The practice of foot binding in Chinese women is a cruel yet mysterious custom that continued for over a thousand years. To civilised men at that time, a pair of perfectly bound feet symbolised the ideal of a woman’s beauty. The ‘golden lotuses’, as these deformed feet were euphemistically called, were regarded as pieces of art and objects of sexual desire. The practice and history of foot binding have been hotly discussed among historians.

The first written record of foot binding can be traced to a book titled ‘Mo Zhuang Man Lu’ 《墨莊漫錄》 by Zhang Bangji (張邦基), a scholar in the 12th century. According to Zhang, the practice of foot binding began at the court of Li Yu (李煜), the last emperor of the Southern Tang during the Five Dynasties (907-960). He ordered his favourite courtesan, Yao Niang (窅娘) to dance on a 6-foot-high golden lotus, with her feet bound with white silk cloth into the shape of a new moon. Other dancers soon imitated the practice to attract the attention of the emperor.1 The lotus foot became the model of beauty among Chinese women. The practice of foot binding started to flourish during the Southern Song Dynasty (1127-1279) and was encouraged by the renowned Confucian scholar Zhu Xi (朱熹) who thought that it would restrain women from unchaste and other immoral behaviour.2 By the Ming Dynasty (1368-1644), foot binding was widespread throughout China and the practice came to be regarded as a symbol of high social status. For many women the practice gave them ‘hope’ for a promising marriage. As an old Chinese saying goes: ‘if you love your daughter, bind her feet; if you love your son, let him study’.3

Foot binding had to start early at the age of 5 to 8 years before the arch of the foot had fully developed. Its success depended on the skilful application of the bandage—a process mostly carried out by the girl’s mother or older sibling. One end of the bandage was usually placed on the inside of the instep and carried over the small toes, forcing them in towards the sole. The big toe was left unbound. The bandage was then wrapped around the heel forcefully to draw the heel and toes close together. The aim was to make the toes bend under and into the sole and to bring the sole and heel as close together as was physically possible (Figs 1 and 2).

Foot binding drew the attention of foreigners after China was forced to open to the imperial powers in 1842. Dr John Preston Maxwell, a medical missionary who went to Fujian from 1898 to 1919, described two medical complications of foot binding. The first was due to interference with blood flow that caused skin ulcers, infection, and gangrene associated with severe pain. If the foot was not unbound, the toes or the whole foot could be lost. In severe cases, women developed septicaemia to which they might even succumb.4 The second complication was displacement of the bones and weakening of the ligaments of the ankle joints. Women with bound feet had difficulty in walking because of the loss of the normal architecture of the feet.

In 1997, a study of older women in Beijing showed that the prevalence of bound feet was surprisingly high—38% among women older than 80 years and 18% among those aged 70 to 79 years. Compared with women with normal feet of the same age, women with bound feet were significantly more prone to fall and sustain hip fractures; less able to squat or rise from a chair without assistance; and less able to perform daily activities such as preparing a meal, walking or climbing stairs. Their limited weight-bearing activity led to reduced hip bone density and increased risk of hip fracture from falling,5 although a more recent study failed to show such an increased risk, surmised by the authors as possibly due to a compensatory improvement in body balance.6

It was not until the late Qing Period in 1898 when Emperor Guangxu (reign 1875-1908), with the support of Kang Youwei (康有為) and Liang Qichao (梁啟超), led the Hundred Days’ Reform that anti–foot binding became a national policy. The ‘Foot Emancipation Society’ was formed to encourage women to build ‘strong bodies and strong action’. Kang and Liang’s efforts awakened liberal consciousness among the Chinese. The movement was discontinued after the Empress Dowager’s coup but was reignited in 1902 when the Empress herself issued an edict of anti–foot binding.7

When the Republic of China was established in 1912, Dr Sun Yat-Sen promulgated an order to prohibit foot binding on 13 March of the same year, although it would be another 20 years before it became a law of the Republic of China in 1932. The practice of foot binding gradually disappeared in the 1950s.8

The authors are indebted to Prof Moira Chan-Yeung for her invaluable advice.