Hallux Valgus and Associated Foot Pathology in Ancient Egyptian Mummies: A Qualitative and Quantitative Computed Tomography Study

ABSTRACT The aim of this study was to gain information on the prevalence and manifestation of hallux valgus and associated foot pathology in ancient Egyptian mummies. Additionally, we investigated possible indicators of postmortem deformation of the feet during mummification. For this study, 34 mummies that had undergone whole body computed tomography (CT) were selected. For qualitative assessment, the body position of the mummies as well as of the feet and the type of wrapping of the feet were documented. At the first metatarsophalangeal joint, the preservation of the flexor hallucis longus tendon, the preservation of the joint capsule/ligaments, and the presence of the medial and lateral sesamoid were documented. Additionally, osteophytes were analyzed. Toe deformities were assessed for all toes. For quantitative assessment, the hallux valgus angle, the intermetatarsal angle D I/II, D I/V, and D IV/V, and the distal metatarsal articular angle (DMAA) were measured. Additionally, sesamoid grading was performed. All 63 evaluable feet showed claw toes in one or more toes. Measurements of hallux valgus angle ranged from −19° to 23° (mean 4.6°). A pathological hallux valgus angle was found in 4 out of 34 mummies (11.8%), unilateral in one, and bilateral in three. In two of the mummies with bilateral pathological hallux valgus angle, pathological DMAA and subluxation of the medial sesamoids were also present, supporting the diagnosis of hallux valgus. A negative intermetatarsal angle was present in both feet of three mummies. In this study, we found a high prevalence of feet changes that indicated postmortem deformities rather than intravital pathologies. This finding raises questions regarding the validity of measurements of the hallux valgus angle postmortem. For further paleopathological studies of hallux valgus, we recommend an approach using a combination of qualitative and quantitative characteristics of hallux valgus and associated feet pathologies.