Crudely made grass-lined moccasins may have been the first foot protection worn by humans starting as far back as 20 to 40 thousand years ago.

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Fashion pressures eventually prevailed, and shoe design took a great step forward in about 1400. For the next 150 years it was trendy among the European upper classes to wear ornately embroidered shoes with extremely pointed toes, which extended beyond the owner’s foot anywhere from four to twenty inches. These were known as Crakows, which reflected their likely origin from Krakow, Poland. Crakows were high fashion for both men and women and were a key element in demonstrating the owners’ social rank—the longer the toe, the higher the status. At times, a silver or gold chain reaching from knee to shoe tip was used to keep the wearer from tripping. However, this deference to style came with a hidden price. The shoes wedged the toes together unnaturally, which led to bunions and fractures.  

First, what is a bunion? Known in medicalese as hallux valgus, it is a deviation of the big toe (hallux in Latin). Rather than pointing straight ahead, the big toe points toward the outside of the foot. Accompanying the angular deformity is a large bump in the inside of the foot at the base of the big toe. In extreme cases, the big toe angles sufficiently that it overlaps the second or even the third toe. Genetics, variations in alignment of adjacent bones, and muscle imbalance can predispose an individual to hallux valgus, but the most common cause is wearing pointy-tipped shoes that unnaturally scrunch the toes together and push the big toe to the side. In medieval times, Crakows were culprits. Louboutin’s are today.

Next, how do bunions relate to fractures? The big toe contributes greatly to balance and gait, and individuals with hallux valgus have diminished standing stability and increased postural sway compared to those with normally aligned toes. This detrimental influence on gait results in increased risks of falling and breaking bones.

Finally, how do we know that medieval fashionistas had bunions and broken bones? The answer comes from an intriguing study published last year in the International Journal of Paleopathology. In case you are behind in your journal reading, here is the gist of the investigation.

The researchers examined the skeletal remains of 177 adult individuals who had been buried in one of four cemeteries located in or near Cambridge, England. The oldest cemetery was at Cherry Hinton, which was an agricultural center. Burials there started about 950 and continued for 200 years, and the researchers assumed the exhumed skeletons to be those of the local, rural peasants. For the study, the skeletons from Cherry Hinton served as historic controls, since Crakows were not in style when this cemetery was accepting bodies.

Two middle groups were sensibly shod even though they lived when Crakows were the rage. The Hospital of St. John the Evangelist cared for the poor and infirm, so logically its cemetery served the same demographic. The parishioners of All Saints by the Castle were apparently a cross-section of Cambridge social classes, so the church’s cemetery logically represented a similar mix, and Crakows were not likely prevalent.

The fashionistas comprised the fourth group, and they might have even been buried with their Crackows on. Their cemetery was at an Augustinian friary, which was the resting place not only for members of the Augustinian order, who drew criticism for wearing “fashionable tight shoes,” but also for prosperous Cambridgians whose donations secured them preferred burial plots.

Using standard anthropological means, the investigators categorized each skeleton according to its age at death and its sex. They next scrutinized the foot bones for telltale signs of bunions. These findings include an angular shift of the joint surface at the big toe’s base along with bony erosions and altered ridging and lipping, which are characteristic findings of chronic joint malalignment. Finally, the researchers examined the entirety of each skeleton for healed fractures.

Data analysis showed that 45% of the friars and 40% of layfolk buried at the friary had bunions, while only 3% of the Cherry Hinton peasants did. The sensibly shod had intermediate incidences of bunions. Furthermore, the investigators discovered that individuals, particularly older folk, with hallux valgus had sustained significantly more broken bones than had individuals with straight toes.

Allowing for some assumptions and circumstantial evidence, the study concludes that wearing Crakows caused wealth-induced bunions, which created gait and balance problems that led to falls and fractures—all recorded in the bones.

Falls and fractures, however, may not have been the cause of the fad’s demise. Rather the English eventually deemed Crakows indecent, and a law prohibited shoe tips longer than two inches. In France, King Charles V ruled against them because Crakows made kneeling for prayer difficult.

For safety, should we revert to grass-lined moccasins or just stick with sensible shoes?

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