Podiatric Pathology In Historic Culture

The year 1912 represents an important landmark in the history of the profession of podiatric medicine and surgery as it marks the establishment of both the National Association of Chiropodists (in the United States) and the National Society of Chiropodists Podiatrists (in the United Kingdom).¹ This history, however, extends far beyond the scope of these domestic organizations. For example, some of the earliest documentation of foot and ankle care is from England and one of the most notable early chiropodists was Dr. Lewis Durlacher. He served under the Royal Households of King George IV, King William IV, and Queen Victoria, and specialized in treatment of corns and ingrown toenails. He also addressed and wrote of Morton’s metatarsalgia years before its namesake, Dr. Thomas George Morton, described the condition.²  It is sometimes interesting to consider the history of podiatric care before our development as a recognized specialty. In this blog, we will give a brief description of several times podiatric treatment was necessary throughout historic culture.

King Henry VIII (1491-1547)

One of the most well-known monarchs of the English throne, King Henry VIII, struggled with lower extremity pathology and faced amputation. He enjoyed good health and an active lifestyle in his first 35 years of reign, however, his last 11 years became complicated by debilitating medical problems. Initially, a jousting accident in 1527 left him with a chronic “sorre leg” on his left thigh, and later on, risk factors such as significant weight gain, a sedentary lifestyle, and changes in diet led to the development of chronic bilateral lower extremity wounds. He was personally interested in medicine and even dabbled in self-medication and wound care, with well-documented descriptions of these in his prescription book. He created many salves and ointments such as ground pearls and white lead, described as “an ointment to take away inflammations and to cease payne and heale ulcers called gray plaster.”³

In 1536, he suffered another jousting accident, in which his horse landed on top of him. He was left unconscious for two hours and with severe crush injuries to both legs. Eventually, multiple purulent wounds developed. He went through episodes of sepsis and his ulcers failed to heal. Years later, descriptions of the chronic ulcerations documented such a stench that they could be appreciated from three rooms away. In fact, the Spanish Ambassador, Eustace Chapuys, described them as “the worst legs in the world.” In his final years of life, he was unable to walk due to bilateral lower extremity swelling and morbid obesity, and had to be carried around the palace in a chair. He died on January 28, 1547, eventually succumbing to bouts of fever from his illness.⁴

Historians speculated about possible etiologies of these wounds, with some examples being bilateral deep venous thrombosis development secondary to the crush injury, relative immobility, and endothelial damage to the deep venous system. Other hypotheses include development of osteomyelitis secondary to an open fracture, and/or a deep abscess with persistent sinus formation. The description of the wounds in historical texts as having malodor and drainage might also seem to correlate with chronic venous stasis ulcerations.⁵

Abraham Lincoln (1809-1865)

Arguably one of the most potentially important chiropodists in early United States history was Dr. Isachar Zacharie. Through much self-promotion he caught the eye and ear of then President Abraham Lincoln. He served to debride corns and calluses, providing relief to the large-statured President as well as several members of his staff.  Although it is unclear if he ever graduated from a college or any medical institution, he bragged that he could perform operations “…in five minutes, without pain or blood, so that the boot or shoe can be worn immediately after the operation…”⁶ It seems unlikely that this would meet the contemporary definition of a surgical procedure!

After President Lincoln’s assassination and well after the end of the Civil War, Dr. Zacharie petitioned Congress for compensation for the treatment the of corns of the Union soldiers during the war. Aside from his podiatric duties, General Banks, on behalf of President Lincoln, asked Dr. Zacharie to employ his skills of gab to assist the Union during the Civil War. He was asked to organize a group of agents in New Orleans to learn of “plans of the enemy, characters of the troops and extent of supplies,” as well as sentiments of local citizens towards the Union forces. Furthermore, according to the New York Herald on October 21, 1863, Dr. Zacharie also met with Confederate officials, including Jefferson Davis, to discuss negotiations for a peaceful resolution to the war.⁶

Frida Kahlo (1907-1954)

Frida Kahlo, the Mexican painter and, disputably the most influential artist of the 20th century, was also victim of lower extremity problems. She contracted poliomyelitis at the age of six, recalling feeling “a terrible pain in her right leg.”⁷ She was bedbound for nine months and medical records indicate that her right leg did not develop the same as the left.⁸ Reports speculate that post-polio syndrome, a condition with a latency period of approximately 15 years and marked by chronic pain, fatigue and vascular insufficiency, was a likely contributor to vascular disease in Ms. Kahlo.^9,10 However, trauma is another speculated cause, as she suffered multiple fractures after being involved in a bus accident at the age of 17.  This seems to have included a crush injury of her right foot and dislocation of both ankles.⁷ She noted in letters that she had also damage to the sciatic nerve and chronic pain to her right lower extremity.¹¹

Interestingly, she expressed her pain in her paintings. The Broken Column (1944) shows nails piercing through her right leg and What the Water Gave Me (1938) shows a volcanic eruption of her affected limb.¹² It seems likely that she experienced ischemic pain, eventually developing wounds on her right foot.  This required amputation of five phalanges and subsequent excision of her sesamoids. In 1953, she required a below-knee amputation of the right lower limb.⁸

These examples demonstrate some notable lower extremity pathologies and interventions over the course of historic culture.

Dr. Kaur is a second-year resident at the Temple University Hospital Podiatric Surgical Residency Program in Philadelphia.

Dr. Meyr is a Clinical Professor in the Department of Surgery at Temple University School of Podiatric Medicine in Philadelphia.

References

1. Lorimer DL. A centenary year. Foot (Edinburgh, Scotland). 2012;22(2):55.

2. Brockbank W. Lewis Durlacher: Surgeon-Chiropodist (1792-1864). Medical History. 1958;2(1):68-69.

3. Carelli F. Henry VIII: man and monarch. London J Primary Care. 2009;2(2):182-183.

4. Keynes M. The personality and health of King Henry VIII (1491-1547). J Med Biography. 2005;13(3):174-183.

5. Chalmers CR, Chaloner EJ. 500 years later: Henry VIII, leg ulcers and the course of history. J Royal Soc Med. 2009;102(12):514-517.

6. Segal CM. Isachar Zacharie: Lincoln’s Chiropodist. Pub Am Jewish Hist Soc. 1953;43(2):71–126.

7. Herrera H. Frida: a biography of Frida Kahlo. New York: Harper & Row; 1983.

8. Budrys V. Frida Kahlo's neurological deficits and her art. Prog Brain Res. 2013;203:241–254.

9. Smith E, Rosenblatt P, Limauro AB. The role of the sympathetic nervous system in acute poliomyelitis; preliminary report. J Pediatr. 1949;34:1–11.

10. Nilsson S. Frida Kahlo suffered probably of post-polio syndrome. Lakartidningen. 2004;101:3696–3697.

11. Zamora M. The Letters of Frida Kahlo: Cartas Apasionadas. San Francisco, CA: Chronicle Books; 1995.

12. Gamble JG. Frida Kahlo: her art and her orthopedics. Pharos Alpha Omega Alpha Honor Med Soc. 2002;65:4–12.

13. Courtney CA, O'Hearn MA, Franck CC. Frida Kahlo: Portrait of Chronic Pain. Physical Therapy. 2017;97(1):90–96.

14. Podiatry. Encyclopedia Britannica. Available at: https://www.britannica.com/science/podiatry.  Published July 20, 1998. Updated September 9, 2019. Accessed September 1, 2021.