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

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.