were more likely to have had fractures that probably resulted from a fall than people without hallux valgus. “When you get older and frailer your balance is not great. If you then have hallux valgus it tips you over the edge, so you lose balance more often than people that have normal-shaped feet,” Mitchell said.

Emma McConnachie, a spokesperson for the College of Podiatry, said that while some feet will develop bunions even without footwear, high heels increase pressure on the big toe joint, thereby speeding up changes.

“A narrow toe box can apply further pressure to the toes and push them into a different shape, much like wearing a corset,” she said.

McConnachie added that bunions mean the foot works in a different way to how it was supposed to. “The findings of the Cambridge team highlight these issues have been around for quite some time,” she said. “It would appear that the fashion choices of the 14th century inflicted similar issues from footwear as we see presenting in clinics today.”