The Neglected Consequences of Foot-Binding

For several hundred years, millions of Chinese girls had their bodies painfully misshapen to conform to a prevailing social expectation. Intact feet, girls were told, would damage their marriage prospects. To achieve a more suitable size and shape, young girls’ feet were crushed repeatedly over years. Each excruciating procedure forced the girls to learn to walk anew, rereading the ground from an unfamiliar position and through unimaginable pain.

The tiny “lotus foot” in its delicate silken shoe was seen as one of the most attractive qualities in a prospective bride; the smaller the foot, the more sexually pleasing the girl was. More recent studies have shown that foot-binding was likely practiced not purely for the sake of marriage, but also to keep girls at home and engaged in handicrafts, such as spinning cotton, in order to contribute to their family’s income. The end result, no matter the motivation, was severe physical impairment. Yet despite foot-binding’s brutality, and hundreds of anthropological studies addressing it, the long-term medical consequences of the practice have been largely neglected. Examining the debilitating, lifelong physical effects that foot-binding had on Chinese girls can be crucial for understanding the lengths to which societies will go to restrict women’s freedom.

“Bound Feet in China,” a 1937 article in The Journal of Bone and Joint Surgery, gives one of the few detailed physical descriptions of foot-binding currently available, but still couches the cruelty of the process in metaphor and largely ignores the lasting health consequences. “The four outer toes are flexed upon the sole and are held in that position,” the authors wrote. “The metatarsals are pressed together as the bandages are applied. In spite of the pain after each kneading, the girl is forced to walk, in order to help re-establish circulation.” In plain English, that means that all of a girl’s toes except the first were crushed toward the bottom of her foot and bound with cloth strips. The process could start when she was as young as 3 years old, though 5 was more common, and was repeated for two or three years—her toes routinely rebroken and bound again more tightly.

In many cases the intense pain of foot-binding was exacerbated by infection (which sometimes led to gangrene), hindered circulation, and weakened bones and ligaments. A girl’s feet typically remained bound with bandages and strips of either silk or cotton, depending on what her family could afford, for the rest of her life.

Humans took millions of years to evolve into bipedal walkers, relying on several points of the foot shifting weight and balance as we take each step. Foot-binding reduced these points to only the big toe and heel bone; the arch was shoved up to make the foot shorter, and the other toes were bent under the ball. In many cases the arch was broken completely. Girls whose feet were bound would never again be able to walk fluidly, severely limiting their ability to move through the world.

Many cultural accounts of foot-binding have been written, especially from a feminist perspective, and many academic studies mention the process. But for one of the only medical descriptions of foot-binding’s long-term consequences, we have to turn to Steve Cummings, an epidemiologist and professor emeritus at the University of California at San Francisco.

Cummings went to Beijing in 1991 to study why older Chinese women had 80 percent fewer hip fractures than American women of the same age range. He and a team of researchers randomly selected neighborhoods from each of Beijing’s central districts, then visited every house that they knew had a woman over the age of 50. They invited more than 300 women to a lab at Peking Union Medical College Hospital, where participants performed a series of regular motions (e.g., standing from a chair with their arms crossed, squatting) along with tests for grip strength and gait speed.

The second participant in the hip-fracture study “came in with two canes and her foot wrapped up oddly,” Cummings told me. “I thought it was just curious.” By that time, he had been living in Beijing for two or three months, and he and his family had traveled extensively through the city and around the country. During those travels, he had never once seen a woman with her feet in the same condition as those of the second study participant.

Soon after, another woman came in with a crutch and an odd kind of shoe. When Cummings asked about the woman’s feet, his colleagues—many of them female doctors in their late 50s—told him that they had been bound. “I assumed it was fairly rare,” he said.

Then more women with bound feet started coming in. What Cummings realized—the reason he hadn’t seen these women elsewhere in China—was that for the most part they physically couldn’t go out. The women he met spent much of their life in or very close to their home, their disability preventing them from venturing farther out. He was seeing them in the lab only because transportation to the hospital was provided.

The women he’d met with bound feet, Cummings eventually wrote in a report on the cohort, were much more likely to have fallen in the previous year than women without, had lower bone density in their hips and lower spines, and had greater trouble getting up from a chair without assistance. Although the consequences for millions of Chinese women living with what he calls a “forced disability” were profound, Cummings’s study was initially turned down by journals like The Lancet and The New England Journal of Medicine. Both told him that because foot-binding was essentially extinct, it wasn’t a current medical problem. He finally sent his report to the American Journal of Public Health in 1996 with a note to explain that although foot-binding is no longer practiced, “the study has enormous implications for how we treat women.”

Cummings’s hip-fracture study had a nearly unheard-of 95 percent participation rate, and about 15 percent of the women he studied had bound feet. That amounted to millions of women stuck at home, unable to engage in everyday activities such as grocery shopping, because they had such difficulty walking—never mind squatting while waiting for the bus or carrying shopping bags while managing canes and crutches. In his study, Cummings concluded that older Chinese women were less prone to hip fractures than American women in part because the former squatted much more often, which builds bone density and strengthens hips. Older Chinese women with bound feet, though, had a completely different story. “The way these women avoided injury,” he said, “was by not doing anything.”

Further clinical study of foot-binding is nearly impossible; the women who were girls when it was outlawed are dying out. Jo Farrell, a Hong Kong–based photographer and cultural anthropologist, spent several years putting together a small art book of China’s last “lotus feet” women, titled Living History: Bound Feet Women of China. She found 50 women to photograph, all in their 80s or older, three of whom died before the book was published in 2015. They had a wider range of mobility than the women Cummings met in Beijing—among them were women who worked in fields, raised children, fixed chimneys, and went bowling—but descriptions of their childhood binding were no less horrifying.

Foot-binding is one phenomenon in the long history of societies controlling women’s physical movement—along with their rights as citizens and their legal status as human beings—as a tenet of civilized existence. In her book Wanderlust: A History of Walking, Rebecca Solnit details laws and practices going back centuries that limited women’s free movement. In certain periods in France, for example, women were arrested if they were found walking on certain streets at certain times.

But women have been bent in more literal ways too. Foot-binding was one. Corsets were another; only rarely do we remember that Victorian women’s hourglass shape came at the expense of their lungs and rib cages. In Japan, most workplaces still require women to wear high heels, even while they’re job hunting. In response to a petition for that requirement to be abolished, Japan’s minister of health and welfare defended it as “occupationally necessary,” despite the strain that high heels put on backs, knees, and foot bones, as well as the risk of vertebral slippage.

Like recent research that makes visible the long-lasting brain damage inflicted by childhood abuse or PTSD, examining the medical consequences of corsets, high heels, and foot-binding in detail forces us to look their effects in the face. Brain scans that show the effects of trauma, or peer-reviewed research on the epigenetic effects of living through a war or genocide, are evidence that survivors’ accounts of abiding damage aren’t imagined. The restrictions of foot-binding and other physical constraints imposed on girls and women are obvious; the damage is real. “A male counterpart,” Cummings said of foot-binding, “is impossible to imagine—both because impairment of male function of any sort was not imaginable and because, had anything like that occurred, it would have been written about at the time, probably with outrage.”

With the unavoidable conclusions provided by modern, in-depth medical research, societies now have the knowledge necessary to avoid the mistakes they made in the past. Whether they have the will, though, is less certain. Foot-binding, as a practice, is extinct, but as Cummings pointed out repeatedly, what it says about how we are willing to treat women, and the damage we will inflict and accept to maintain control over their movement and their freedom, is anything but settled.