Hallux valgus in a historical French population: paleopathological study of 605 first metatarsal bones.

OBJECTIVES: 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.

Is the incidence of elbow osteoarthritis underestimated? Insights from paleopathology.

OBJECTIVES: Osteoarthritis is uncommon at the elbow in contemporary populations. We sought to determine whether this was also the case in medieval and premodern times. MATERIAL AND METHODS: Standard criteria for osteoarthritis were applied to 496 complete elbows from a necropolis in Provence, France. RESULTS: Osteoarthritis was found in 27% of elbows. Significant differences were noted across periods and age groups but not between the right and left sides. CONCLUSION: Our data suggest that the symptoms of elbow osteoarthritis may be far milder than expected from the underlying pathological lesions. The incidence of elbow osteoarthritis in contemporary populations is probably underestimated. The high prevalence of elbow osteoarthritis in archeological populations cannot be taken as a marker for activities placing stress on the upper limbs.