title: Lifelong bound feet in China: a quantitative ultrasound and lifestyle questionnaire study in postmenopausal women.
abstract: OBJECTIVE
  The phenomenon of foot binding, also known as 'lotus feet', has an enduring and influential history in China. To achieve a man-made smaller foot size, lifelong foot binding may have had adverse effects on the skeleton. We investigated bone properties in postmenopausal women with bound feet, which may provide new information for developing countermeasures for prevention of fragility fractures.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  This study involved 254 postmenopausal women aged 65-80, including 172 with bound feet and 82 age- and gender-matched control subjects, living in a remote region of China.
  
  
  RESULTS
  Anthropometric, SF-36 Lifestyle Questionnaire and heel quantitative ultrasound (QUS) data were collected for the whole study population. A small subset of two cases was also invited for assessment of bone mineral density and microarchitecture at the distal tibia using high-resolution peripheral quantitative CT (HR-pQCT) and gait and balance tests.
  
  
  RESULTS
  Women with bound feet had significantly lower QUS values than age-matched women with normal feet; this was supported by HR-pQCT data. However, SF-36 Questionnaire results did not reveal any statistically significant differences in any categorical responses, including physical functioning, general health vitality and physical component summary score, and number of previous fractures. No impairment of body balance was found in the small subset.
  
  
  CONCLUSIONS
  The man-made changes caused by foot binding led to reduced physical activity, making the subjects prone to osteoporosis. Women with bound feet and osteoporosis did not have a higher incidence of fragility fractures than controls. This might be explained by compensation in physical activity to improve body balance, implying the importance of improving or maintaining body balance in overall prevention strategies against fragility fractures.
authors.affiliation: Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Ling
authors.initials: L
authors.lastname: Qin
authors.affiliation: Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Department of Mechanical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China.
authors.forename: Mian
authors.initials: M
authors.lastname: Xu
authors.affiliation: Department of Orthopaedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China.
authors.forename: Hanchang
authors.initials: H
authors.lastname: Lao
authors.affiliation: Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Michael C
authors.initials: MC
authors.lastname: O'Laughlin
authors.affiliation: Department of Mechanical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
authors.forename: Shan
authors.initials: S
authors.lastname: Tong
authors.affiliation: Training Department of International Osteoporosis Diagnosis and Treatment, Health Promotion Foundation of China, Beijing, China.
authors.forename: Yanling
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: V W  Y
authors.initials: VW
authors.lastname: Hung
authors.affiliation: Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: J C Y
authors.initials: JC
authors.lastname: Cheng
authors.affiliation: Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
authors.forename: Xia
authors.initials: X
authors.lastname: Guo
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D000368:Aged; D015519:Bone Density; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003469:Culture; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging* / Q000473:pathology; D005531:Foot Deformities, Acquired / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006365:Heel / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D017698:Postmenopause; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013977:Tibia / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography; D016474:Weight-Bearing
keywords: ORTHOPAEDIC & TRAUMA SURGERY