Ancient Roman Man Tiptoed Through Life From A Hip Fracture

In a small cemetery south of Naples, two dozen skeletons dating to the era of the Roman Empire have been discovered. One, an older man, was buried like everyone else, but his body held a secret -- a badly healed hip fracture caused him to walk on tiptoe, which also tore up his knee.

The skeleton comes from the site of Erculam-Herculia in the modern town of San Marco di Castellabate. While little is known historically about this specific cemetery, the nearby city of Velia has produced archaeological information that suggests many men made their living as fishermen along the southwest coast of Italy in the 1st-2nd centuries AD. It was at Erculam that bioarchaeologist Nancy Lovell examined this particular skeleton, as well as 28 others, and she reported her findings in last month's issue of the International Journal of Paleopathology.

Lovell found nothing about the Roman man's skeleton to suggest what he may have done for a living, but his bones betray his advanced age. He had no teeth in his lower jaw and just one in his upper. His spine held evidence of numerous herniated discs and a vertebral fracture, all potentially clues to underlying osteoporosis, which itself might be related to difficulties eating a balanced diet with no teeth.

The injury in question, though, is to the right femur near the hip joint. There is shortening and rotation of the neck and head of the femur, both caused by a fracture. It is well-healed, so the fracture happened many years before the man's death, but other parts of his skeleton reveal how he was forced to compensate for the changes to his right hip.

Osteoarthritis is rampant in the man's right knee. The extent of it is so severe that the knee joint has what experts call "eburnation" -- from the Latin word for "ivory" which it resembles, eburnation is the result of complete destruction of the joint and its cartilage, so that bone rubs against bone during movement. At least two of his right toes also display eburnation, and the big toe shows evidence of hyperflexion. This extra range of motion plus a bony indication of a strong outside calf muscle add up to a man who was walking on tiptoe to compensate for the thigh bone shortened by a fracture.

The cause of this fracture, Lovell hypothesizes based on a close analysis of the bones, was indirect blunt force trauma. Specifically, the way that the femur healed "is consistent with a fall onto the feet from a height, with the force of impact transmitted upward." But if this man did have osteoporosis, as she suspects from the vertebral issues, he may have simply slipped, tripped or turned his ankle. Even these minor mistakes could lead to a fracture in someone with compromised bone density.

The impact of the fracture on the man's life, Lovell notes, would have been immediate and long-lasting. "Although he survived his injury by many years, he would not have been able to return to most tasks associated with a fishing or agricultural way of life, other than those tasks that were sedentary," she writes. Changes related to the way he walked clearly affected numerous parts of his skeleton, suggesting that, while he was cared for during his recovery, eventually he had to return to work.

Even more interesting, though, is the evidence this case brings to our understanding of impairment and disability in the past. Bioarchaeologists discuss these topics using skeletal evidence of physical impairment and archaeological evidence of social repercussions to figure out how people with non-traditional bodies were seen by other members of their group.

"The burial of this man in the communal cemetery, in a manner consistent with other adults," Lovell concludes, "suggests that while he may have been recognized as mobility impaired, he was not socially identified as disabled." This Roman man may have tiptoed through the end of his life, but to his peers, he was not in any way different from the rest of them.