High fashion and health are not necessarily obvious partners, but what is fashionable may not always be healthy. A recent report of an increase in bunions found in medieval skeletons was attributed to the fashion of wearing pointy toed shoes.

Bunions – less common today but still a problem – are a deformity of the bones at the base of your big toe. The big toe bone bends towards the other toes and the base forms a lump at the side which can be red and painful. They may occur naturally but wearing tight shoes of pointy ones that crush the toes together amplifies natural problems. If a similar thing happens with the little toe, they’re called by the deceptively cute name buinionettes.

The fashion for pointy shoes among men in the 14th century meant that most shoes had a pointy shape. But as is the case today, fashion comes at a price and not everybody could afford the most fashionable items. Society men with money displayed a disproportionate number of bunions when compared with the average worker or poor man who had to make do with rags or simple shoes.

One finding by the research team led by Dr Jenna Dittmar from Cambridge University was that Augustinian friars showed a high incidence of bunions. Even though the friars should have been dressing simply and modestly it was clear they had succumbed to high fashion.

Pointy shoes continued to grow in length and started to curl upwards. These shoes, called poulaines, became so long that the toes were attached under the knees by chains of silver or gold. But the fashion was not restricted to everyday wear for men. Examples of pointy toed footwear on suits of armour exist.

Wearing long pointy leather shoes in battle was a distinct hindrance. It’s reported that at the Battle of Nicopolis in 1396, the French contingent of a European army hurriedly cut off the pointy tips of their shoes as they were forced to retreat quickly from an overpowering enemy.

In France, poulaines were getting in the way of religious worship. The long pointy toes made it impossible for some men to kneel and pray. In 1368, Charles V of France banned them from being made and worn in Paris.

In 1463 King Edward IV passed a law which stated that anyone “under the state of a Lord, Esquire, [or] Gentleman” was forbidden from wearing poulaines over two inches in length. By 1465 they were banned in England completely. In fashion things come and go and old ideas get recycled. In the 1950s and 60s a modern reincarnation of the poulaine appeared in the form of winklepickers, a shoe favoured by Teddy boys. Winkles are a staple seaside snack, still popular today and for sale on Brighton seafront. Dyes, used in clothing and fashion can be extracted from the winkle and to winkle something out is to use a small pointed instrument. One way of getting the meat of the shellfish out of the shell is with a pin. Hence the name given to the winklepicker, with its sharp pointy toe. Unlike the medieval poulaines, where the point of the shoe could measure up to 2ft long (60cm), winklepickers had much more modest points.

The researchers examining the medieval skeletons found another associated health issue suffered by older men wearing poulaines. Many showed signed of fractured bones indicating falls. The big toe, in its natural non-bunion position is a great aid to balance. With bad bunions, where the toes can bend to almost 90 degrees, balance can be affected. In skeletons of older men – estimated to be over the age of 45, there was a higher incidence of broken bones and associated bunions. This indicated that the men had been wearing fashionable shoes for many years.

Our feet have evolved to enable us to stand on two legs and provide balance. Any change in the shape or elevation of our feet has the potential to cause problems. Unlike medieval times where it was rich men who suffered, today it’s more likely to be women who suffer for fashion. High heels and pointed toes will, over time, distort the natural shape of a foot.

Feet are complex anatomically. There are 26 separate bones and 30 joints in each foot, 100 muscles, ligaments and tendons all work together to support us in an upright position, to provide balance and mobility. One tendon in particular is the Achilles tendon. This runs from the calf muscle to the heel. The Achilles tendon makes it possible to run, jump, climb stairs and stand on your toes. Take care of your feet, fashion may be your thing, but if it hurts it won’t be doing you any good.