Bioarchaeological Implications of Calcaneal Spurs in the Medieval Nubian Population of Kulubnarti Lindsay Marker Department of Anthropology Primary Thesis Advisor Matthew Sponheimer, Department of Anthropology Defense Committee Members Douglas Bamforth, Department of Anthropology Patricia Sullivan, Department of English University of Colorado at Boulder April 2016 1 Table of Contents List of Figures ............................................................................................................................. 4 Abstract …................................................................................................................................... 6 Chapter 1: Introduction …........................................................................................................... 8 Chapter 2: Anatomy …................................................................................................................ 11 2.1 Chapter Overview …................................................................................................. 11 2.2 Bone Composition …................................................................................................ 11 2.3 Plantar Foot Anatomy …........................................................................................... 12 2.4 Posterior Foot Anatomy …........................................................................................ 15 Chapter 3: Literature Review and Background of Calcaneal Enthesophytes ............................. 18 3.1 Chapter Overview …................................................................................................. 18 3.2 Spur Morphology ….................................................................................................. 18 3.3 History …................................................................................................................... 20 3.4 Modern-day Etiological Theories ….......................................................................... 22 3.5 Achilles Tendon …..................................................................................................... 25 3.6 Degenerative Disease …............................................................................................ 27 3.7 Enthesophyte Statistics .............................................................................................. 28 3.8 Chapter Summary ….................................................................................................. 31 Chapter 4: Kulubnarti Background .............................................................................................. 33 4.1 Chapter Overview ….................................................................................................. 33 4.2 Geography ….............................................................................................................. 33 2 4.3 The Christian Period at Kulubnarti …........................................................................ 36 4.4 Cemetery Excavations …........................................................................................... 37 4.5 Archaeological Discoveries …................................................................................... 39 4.6 Topographical Features and Pedal Implications ….................................................... 41 4.7 Hypotheses …............................................................................................................. 43 Chapter 5: Material and Methods …............................................................................................ 45 Chapter 6: Results ….................................................................................................................... 50 Chapter 7: Discussion ….............................................................................................................. 63 7.1 Chapter Overview ….................................................................................................. 63 7.2 Introduction …............................................................................................................ 63 7.3 Plantar Spur Size ….................................................................................................... 64 7.4 Age-related Variation ................................................................................................. 65 7.5 Kulubnarti vs. Modern Populations ........................................................................... 67 7.6 Variation by Cemetery …............................................................................................ 69 7.7 Sex-related Variation ….............................................................................................. 69 7.8 Bioarchaeological Implications ….............................................................................. 71 7.9 Chapter Summary …................................................................................................... 72 Chapter 8: Conclusion ….............................................................................................................. 73 Bibliography …............................................................................................................................. 75 3 List of Figures Figure 2.1: Superior aspect of the calcaneus .….................................................................................. 14 Figure 2.2: Lateral aspect of the calcaneus …...................................................................................... 14 Figure 2.3: Plantar aspect of the foot (A) The plantar aponeurosis .…............................................................................................... 15 (B) The abductor hallucis, flexor digitorum brevis and abductor digiti minimi muscles …......................................................................... 15 Figure 2.4: Posterior and lateral view of the calf muscles and the Achilles tendon ..…...................... 17 Figure 2.5: Medial view of the calcaneus, posterior calcaneal bursae and the Achilles tendon enthesis .................................................................................. 17 Figure 3.1: Lateral view of radiographs depicting enthesophytes (A) Plantar spur ....................................................................................................................... 19 (B) Achilles tendon spur .......................................................................................................... 19 Figure 4.1: Map of Nubia .................................................................................................................... 35 Figure 4.2: Map of Lake Nubia (Lake Nassar) .................................................................................... 36 Figure 4.3: Mummified remains of a female from Kulubnarti ............................................................ 39 Figure 4.4: Landscape surrounding the island (S) cemetery ............................................................... 43 Figure 5.1. Example measurement of a plantar enthesophyte ............................................................. 48 Figure 6.1: Enthesophyte length in males and females ........................................................................ 51 Figure 6.2: Calcaneus length in males and females ............................................................................. 51 Figure 6.3: Correlation between plantar enthesophytes and increasing age (A) Logistical Regression ........................................................................................................ 53 (B) Graphical representation of frequency .............................................................................. 53 Figure 6.4: Correlation between Achilles tendon enthesophytes and increasing age (A) Logistical Regression ........................................................................................................ 54 (B) Graphical representation of frequency .............................................................................. 54 Figure 6.5: Inferior enthesophytes by site and prevalence (A) Contingency table ............................................................................................................. 56 (B) Graphical representation of frequency .............................................................................. 56 Figure 6.6: Dorsal enthesophytes by site and prevalence (A) Contingency table ............................................................................................................. 57 (B) Graphical representation of frequency .............................................................................. 57 Figure 6.7: Prevalence of plantar spurs in males and females in the combined cemeteries (A) Contingency table ............................................................................................................. 59 (B) Graphical representation of frequency .............................................................................. 59 Figure 6.8: Prevalence of dorsal spurs in males and females in the combined cemeteries (A) Contingency table .............................................................................................................. 60 (B) Graphical representation of frequency ............................................................................... 60 Figure 6.9: Prevalence of plantar spurs in males and females in the mainland (R) cemetery (A) Contingency table .............................................................................................................