title: Hallux valgus in a historical French population: paleopathological study of 605 first metatarsal bones.
abstract: OBJECTIVE
  To estimate the prevalence of hallux valgus in a historical population in France, to identify associated skeletal abnormalities, and to look for an influence of footwear changes through time.
  
  
  METHODS
  We studied the 605 first metatarsals found in the necropolis of the Notre-Dame-du-Bourg cathedral in Digne in the Alpes-de-Hautes-Provence region of southern France. The necropolis contains remains from the 5th to the 17th century.
  
  
  RESULTS
  Hallux valgus was identified only in individuals older than 30years at death, and its prevalence increased significantly with age. Exostosis at the medial and dorsal aspects of the head of the first metatarsal were common in advanced forms. The prevalence was comparable in males and females in the Middle Ages but was significantly higher in males in the 16th and 17th centuries, whereas in contemporary populations females are selectively affected.
  
  
  CONCLUSIONS
  The increase in the prevalence of hallux valgus over time suggests an influence of changes in footwear. The heeled shoes and boots made of stiff leather that men wore in premodern times probably promoted the development of hallux valgus. However, the prevalence of hallux valgus in women in western industrialized countries today is even higher than that in our historical population of older premodern individuals, suggesting an extremely deleterious effect of contemporary female footwear.
authors.affiliation: Human Paleontology Institute Antenna, Prehistory Department, National Museum of Natural History, USM 103, UMR 5198, Europôle de l'Arbois, Bâtiment Villemin-BP 80, Aix en Provence Cedex 04, France. mafartbertrand@aol.com <mafartbertrand@aol.com>
authors.forename: Bertrand
authors.initials: B
authors.lastname: Mafart
mesh_terms: D000328:Adult; D017677:Age Distribution; D015984:Causality; D005260:Female; D005602:France / Q000453:epidemiology; D006215:Hallux Valgus / Q000453:epidemiology / Q000266:history* / Q000473:pathology; D049668:History, 15th Century; D049669:History, 16th Century; D049670:History, 17th Century; D049691:History, Medieval; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000473:pathology*; D008875:Middle Aged; D010164:Paleopathology; D015995:Prevalence; D017678:Sex Distribution; D012775:Shoes / Q000266:history*