June 1990, Vol. 29, No, 5
Review
The Chinese Foot-Binding Syndrome Observations on the History and Sequelae of Wearing III-Fitting Shoes ROBERT JACKSON, M.D.
tory pain the next great leap forward of the high priests of fashion,"" "Women long ago learned that not diamonds but high heels are a girl's best friend,"^
From the Division of Dermatology, Ottawa Givic Hospital, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Ganada
P
eople are to learn that pointed toes and big joints are not natural; that they do not come of themselves, and that the foot gear which produces them cannot have any propriety of beauty. The various long-toed, narrow-toed, broad-toed, stub-toed, short heeled, thick-soled, stiff, awkward things that are worn by the masses must be seen to be, as they are, unfit coverings to be put upon a decent human foot,"^ "It is quite clear that the foot must enter the shoe, and if the shoe differs in shape from the foot, it is no less plain that the foot being the more pliable, must necessarily adapt itself to the shape of the shoe,"^ "Only one person in a hundred is born with imperfect feet, but in the course of life, nine out of ten suffer from some foot ailment, A ten-year study has shown that in the United States 40 percent of the population have developed foot trouble by the age of six, and by the 20th year, the percentage has doubled. The perfect feet found among primitive people, very young children and those who do not wear shoes, become deformed in civilization by hard pavements and the rigid confinement of the foot in ill-designed shoes,"^ "The cavalier treatment to which the human race has subjected its feet for the last thousand years following the dictates of fashion, does not make one suppose that the era of non-deforming shoes is in sight. Instead one awaits with a grimace of anticipa-
History The patron saints of shoemakers. Saint Crispin and Saint Crispinian, can be traced to the 8th Century at Soissons in France; the feast date is October 25, The story of what so-called civilized man has done to his feet over the years has been outlined in several papers,^'"'''"" and is briefly depicted in Figures 1 to 8, A most complete illustrated reference book of footwear from Egyptian to modern times is The Mode of Footwear.^ Currently Seen Abnormalities What are the currently seen sequelae of putting a foot into an ill-fitting shoe? Many of these are outlined in my text on Morphological Dermatology^° and depicted in Figures 9, 10, 11, The so-called Chinese foot-binding syndrome occurs mainly in women and consists of varying degrees of one or more of the following: 1. Hard corns or callosities on the tips of the toes, some subungual, on the dorsa of the phalangeal joints, on the dorsolateral aspect of the fifth toe, on the medial aspect of the big toe, over the medial aspect of the first metatarsal-phalangeal joint, over the lateral- and medial and central portion of the sole, anterior to the central portion of the anterior arch. Rarely, calluses may be present over bony prominences on the dorsa of the foot,
Address correspondence to: Robert Jackson, M,D., 1081 Carling Avenue Suite 508, Ottawa ON K1Y 4G2, Canada. The term Chinese foot-binding syndrome has been used to describe all the changes produced by wearing ill-fitting shoes, as it seemed to be an ideal example of how ridiculously human beings can deform their feet as the result of la belle indifference in pursuit of fashion.
2. Soft corns at the sides or base of the third or fourth interdigital toe space, 3. Compression of the toes, especially the four lateral ones, with loss on the interdigital spaces and squaring of the tips.
322
No. 5
CHINESE FOOT-BINDING SYNDROME
Jackson
323
FIG, 1, The "golden lily" foot produced by the Chinese foot-binding syndrome. It was produced from the T'ang dynasty in the 7th century up to the 20th century. There are many anecdotes as to the origin of foot binding. One says it arose when an empress was born with club feet, and other babies at the court had their feet bound to prevent the royal infant from appearing to be abnormal. Another says that the feet were bound to prevent the women from running away from their masters. A third states that their feet were hobbled so that it was not possible for them to do any work—the ultimate hallmark of a rich and idle upper class. A similar type of reasoning has been applied to having fingernails one inch long. Throughout history only the rich and idle had the wherewithal to indulge in the various dictates of fashion. It can be assumed that, until modern times, the working class wore shoes that did not deform the feet. In his account of the Chinese Civil War in 1935, Fdgar Snow reported that when the Kuomintang captured a village, it freed girls with bound feet on the presumption that they were of the upper class and anti-Communist, but they executed or sold into slavery girls with natural feet on the presumption that they were peasants and therefore partisans of the Communists. After 1912 when Yuan Shih-Kai became president he made it a penal offense to bind a girl's feet. This ban led to three types of feminine shoes. First, a shoe for the natural foot, a second style for the deformed foot, and a third also for the deformed foot but designed to conceal the deformity. This latter was called the deer foot or theater boot, a fashionable shoe worn not only by the deformed-footed women but by other well-dressed Chinese women who wished to appear to have lily feet. Reprinted with permission of publisher from Ploss HM, Bartels P. Das Weib in der Naturunk Volheshunde. Berlin: Verlag, 1927:287-300. 4. Lateral deviation of the first and second toes, and medial deviation of the fourth and fifth toes, to such an extent that the fifth toe may be pushed under the fourth and the second under the third. If the lateral deviation of the big toe is severe it may lift up the second, and sometimes the third toe, 5. Elevation of the interphalangeal joints to form an inverted V, usually on the second and third toes (claw toes), and severe flexion of distal interphalangeal joints (hammer toes). 6. Presence of an enlarged, medially extending first metatarsal-phalangeal joint over which a large callus is present, and associated with at least some lateral deviation of the big toe (bunion). Metatarsus primus varus is a congenital deformity. Bunion and lateral deviation of great toe {hallux valgus) are shoe acquired.
FIG. 2. Piked or sharp-pointed toes. These were introduced into Europe from the East after the Crusades,
7. Compression and deformity of the toenails in association with compression of toes. Sometimes longitudinal horny hypertrophy of the toenails occurs. The side of the toenail may be buried in the lateral nail fold, and hence cause ingrowing toenails. The nails may also
324
INTERNATIONAL JOURNAL OF DERMATOLOGY
June 1990
Vol. 29
FIG, 4, Bucket-topped boot of the Cavaliers (supporters of Charles I in the English Civil War 1630-1660).
callosities. Occasionally a solitary wart may exist in a corn. 2, The presence of a congenitally shortened first metatarsal (Morton's toe) may cause some of the changes listed in items 1-8, 3, Occasionally, congenital (lateral deviation of the big toe) or acquired (postpoliomyelitis, postinfantile hemangioma radiation damage to metatarsals) factors may produce a few of the changes listed. FIG. 3. period.
Venetian chopine or platform shoe, Italian Renaissance
show subungual keratosis, forming the nail plate to an inverted U shape. The keratosis is made up of very firm, whitish keratin material. The plate is lifted up towards its distal end and may show whitish areas. In effect, this is a callus of the nail, 8, Symmetry of these changes. If items 1 - 8 are present, there need be no question of the diagnosis. Nonetheless, findings do exist that confuse or complicate the diagnosis, 1, Presence of definite verrucae vulgares (of the solitary, mother-daughter, or mosaic type) about the corns and
FIG. 5. The squat or Louis heel. These shoes were introduced by Louis XIV (1638-1715) to give the fashion-conscious Sun King added height. The high heels also made the calves more shapely.
No. 5
CHINESE EOOT-BINDINC SYNDROME
325
Jackson
SPRING AND SUMMER CATALOGUE (NO.
46).
S3
Boots and Shoes. N o t ^"^ ^°^^ Footwear by the modem method, without salesmen ? Thous^inds are doing so, why not you ? In pr^sctiting you with this Catalogue of up-m-date perfect-fitting serviceable Spring Shoes, we have selected just those styles that we trust will particularly interest you and give perfect satisfaction, Lndlcs* Boots.
Wehive plo^Buri.' In lntroditcinK thli neaHon for ladles', utnU and ohlldroii'ii weRi-, Kuniitne Australian ftlttsed kanururoa, tnnnod by chrome nrooDHA and lit the tougncHt nnd rDiigi'MtwoiuiiiR leather In existence, noft an kill, bright tlninh, dooH not peel, nnd RIVOS comfort to the mu^l Under (cal
FIG. 6. The winkle picker (winkle—a small edible snail). The ladies shoes were listed in a 1901 Eaton's catalogue, a large Canadian retail chain and mail order store.
tk. Olnrnl knnBftroo. buttcnoii, with the h:uiiiiliie uotxlyaur wolto
Review
The Chinese Foot-Binding Syndrome Observations on the History and Sequelae of Wearing III-Fitting Shoes ROBERT JACKSON, M.D.
tory pain the next great leap forward of the high priests of fashion,"" "Women long ago learned that not diamonds but high heels are a girl's best friend,"^
From the Division of Dermatology, Ottawa Givic Hospital, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Ganada
P
eople are to learn that pointed toes and big joints are not natural; that they do not come of themselves, and that the foot gear which produces them cannot have any propriety of beauty. The various long-toed, narrow-toed, broad-toed, stub-toed, short heeled, thick-soled, stiff, awkward things that are worn by the masses must be seen to be, as they are, unfit coverings to be put upon a decent human foot,"^ "It is quite clear that the foot must enter the shoe, and if the shoe differs in shape from the foot, it is no less plain that the foot being the more pliable, must necessarily adapt itself to the shape of the shoe,"^ "Only one person in a hundred is born with imperfect feet, but in the course of life, nine out of ten suffer from some foot ailment, A ten-year study has shown that in the United States 40 percent of the population have developed foot trouble by the age of six, and by the 20th year, the percentage has doubled. The perfect feet found among primitive people, very young children and those who do not wear shoes, become deformed in civilization by hard pavements and the rigid confinement of the foot in ill-designed shoes,"^ "The cavalier treatment to which the human race has subjected its feet for the last thousand years following the dictates of fashion, does not make one suppose that the era of non-deforming shoes is in sight. Instead one awaits with a grimace of anticipa-
History The patron saints of shoemakers. Saint Crispin and Saint Crispinian, can be traced to the 8th Century at Soissons in France; the feast date is October 25, The story of what so-called civilized man has done to his feet over the years has been outlined in several papers,^'"'''"" and is briefly depicted in Figures 1 to 8, A most complete illustrated reference book of footwear from Egyptian to modern times is The Mode of Footwear.^ Currently Seen Abnormalities What are the currently seen sequelae of putting a foot into an ill-fitting shoe? Many of these are outlined in my text on Morphological Dermatology^° and depicted in Figures 9, 10, 11, The so-called Chinese foot-binding syndrome occurs mainly in women and consists of varying degrees of one or more of the following: 1. Hard corns or callosities on the tips of the toes, some subungual, on the dorsa of the phalangeal joints, on the dorsolateral aspect of the fifth toe, on the medial aspect of the big toe, over the medial aspect of the first metatarsal-phalangeal joint, over the lateral- and medial and central portion of the sole, anterior to the central portion of the anterior arch. Rarely, calluses may be present over bony prominences on the dorsa of the foot,
Address correspondence to: Robert Jackson, M,D., 1081 Carling Avenue Suite 508, Ottawa ON K1Y 4G2, Canada. The term Chinese foot-binding syndrome has been used to describe all the changes produced by wearing ill-fitting shoes, as it seemed to be an ideal example of how ridiculously human beings can deform their feet as the result of la belle indifference in pursuit of fashion.
2. Soft corns at the sides or base of the third or fourth interdigital toe space, 3. Compression of the toes, especially the four lateral ones, with loss on the interdigital spaces and squaring of the tips.
322
No. 5
CHINESE FOOT-BINDING SYNDROME
Jackson
323
FIG, 1, The "golden lily" foot produced by the Chinese foot-binding syndrome. It was produced from the T'ang dynasty in the 7th century up to the 20th century. There are many anecdotes as to the origin of foot binding. One says it arose when an empress was born with club feet, and other babies at the court had their feet bound to prevent the royal infant from appearing to be abnormal. Another says that the feet were bound to prevent the women from running away from their masters. A third states that their feet were hobbled so that it was not possible for them to do any work—the ultimate hallmark of a rich and idle upper class. A similar type of reasoning has been applied to having fingernails one inch long. Throughout history only the rich and idle had the wherewithal to indulge in the various dictates of fashion. It can be assumed that, until modern times, the working class wore shoes that did not deform the feet. In his account of the Chinese Civil War in 1935, Fdgar Snow reported that when the Kuomintang captured a village, it freed girls with bound feet on the presumption that they were of the upper class and anti-Communist, but they executed or sold into slavery girls with natural feet on the presumption that they were peasants and therefore partisans of the Communists. After 1912 when Yuan Shih-Kai became president he made it a penal offense to bind a girl's feet. This ban led to three types of feminine shoes. First, a shoe for the natural foot, a second style for the deformed foot, and a third also for the deformed foot but designed to conceal the deformity. This latter was called the deer foot or theater boot, a fashionable shoe worn not only by the deformed-footed women but by other well-dressed Chinese women who wished to appear to have lily feet. Reprinted with permission of publisher from Ploss HM, Bartels P. Das Weib in der Naturunk Volheshunde. Berlin: Verlag, 1927:287-300. 4. Lateral deviation of the first and second toes, and medial deviation of the fourth and fifth toes, to such an extent that the fifth toe may be pushed under the fourth and the second under the third. If the lateral deviation of the big toe is severe it may lift up the second, and sometimes the third toe, 5. Elevation of the interphalangeal joints to form an inverted V, usually on the second and third toes (claw toes), and severe flexion of distal interphalangeal joints (hammer toes). 6. Presence of an enlarged, medially extending first metatarsal-phalangeal joint over which a large callus is present, and associated with at least some lateral deviation of the big toe (bunion). Metatarsus primus varus is a congenital deformity. Bunion and lateral deviation of great toe {hallux valgus) are shoe acquired.
FIG. 2. Piked or sharp-pointed toes. These were introduced into Europe from the East after the Crusades,
7. Compression and deformity of the toenails in association with compression of toes. Sometimes longitudinal horny hypertrophy of the toenails occurs. The side of the toenail may be buried in the lateral nail fold, and hence cause ingrowing toenails. The nails may also
324
INTERNATIONAL JOURNAL OF DERMATOLOGY
June 1990
Vol. 29
FIG, 4, Bucket-topped boot of the Cavaliers (supporters of Charles I in the English Civil War 1630-1660).
callosities. Occasionally a solitary wart may exist in a corn. 2, The presence of a congenitally shortened first metatarsal (Morton's toe) may cause some of the changes listed in items 1-8, 3, Occasionally, congenital (lateral deviation of the big toe) or acquired (postpoliomyelitis, postinfantile hemangioma radiation damage to metatarsals) factors may produce a few of the changes listed. FIG. 3. period.
Venetian chopine or platform shoe, Italian Renaissance
show subungual keratosis, forming the nail plate to an inverted U shape. The keratosis is made up of very firm, whitish keratin material. The plate is lifted up towards its distal end and may show whitish areas. In effect, this is a callus of the nail, 8, Symmetry of these changes. If items 1 - 8 are present, there need be no question of the diagnosis. Nonetheless, findings do exist that confuse or complicate the diagnosis, 1, Presence of definite verrucae vulgares (of the solitary, mother-daughter, or mosaic type) about the corns and
FIG. 5. The squat or Louis heel. These shoes were introduced by Louis XIV (1638-1715) to give the fashion-conscious Sun King added height. The high heels also made the calves more shapely.
No. 5
CHINESE EOOT-BINDINC SYNDROME
325
Jackson
SPRING AND SUMMER CATALOGUE (NO.
46).
S3
Boots and Shoes. N o t ^"^ ^°^^ Footwear by the modem method, without salesmen ? Thous^inds are doing so, why not you ? In pr^sctiting you with this Catalogue of up-m-date perfect-fitting serviceable Spring Shoes, we have selected just those styles that we trust will particularly interest you and give perfect satisfaction, Lndlcs* Boots.
Wehive plo^Buri.' In lntroditcinK thli neaHon for ladles', utnU and ohlldroii'ii weRi-, Kuniitne Australian ftlttsed kanururoa, tnnnod by chrome nrooDHA and lit the tougncHt nnd rDiigi'MtwoiuiiiR leather In existence, noft an kill, bright tlninh, dooH not peel, nnd RIVOS comfort to the mu^l Under (cal
FIG. 6. The winkle picker (winkle—a small edible snail). The ladies shoes were listed in a 1901 Eaton's catalogue, a large Canadian retail chain and mail order store.
tk. Olnrnl knnBftroo. buttcnoii, with the h:uiiiiliie uotxlyaur wolto
