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

Jenna M. Dittmar*, Piers D. Mitchell, Craig Cessford, Sarah A. Inskip, John E. Robb

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
5 Downloads (Pure)


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.

Original languageEnglish
Pages (from-to)90-100
Number of pages11
JournalInternational Journal of Paleopathology
Early online date11 Jun 2021
Publication statusPublished - 31 Dec 2021

Bibliographical note

Funding Information:
The authors would like to thank Bram Mulder and Ket Smithson for providing microCT images used in this paper, as well as Trish Biers of the Duckworth Collection at the University of Cambridge, and the members of Cambridge Archaeological Unit for their help and support. We would also like to thank the anonymous reviewers for their comments on this manuscript. This research was funded by the Wellcome Trust [Award no 2000368/Z/15/Z] and St John's College, Cambridge. This work is licensed under a Creative Commons Attribution 4.0 International License.


  • Bunion
  • Fall
  • Fashion trends
  • FOOSH injury
  • Foot problems
  • Impaired mobility
  • Social status


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