Fashions in the Middle Ages took centuries to change however something happened at the end of the 15th century when the fashion for long toed shoes in Europe became passé, almost over night. Records, archives and dated paintings all confirm the fashion for extremely broad shoes (Bears Paw) became vogue in a very short space of time. The broad shoes boasted of individual compartments for each toe, and were a podiatrists’ delight. No reason has ever been given to explain this phenomenon. Syphilis was a disease thought to be introduced to Europe in the 15th century (carried back by Christopher Columbus’s crew). Most medical authorities accept disease caused by bacterium treponema palladium, had existed in Europe prior to this time but the new strain was thought to be more virulent and spread by sexual contact. By the beginning of the 16th century the European continent was devastated as the syphilis epidemic spread to Russia, China, India and Africa. Initially physicians were left helpless and refused to treat the suffering, leaving them to barbers, bath attendants and quacks (many of which were corn cutters). The presence of the pox and the knowledge of its transmission gave good reason to influence sexual practice. Until this time, women had practiced birth control with little interference from religious or civil authorities. In periods when marriage was delayed (such as when suitors were off fighting the Holy War), masturbation was ubiquitous with "intimate ceremonies" of courtship common place. In the highly sensual and carnal courting custom of “Donnoi”, naked couples lay together, separated by only a pillow and intimate contact took place. Coitus was considered taboo so with no stretch of the imagination, a long extension on the end of the foot could be put to good use. From the 11th century the length of men’s shoes in Europe got longer and longer until they were 61 cms longer than the foot.
Despite Papal and sumptuary law to prevent lower classes from wearing poulaines (long toed shoes), the fashion continued unabated for four hundred years. Shoes were stiffened with moss and grass and had hawk bells sown on the end, to indicate to all, the wearer was interested in sexual frolic. The long shoes caused men to adopt a wide base, high stepping gait and this became the norm for fashionable courtiers. The tertiary stages of neuro-syphilis leave the syphilitic person with Tabes Dorsalis, a progressive locomotor ataxia which causes people to stoop forward and walk with a wide based, "high-stepping" gait. This is the exact same style enforced on men wearing fashionable poulaines. General paresis (or general paralysis of the insane) describes brain damage causing impaired mental function with serious personality and grandeous delusional behaviors. This often leaves the person a semi imbecile. A new muse appeared across European Courts, the Court Jester or professional fool and many historians believe the fool was there to disarm criticism by making the syphilitic king appear nearly normal. Charcot neuropathy commonly seen in diabetes, today was first described in the 19th century in patients with tertiary syphilis. The condition is a progressive deterioration of weight-bearing joints of the foot or ankle. The discovery of antibiotics markedly reduced the incidence of syphilis in the general population but ironically diabetes mellitus replaced it as the main cause of Charcot neuropathy in modern times. The life expectancy of diabetics in the Middle Ages was short, and few would live long enough to develop Charcot Foot but people living with tertiary syphilis would survive and suffer the later stages of neurosyphilis. In today’s diabetic population, it is estimated almost 50% of people with severe neuropathy have associated plantar ulcerations and the author has postulated the same incidence was found in the Middle Ages, and probably higher. Modern technology allows special shoes, foot orthoses, and walking aids to stabilize and protect the compromised foot. I believe the change in shoe style was necessitated to accommodate the presence of disease and the exact same shie designs are seen today in post surgical moon boots used to support and protect injured tissues and surgical shoes to accommodate insensitive feet. Something strange did happened in the late 15th century which saw a radical shift in shoe design in an unprecedented short period of time. I believe long toed shoes initially were used as sex toys then later protection from sexually transmitted disease. In the aftermath of the virulent syphilis epidemic of the 15th century shoe fashions changed to accommodate Charcot Foot.