Sample Survey Of Foot-binding Deformity In Part Regions Of Four Provinces, China

Foot-binding is a kind of traditional custom among Han women in China's feudal society. At the time, little girls usually began to bind their feet at five or six years old by using a small piece of cloth so as to make the feet pointed at the anterior extremity and to limit its growth in length as well. Along with growth, their insteps were extruded to raise up, which finally forms women's bound feet called"three-cun lily feet". This custom, which had ever gained great popularity in most areas of China, was originated in Southern Tang Dynasty, flourished in Song Dynasty and reached its peak in Qing Dynasty. It was firstly forbidden in the beginning of 20 century, however, it is in the 1950's that the custom had totally disappeared in China. Thus, women who bound their feet during this transitional period had made up the last generation of women with bound feet in China who are mostly more than 70 years old now. Foot-binding deformity is caused by man-made outside force involving multi- B&J deformities and multi-ligaments & muscle abnormal symphysic teratisms. Up to now, there have not been any medical science related investigations in the aspects of the patient history of foot-binding, configurational features of deformity, pathological changes or epidemiology because of the reasons such as social customs, traditional conceptions and individual privacies. The author here makes a series of detailed studies on the distributions, types and pathology changes of the existing foot-binding deformities in China in the perspective of medical science. Object The study aims to find out the endemic distributions, regional distinctions and the main methods of foot-binding among women with bound feet still alive in china; analyze the types, pathological features and severity of the foot-binding deformity as well as some correlation factors; roughly analyze the influence on the body functions of women caused by foot-binding deformity. Method The investigation was carried out in Shandong province, Yunnan province, Fujian province and Shanxi province among altogether 241 women, aging from 69 to 100 (80.4±5.8 at average). The types of foot-binding are grouped according to different ways of foot-binding and their different morphogenetic features, and different degrees of deformities are also divided according to the different severity of foot-bindings. The author draws at random 20 of them to make double feet AP, LP and loxosis X-ray examinations and 10 of them to make 3D CT reestablishments; measures the Hibbs angle and M′eary angle of the clubfoot and compares them with that of normal foot according to the lateral projection; describes the morphogenetic and the imageological features of all types of foot-binding deformities; inquires about the starting age and the total years of their foot-binding in order to find out the distinctions of these details among all kinds of foot-binding deformities. Photos of all the target objects have been taken for helping measure the length of clubfeet of all types of foot-binding deformity and the width of 1st metatarsophalangeal joint and for comparing with the normal feet in order to analyze the changes of clubfeet in size. The states of the lower limb function of these women are also investigated in order to analyze the different influences on the body functions caused by different types and degree of foot-binding deformities.Result The cases in Shandong province, Yunnan province and Shaanxi province have represented the features of the major types of foot-binding deformity existing in most areas of China, that is, Talipes Calcaneus deformity; the cases in Fujian province have represent the features of the other kind of foot-binding deformity , that is, Talipes Equinus deformity. Foot-binding deformity can be divided into Talipes Calcaneus type and Talipes Equinus type according to the clubfoot morphogenetic features, which can be also called Shangdong type and Fujian type correspondingly according to their regional distributions. The two types of foot-binding deformities can be also divided into 3 degrees—light, middle and heavy—according to the severity. The starting age of Talipes Calcaneus type foot-binding is 8.9±2.9 years old at average and that of Talipes Equinus type foot-binding is 5.9±2.3 years old. Besides, the starting ages of different degrees of deformity also differ from each other obviously(P<0.05), so as the duration of Talipes Calcaneus type foot-binding of different degree(sP<0.05). The foot-binding methods of the two types of deformities are different from each other. For Talipes Calcaneus type, the first step is to bind the propodium by a piece of cloth which results in its deformity with the 2nd～5th toes curling towards the foot plate and the second step is to bind in order to heighten the instep and to shorten the length of foot. For Talipes Equinus type, the way is to bind the foot with a piece of cloth in order to heighten the instep firstly, which usually results in the passive deformity of the propodium with dorsiflexion deformity after a long time of weight loading walking on the propodium. Women with Talipes Calcaneus type clubfeet usually walk with Talipes Calcaneus gait and the weight is loaded mostly on their heels. Women with Talipes Equinus type clubfeet usually walk with Talipes Equinus gait and the weight is mostly loaded on their propodiums, which requires them to draw assistance from a kind of special high-heeled shoes to walk. The morphogenetic features of the two types of foot-binding deformities are different. Talipes Calcaneus type is characterized by the features of big heel, small propodium and high instep with the 2nd,3rd,4th and 5th toes curled towards footplate; Talipes Equinus type is characterized by the features of small heel, big propodium and high instep and the flat of propodium is usually lower than that of the heel in the shape of echelon. The length and width of the two types of clubfoot is obviously narrower than that of the normal foot. The imageological features of the two types of foot-binding deformity are different. Talipes Calcaneus type is mainly characterized with the downward dislocation or semiluxation of the 2nd~5th toes'metatarsophalangeal joints, different degrees of wedging of tarsal bones, heightening of the instep as well as the planter flexion anomaly of the propodiums. Its Hibbs angle is 48°～80°>45°and M′eary angle is 15°～28°>5°. Talipes Equinus type is mainly characterized with dorsiflexion semiluxation of each metatarsophalangeal joint,different degrees of wedging of tarsal bones, heightening of the instep as well as severe planter flexion anomaly of the propodiums with each metatarsal bone close to be vertical to the ground. Its Hibbs angle is 113°>45°and M′eary angle is 53°>5°. The states of lower limbs functions of all cases in different degrees of foot-binding deformities also differ from each other obviously(P<0.05).Conclusion The forming of the foot-binding deformity is caused by the outside force acting on the bone and joint of feet in the period of one's childhood when the skeletons is still immature. Along with growth, the bone, joint and ligament get durative damages which naturally results in the deformities of bones and joints as well as the gait irregularity as we can see. Besides, the starting age and the duration of foot-binding can also result in different severe degrees of deformity—the earlier the foot-binding starts and the longer it lasts, the more sever the deformity is. In addition, the foot-binding deformity does influence women's state of lower limbs functions as well—the more sever the deformity is, the weaker the lower limbs function is.