Exposome

Exposome (pronounced eks-poh-sohm)

(1) A concept describing (1) the environmental exposures an individual encounters throughout life and (2) how these factors impact an individual's biology and health.

(2) The collection of environmental factors (stress, diet, climate, health-care etc) to which an individual is exposed and which can have an effect on health outcomes.

2005: The construct was expos(e) +‎ -ome, the word coined by cancer epidemiologist Dr Christopher Wild, then director of the International Agency for Research on Cancer (IARC).  Expose (in the sense of “to lay open to danger, attack, harm etc”; “to lay open to something specified”) dates from the mid-fifteenth century and was from the late Middle English exposen, from the Middle French exposer (to lay open, set forth), from the Latin expōnō (set forth), with contamination from poser (to lay, place). The –ome suffix was an alteration of -oma, from the Ancient Greek -ωμα (-ōma).  It was only partially cognate to -some (body), from σῶμα (soma) (body), in that both share the case ending -μα (-ma), but the ω was unrelated.  The sense was of “a mass of something” and use is familiar in forms such as genome (in genetics the complete genetic information (DNA (deoxyribonucleic acid) or RNA (ribonucleic acid)) and phenome (the whole set of phenotypic entities in a cell, tissue, organ, organisms, and species). Exposome is a noun and exposomic is an adjective; the noun plural is exposomes.

The study and assessment of external and internal factors (chemical, physical, biological, social, climatic etc) factors that may influence human health is not new and evidence of interest in the topic(s) exist in the literature of physicians and philosophers (there was sometimes overlap) from the ancient civilizations of Greece, Rome, China, Persia and India.  One of the paradoxes of modernity in medicine was that simultaneously there developed an interest in (1) interdisciplinary and holistic approaches while (2) specialization become increasingly entrenched, the latter leading sometimes to a “siloing” in research and data accumulation.  What makes exposome a useful tool is it is a way of expressing the interplay between genetics and environmental factors in the development of diseases with a particular focus on chronic conditions and widely the concept has been applied in many fields of medicine beyond public health.  What it does is calculate the cumulative effect of multiple exposures, allowing researchers to “scope-down” to specific or general gene-environment interactions, producing data to permit a more accurate assessment of disease risk and thus the identification of useful modes of intervention.

Dr Wild’s coining of exposome came about because some word or phrase was needed to describe his innovation which was the application of a systematic approach to measuring environmental exposures to what was coming to be known about the human genome; in a sense it was an exercise in cause and effect, the three components being (1) the external exposome, (2) the internal exposome and (3) the biological response.  The external exposome included factors such as air pollution, diet and socioeconomic factors as well as specific external factors like chemicals and radiation.  The internal exposome included endogenous factors, such as hormones, inflammation, oxidative stress, and gut microbiota.  The biological response described the complex interactions between the external and internal exposome factors and their influence on an individual's physiology and health.

At its most comprehensive (and complex), the exposome is a cumulative measure of all environmental exposures to which an individual has been subject throughout their entire life.  While that’s something that can be modelled for an “imagined person”, in a real-world instance it will probably always be only partially complete, not least because in some cases critical environmental exposures may not be known for long after their effect has been exerted; indeed, some may be revealed only by an autopsy (post mortem).  Conceptually however, the process can be illustrated by example and one illustrative of the approach is to contrast the factors affecting the same individual living in three different places.  What that approach does is emphasize certain obvious differences between places but variations in an exposome don’t depend on the sample being taken in locations thousands of miles apart.  For a variety of reasons, the same individual might record a radically different outcome if (in theory) living their entire life in one suburb compared with one adjacent or even in one room in one dwelling compared with another perhaps only a few feet away.  Conditions can be similar across a wide geographical spread or different despite close proximity (even between people sitting within speaking distance), the phenomenon of “micro-climates” in open-plan offices well documented.  The number of variables which can be used usefully to calculate (estimate might be a better word) an individual’s (or a group’s) exposome is probably at least in the dozens but could easily be expanded well into three figures were one to itemize influences (such as chemicals or specifics types of pollutant matter) and such is the complexity of the process that the mere existence of some factors might be detrimental to some individuals yet neutral or even beneficial to others.  At this stage, although the implications of applying AI (artificial intelligence) to the interaction of large data sets with a individual’s genetic mix have intrigued some, the exposome remains an indicative conceptual model rather than a defined process.

As an example, consider the same individual living variously in New York City, Dubai or Los Angeles.  In each of those places, some factors will be universal within the locality while others will vary according to which part of place one inhabits and even at what elevation at the same address; the physical environment in a building’s ground floor greatly can vary from that which prevails on the 44^th floor:

Lindsay Lohan in New York City in pastel yellow & black bouclé tweed mini-dress.  Maintaining an ideal BMI (body mass index) is a positive factor in ones exposome. 

(1) Air Quality and Pollution: Moderate to high levels of air pollution, especially from traffic (NO₂, PM2.5). Seasonal heating (oil and gas) contributes in winter.  Subway air has unique particulate matter exposure.

(2) Climate and UV Radiation: Humid continental climate—cold winters and hot summers. Seasonal variability affects respiratory and cardiovascular stressors.

(3) Diet and Food Environment: Diverse food options—high availability of ultra-processed foods but also global cuisines. Food deserts in poorer boroughs can reduce fresh produce access.

(4) Built Environment and Urban Design: Dense, walkable, vertical urban environment. High reliance on public transport; more noise pollution and crowding stress.  Lower car ownership can reduce personal emissions exposure.

(5) Cultural and Psychosocial Stressors: High-paced lifestyle, long working hours. High density increases social stress, noise, and mental health challenges.  Diversity can be enriching or alienating, depending on context.

(6) Economic and Occupational Exposures: Highly competitive job market. Occupational exposures vary widely—white-collar vs service industries. Union protections exist in some sectors.

(7) Healthcare Access and Public Policy: Robust healthcare infrastructure, but disparities remain by borough and income. Medicaid and public hospitals provide some safety net.

Lindsay Lohan in Dubai in J.Lo flamingo pink velour tracksuit.  A healthy diet and regular exercise are factors in one's exposome. 

(1) Air Quality and Pollution: Frequently exposed to dust storms (fine desert dust), high PM10 levels, and air conditioning pollutants. Limited greenery means less natural air filtration.  Desalination plants and industrial expansion add further exposure.

(2) Climate and UV Radiation: Extreme desert heat (45°C+), intense UV exposure, little rain. Heat stress and dehydration risks are chronic, especially for outdoor workers.

(3) Diet and Food Environment: High import dependency. Abundant processed and fast foods, especially in malls. Dietary pattern skewed toward high sugar and fat content.  Cultural fasting (eg Ramadan) introduces cyclical dietary stressors.

(4) Built Environment and Urban Design: Car-centric city. Pedestrian-unfriendly in many areas due to heat and design. Heavy air conditioning use is a major indoor exposure pathway.

(5) Cultural and Psychosocial Stressors: Strict social codes and legal restrictions influence behavioral exposures. Expat life often means social disconnection and job insecurity for migrant workers.

(6) Economic and Occupational Exposures: Large migrant workforce faces occupational health risks, including long hours in extreme heat. Labor protections are inconsistent.

(7) Healthcare Access and Public Policy: Healthcare access stratified—good for citizens and wealthy expats, less so for low-wage migrants. Private sector dominates.

Lindsay Lohan in Los Angeles in 2005 Mercedes-Benz SL65 AMG (2005-2011) Roadster (R230, 2002-2011).  Smoking is a factor in one's exposome.

(1) Air Quality and Pollution: Known for smog due to vehicle emissions and topography (valley trap). Ozone levels high, especially in summer. Wildfire smoke increasingly common.

(2) Climate and UV Radiation: Mediterranean climate with mild, dry summers. High UV exposure, though moderated by coastal influence. Drought conditions affect water quality and stress.

(3) Diet and Food Environment: Strong health-food culture, organic and plant-based diets more common. Yet fast food and food deserts remain in less affluent areas.  Hispanic and Asian dietary influences prominent.

(4) Built Environment and Urban Design: Sprawling, suburban in many parts. High car dependence means more exposure to vehicle exhaust.  Outdoor activities more common in certain demographics (eg, beach culture).

(5) Cultural and Psychosocial Stressors: Cultural emphasis on appearance, wealth, and entertainment may increase psychosocial pressure.  Homelessness crisis also creates variable community stress exposures.

(6) Economic and Occupational Exposures: Gig economy widespread, leading to precarious employment. Hollywood and tech industries also introduce unique workplace stress patterns.

(7) Healthcare Access and Public Policy: California’s public health programs are progressive, but uninsured rates still high. Proximity to cutting-edge research centers can boost care quality for some.

So one's exposome is a product of what one wants or gets from life, mapped onto a risk analysis table.  In New York City, one copes with urban pollution and persistent subway dust in an increasingly variable climate marked by periods of high humidity, a dietary range determined by one's wealth, the advantage of a good (if not always pleasant) mass transit system and the possibility of a “walking distance” lifestyle, albeit it in usually crowded, fast-paced surroundings.  Employment conditions are mixed and access to quality health care is a product of one's insurance status or wealth.

In Dubai, one lives with frequent dust storms, months of intense heat and UV exposure, a dependence on food imports, the constant temptation of fast food (FSS; fat, salt, sugar).  The car-centric lifestyle has created a built environment described as “pedestrian-hostile” and there are sometimes severe legal limits on the personal freedom especially for migrant workers who are subject to heat exposure and limited labor rights (even those which exist often not enforced).  The health system distinctly is tiered (based on wealth) and almost exclusively privatized.

The air quality in Los Angeles greatly has improved since the 1970s but climate change has resulted in the more frequent intrusion of smoke from wildfires and the prevailing UV exposure tends to be high; the climate is not as “mild” as once it was rated.  While there are pockets in which walkability is good, Los Angeles mostly is a car-dependent culture and the coverage and frequency of mass-transit has in recent decades declined.  Although this is not unique to the city, there's heightened awareness of a sensitivity to specific cultural pressures based on appearances and perceptions of lifestyle while housing stress is increasing.  Economic pressures are being exacerbated by the growth of the gig economy and traditionally secure forms of employment are being displaced by AI (bots, robots and hybrids).  Although California's healthcare system is sometimes described as "progressive", on the ground, outcomes are patchy.

So each location shapes the exposome in distinctive ways and the potential exists for the process better to be modelled so public health interventions and policies can be adjusted.  Of course, some risks are global: anywhere on the planet there’s always the chance one might be murdered by the Freemasons but some things which might seem unlikely to be affected by location turn out also to be an exposome variable. Because planet Earth is (1) roughly spherical, (2) and travels through space (where concepts like up & down don’t apply) and (3) constantly is exposed to meteoroids (every day Earth receives tons of “space dust”), it would be reasonable to assume one is equally likely to be struck by a meteoroid wherever one may be.  However, according to NASA (the US National Aeronautics and Space Administration), strikes are not equally likely everywhere, some latitudes (and regions) being more prone, due to several factors:

(1) Because Earth’s rotation and orbital motion create a bias, meteoroids tend more often to approach from the direction of Earth’s orbital motion (the “apex direction”), meaning the leading hemisphere (the side facing Earth's motion, near the dawn terminator) sees more meteoroid entries than the trailing hemisphere.  On a global scale, the effect is small but is measurable with the risk increasing as one approaches the equatorial regions where rotational velocity is greatest.

(2) Because most meteoroids approach from near the plane of the Solar System (the ecliptic plane), there’s what NASA calls a “latitude distribution bias”: Earth’s equator being tilted only some 23.5° from the ecliptic, meteoroids are more likely to intersect Earth’s atmosphere near lower latitudes (the tropical & sub-tropical zones) than near the poles.  So, those wishing to lower their risk should try to live in the Arctic or Antarctic although those suffering chronic kosmikophobia (fear of cosmic phenomena) are likely already residents.

(3) Some 70% of the Earth’s surface area being the seas and oceans, statistically, most meteoroids land in the water rather than in land so the lesson is clear: avoid living at sea.  The calculated probability is of course just math; because sparsely populated deserts accumulate meteorites better because erosion is low, a large number have been found in places like the Sahara and outback Australia but those numbers reflect a preservation bias and don’t necessarily confirm a higher strike rate.  The lesson from the statisticians is: Don’t dismiss the notion of living in a desert because of a fear of being struck by a meteoroid.

(4) Gravitational focusing, although it does increase Earth’s meteoroid capture rates (disproportionately so for objects travelling more slowly), is a global effect so there is no known locational bias.  While there is at least one documented case of a person being struck by a meteoroid, the evidence does suggest the risk is too low to be statistically significant and should thus not be factored into the calculation of one’s exposome because one is anywhere at greater risk of being murdered by the Freemasons.

Ms Ann Hodges with bruise, Alabama, September. 1952.  Painful though it would have been, she did get  her “15 minutes of fame” and eventually sold the fragment for US$25 so there was that.

In the narrow technical sense, many people have been struck by objects from space (as estimated 40+ tons of the stuff arrives every day) but most fragments are dust particles, too small to be noticed.  The only scientifically verified injury a person has suffered was an impressively large bruise a meteorite (the part of a meteoroid that survives its fiery passage through the atmosphere to land on Earth’s surface) on 10 September 1954 inflicted on Ms Ann Hodges (1920-1972) of Sylacauga, Alabama in the US.  Weighing 7.9 lb (3.6 kg), the intruder crashed through the roof of her house and bounced off a radio, striking her while enjoying a nap on the sofa.  The meteoroid was called Sylacauga and, just as appropriately, the offending meteorite was named the Hodges Fragment.  Anatomically modern humans (AMH) have been walking the planet for perhaps 300,000 years and we’ve been (more or less) behaviorally modern (BMH) for maybe a quarter of that so it’s possible many more of us have been struck,  In the absence of records, while it’s impossible to be definitive, it’s likely more have been murdered by the Freemasons that have ever been killed by stuff falling from space although, as the history of species extinction illustrates, a direct hit on someone is not a prerequisite for dire consequences.

Podophilia

Podophilia (pronounced podd-ah-fil-ee-uh or pod-oh-fil=ee-uh)

A paraphilia describing the sexualized objectification of feet (and sometimes footwear), commonly called foot fetishism although the correct clinical description is now "foot partialism".

1980s: The construct was podo- +‎ -philia.  Podo- (pertaining to a foot or a foot-like part) was from the Ancient Greek πούς (poús), from the primitive Indo-European pṓds.  It was cognate with the Mycenaean Greek po, the Latin pēs, the Sanskrit पद् (pad), the Old Armenian ոտն (otn) & հետ (het), the Gothic fōtus and the Old English fōt (from which Modern English gained foot).  The Greek poús was the ancient Greek and Byzantine unit of length originally based upon the length of a shod foot and the idea in Europe endured for centuries although until the seventeenth century there were little attempts at standardization, even within the one jurisdiction and although things were settled well before the twentieth century, in the legal sense it wasn't until 1959 that the US, Canada, New Zealand, South Africa, Australia and the UK signed the "International Yard and Pound Agreement" which codified avoirdupois weight and length then used in all those nations, a set (although largely supplanted by the metric system (except in the US)) which officially still defines both Imperial and US customary units.  The suffix –philia was from the From Ancient Greek φιλία (philía) (fraternal love), from φῐλέω (philéō) (to love), from the earlier Ionic Greek (where the meanings diverged somewhat over the years.  It was used to to form nouns meaning a fondness, liking or love of something and in pathology picked up the specific technical sense of abnormal liking or tendency such a paraphilia.  One with specific attraction to feet or footwear is a podophile and their predilections are described as podophilic.

Lindsay Lohan and her lawyer in court, Los Angeles, December 2011.

The English phrase “length of the chancellor's foot” is neither an allusion to lineal measurement nor an early example of political podophilia.  It is a critique of law and most associated with a passage by the English jurist and scholar John Selden (1584–1654) which appeared in his Table Talk (published posthumously in London in 1689), discussing the flexible, adaptable law of equity and how its administration differed from the rigid, precedent-bound courts of common law: “Equity is a roguish thing: for law we have a measure… equity is according to the conscience of him that is Chancellor, and as that is larger or narrower, so is equity. ’Tis all one as if they should make the standard for the measure we call a 'foot' a Chancellor’s foot; what an uncertain measure would this be! One Chancellor has a long foot, another a short foot, a third an indifferent foot.”

In other words, in the Court of Chancellery, equity was administered by the Lord Chancellor at his discretion, the attraction being when the application of common law precedents were seen to create an obvious injustice, equity could intervene to provide a just result: justice based on fairness rather than strict legal rules.  However, implicit in that flexibility was the estimation of equity could vary from one Chancellor to next and thus the Court of Chancellery soon created its own contradictions, attracting critics who noted an outcome depended on the personal judgment of the Lord Chancellor who reached his decision on a “case-by-case” basis.

The Lord Chancellor with feet in flippers: Lord Hailsham of St Marylebone (Quintin Hogg, 1907-2001; Lord Chancellor 1970-1974 & 1979-1987).  Hailsham was a Tory (Conservative) but the photograph was taken by the Labour Party politician Lord Healey (Dennis Healey, 1917–2015).

The rationale was both clear and commendable but lawyers trained in the courts of common law liked the certainty and predictability of adherence to precedence; their fees were dependent on them winning their clients’ cases, not seeking an abstraction like “justice”.  Thus the phrase became legal shorthand for judicial arbitrariness in which outcomes depended on personal discretion rather than objective standards.  The equity lawyers were of course sensitive to the criticism and what evolved in the Court of Chancellery was its own set of “rules” although these came to be called “equitable maxims” and were principles & concepts which can be thought of as a kind of “proto-fuzzy law” in that they existed to ensure justice and fairness would be delivered but in a consistent manner.  The phrase however survives as a critique of subjective decision-making by authorities or inconsistencies in governance or law.

Often focused on toe cleavage, many self-described foot fetishists provide curated content.

Although the psychiatric community has since the mid-twentieth century devoted some time to discussing, re-defining and pondering what is apparently the 1800-odd year history of foot fetishism, a glance at the literature does suggest it’s been thought usually an interesting quirk in the human condition rather than a condition, much less a mental disorder.  Before the American Psychiatric Association (APA) in 1987 published the revised third edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM-III-R), fetishism was usually described as a persistent preferential sexual arousal in association with non-living objects or an over-inclusive focus on (typically non-sexualized) body parts (most famously feet) and body secretions.  With the DSM-III-R, the concept of partialism (an exclusive focus on part of the body) was separated from the historic category of fetishism and appended to the “Paraphilia Not Otherwise Specified” category.  Although one of the dustier corners of psychiatry, the field had always fascinated some and in the years since the DSM-III-R was published, a literature did emerge, most critics maintaining partialism and fetishism are related, can be co-associated, and are non-exclusive domains of sexual behavior.  There was a technical basis for this position because introduced in DSM-IV (1994) was a (since further elaborated) codification of the secondary clinical significance criterion for designating a psychiatric disorder, one the implications of which was that it appeared to suggest a diagnostic distinction between partialism and fetishism was no longer clinically meaningful or necessary.  The recommendation was that the prime diagnostic criterion for fetishism be modified to reflect the reintegration of partialism and that a fetishistic focus on non-sexual body parts be a specifier of Fetishism.

Lindsay Lohan’s feet: the right plantar flexing (left), the left dorsiflexing (right).  Wikifeet's expert critics rate Ms Lohan's feet at 4½ stars (beautiful feet); her page has 3653 images.

Fetish was from the Latin facere (to make) which begat factitious (made by art), from which the Portuguese feitico was derived (fetiche in the French), from which English gained fetish.  A fetish in this context was defined as "a thing irrationally revered; an object in which power or force was concentrated".  In English, use of fetish to indicate an object of desire in the sense of “someone who is aroused due to a body part, or an object belonging to a person who is the object of desire” dates from 1897 (although the condition is mentioned in thirteenth century medical documents), an era during which the language of modern psychiatry was being assembled.  However, the earliest known literary evidence of podophilia lies in dozens of brooding, obsessive love letters from the second century AD of uncertain authorship and addressed to both male and female youths.  That there are those to whom an object or body part has the power to captivate and enthral has presumably been part of the human condition from the start.

Suspected podophiles, parked outside shoe shop.

From the beginnings of modern psychiatry, such a focus was not in itself considered a disorder, unless accompanied by distress or impairment although it was noted by many that if even a nominally “harmless” fetish became an obsession, it certainly could impair healthy sexuality.  In DSM-5 (2013), the diagnosis was assigned to individuals who experience sexual arousal from objects or a specific part of the body which is not typically regarded as erotic and presumably any body part or object can be a fetish, the most frequently mentioned including underwear, shoes, stockings, gloves, hair and latex.   Fetishists may use the desired article for sexual gratification in the absence of a partner although it’s recorded this may involve nothing more than touching smelling the item and the condition appears to manifest almost exclusively in men, the literature suggesting a quarter of fetishistic men are homosexual but caution needs always to be attached to these numbers.  Because fetishism is something which many happily enjoy their whole adult lives, it never comes to the attention of doctors and a high proportion of the statistical material about fetishism is from patients self-reporting.  The statistics in a sense reflect thus not the whole cohort of the population with the condition but rather those who either want to talk about it or are responding to surveys.  That is of course true of other mental illnesses but is exaggerated with fetishism because so much lies with the spectrum of normal human behavior and the definitional limitations in the DSM-5 reflect this, including three criteria for Fetishistic Disorder and three specifiers:

Criterion 1: Over a six month period, the individual has experienced sexual urges focused on a non-genital body part, or inanimate object, or other stimulus, and has acted out urges, fantasies, or behaviors.

Criterion 2: The fantasies, urges, or behaviors cause distress, or impairment in functioning.

Criterion 3: The fetishized object is not an article of clothing employed in cross dressing, or a sexual stimulation device, such as a vibrator.

Specifiers for the diagnosis include the type of stimulus which is the focus of attention (1) the non-genital or erogenous areas of the body (famously feet) and this condition is known also as Partialism (a preoccupation with a part of the body rather than the whole person), (2) Non-living object(s) (such as shoes), (3) specific activities (such as smoking during sex).

Not AOC’s feet.

The foot particularists also do PSAs (public service announcements).  When an image of feet was posted to Instagram with a caption claiming they belonged to Alexandria Ocasio-Cortez (AOC, b 1989, US Representative (Democrat-New York) since 2019 and one of "the squad"), the alleged foot-selfie was lent a whiff of scandal by their owner being in the bath, holding a vape with a bottle of pumpkin-scented shampoo nearby.  Quickly the story was debunked by the online foot fetishists at WikiFeet, the internet’s most comprehensive collection of pictures of women's feet.  In this case, Ms Alexandria Ocasio-Cortez’s Wikifeet page was used to C&C (compare and contrast) against the images in their library and it wasn’t a difficult task for the Wikifeet experts because the toes in the image were mildly brachydactyly (an inherited trait whereby the bones of the digits are relatively short) whereas AOC’s are not so afflicted.  Wikifeet’s users rate AOC’s feet at “3.92 stars” (nice feet), based on the 83 images in her page (many in sandals but some daringly bare).  Further research by the Wikifeet particularists revealed the feet in the bat really belonged to Sydney Leathers (b 1991) who became even better known by parlaying the publicity she attracted for being the sexting partner of disgraced New York politician Anthony Weiner (b 1964) into an apparently brief career as an aspiring porn star.  Why that didn’t flourish isn’t clear because rarely has there been a better porn star name than "Sydney Leathers" and Australian fellmongers and fetishists alike missed a marketing opportunity there.

Gianvito Rossi 85 suede pumps, US$1,210 at net-a-porter.

Noting the definitional model in the DSM-IV-TR (2000), despite the history in psychiatry’s world of paraphilias and a notable presence in popular culture, there were those who claimed the very notion of a foot fetish was false because of that critical phrase “non-living” which would seem to disqualify a foot (unless of course it was no longer alive but such an interest would be seriously weird and a different condition; although in this context there are deconstructionists who would make a distinction between a depiction of a live foot and the foot itself, clinicians probably regard them as interchangeable tools of the fetishist although the techniques of consumption would vary).  The critic noted many fetishes are extensions of the human body, such as articles of clothing or footwear but that did not extend to feet and that diagnostically, a sexual fascination with feet did correctly belong in the category of “Paraphilia Not Otherwise Specified,” and thus be regarded as partialism: Foot partialism.

Design by Davina-India.  Although the extreme examples won’t be possible to render as practical products without (unanticipated) advances in materials, 3D printing offers possibilities for the shoe-oriented faction of the foot partialists.

It was Sigmund Freud (1856-1939) who admitted that, lawfulness aside, as animals, the only truly aberrant sexual behavior in humans could be said to be its absence (something which the modern asexual movement re-defines rather than disproves).  It seemed to be in that spirit the DSM-5 was revised to treat podophila and many other “harmless” behaviors as “normal” and thus within the purview of the manual only to the extent of being described, clinical intervention no longer required.  Whether all psychiatrists agree with the new permissiveness isn’t known but early reports suggest there’s nothing in the DSM-5-TR (2022) to suggest podophiles will soon again be labeled as deviants.

Most Beautiful Ankle competition, Hounslow, England, 1936. What such competitions did was “level the playing field” to ensure a woman was judged only on the body-part being assessed, the rest of her concealed behind a screen so a judge wouldn't ne influenced by “extraneous aspects”.

The matter of podophilia is not exactly a neglected field but beyond the particularists it’s a niche topic for study, probably because despite being often curated as collections of images of objectified, un-clothed body parts, the stuff inherently is SFW (suitable for work) so is not as controversial as some fetishes.  Indeed, even were someone found to be in possession of many images of the feet of minors, unless the circumstances were unusual and disclosed suspicion of other behaviours, it’s likely no offence has been committed.  There have though been some academic studies including Sexualization of the Female Foot as a Response to Sexually Transmitted Epidemics: A Preliminary Study (1998) by A. James Giannini, Andrew E. Slaby, Gale Colapietro, Steven M. Melemis & Rachel K. Bowman.  A review of historic literature, the authors hypothesized a relationship between epidemics of sexually transmitted diseases and foot fetishism, the research prompted by an exponential increase in the behaviour seen in the 1980s, early in the AIDS epidemic.

Most Beautiful Legs competition, Palisades Amusement Park, New York, 1951.  Note the judge crouching to ensure the perfect angle, presumably a podophile with a well-trained eye.

The paper noted that during the second millennium there have been four major epidemics of STDs (sexually transmitted diseases, then the preferred term for what are now classed as STIs (sexually transmitted infections)): (1) what’s believed to have been an outbreak of gonorrhoea in the thirteenth century, syphilis in (2) the sixteenth and (3) nineteenth and (4) AIDS in the late twentieth and during each “there seemed to emerge a sexual focus on the female foot” which “disappeared with the epidemic's subsidence, usually after 30-60 years.”  What was intriguing was “the focus on feet was unique to each of these epidemic periods” whereas in all other eras studied, “eroticism was attached to breasts, buttocks and thighs.”  It was not suggested feet (bare or otherwise) didn’t appear in Biblical, Egyptian or Classical art and literature but they were not depicted as “sexual foci”.

It was in the thirteenth century things began to change as romantic writings came to include paeans to women's feet and the details were often not metaphorical but anatomical, describing in loving admiration the “aesthetically idealized woman's foot” which was to be “narrow with high arches.  The toes were to be somewhat long with no ‘webbing’ or folds of skin in between.  The great toe was longer than the second toe. The nails were to be elongated with large white moons and pale-pink nail-beds.”  The perfect foot was expected to be “white on both plantar and ventral aspects” so clearly, like thighs, buttocks and breasts, women’s feet were expected to conform to what men had decided was “beautiful” and those with body parts outside the “standardized image” could not be beautiful. Plus ça change…

Most Beautiful Ankle competition, Cliftonville open air swimming pool, Margate, England, 1936.

The Church looked askance at this “new” fetish, damning it as a “further form of degeneracy as Europe” and though the paper finds the trend faded to oblivion with the end of what is now believed to have been an epidemic of gonorrhoea, with the outbreak of syphilis in the sixteenth century, there appears again a “near-simultaneous reappearance of the foot fetish” which began in southern Europe before spreading north and the art of the time suggests it was then “toe-cleavage” was first identified as a motif, as a “voyeuristic mark of this time period as decolletage for other generations”.  Interestingly 300-odd years on the ideal structure was re-imagined, an “elongated second toe” suddenly fashionable.  When syphilis re-appeared in the 1800s, so did the focus on women’s feet and because photography was available to the Victorians, there’s a record also of the reaction of polite society with the female foot “removed from photographic tintypes”: While men’s boots commonly remained exposed, women's boots or shoes were either covered with fabric or “mechanically cropped from the plate”.  Ballerinas would perform bare-footed (critics writing of her feet as they “flexed and extended”) ice-cream confections (called the “Trilby”) were sold in the shape of a woman’s foot and the “Cinderella fairy tale was revived with foot fetishistic overtones not now reflected in twentieth century versions”.  

Technicians recording metrics for a contestant in Miss Italia, Rome, 1949.

“Body part” contests offered scope for those who wouldn’t be “competitive” in mainstream beauty contests.  As a footnote, the perfection (in the sense of digital depiction) of generative AI (artificial intelligence) may see the end of the industry’s “body part model” niche in which those with exceptional hands, feet, eyes etc were contracted for photo-shoots involving just that one part.

In the nineteenth century, some did offer explanations (sometimes fanciful) for the phenomenon and although in the medical literature there were observations of the use of the foot “as a safe-sex alternative”, no systematic studies seem to have been undertaken.  The AIDS epidemic revived the interest and the proliferation of foot-fetish publications in the 1980s (before the internet was a mainstream product) was a marker of the trend and interestingly, the titles of what were usually glossy magazines avoided the words “feet” & “foot”, instead using “neutral” terms such as “Leg Action, Thigh High, Leg Show, Leg-Scene, High-heeled Women, Silk Stockings or Leg Tease”.  Despite that, the content seems overwhelmingly foot-centric and the conclusion was the publishers wished to “avoid embarrassment for the purchaser”.  That was interesting in that publications devoted to other body parts seemed to tend to use unambiguous titles and the paradox was that although feet were SWF, the perception was there was shame attached to the predilection, something not suffered by consumers of the definitely NSFW (not suitable for work) breast-related material.  Editorially, there were photographs mostly including feet and tips & techniques for “foot sex” which could be “a pleasurable sexual alternative without risk of sexually transmitted diseases”, the foot described as a safe “erotic alternative to the anus and genitals”.  It was at this point even the mainstream magazines began to advocate “toe sucking” and “foot biting” between couples, not to avoid infections but because for even the most sexually jaded it would be a “genuinely new” experience, novelty in this field much valued.  Diligent washing prior to sucking and biting was recommended.

First heat of Miss Slender Legs Competition, Miami, Florida, 1952.

The pop band The Monks in 1979 released the single Nice Legs Shame About Her Face so the contest in Miami was really an early example of DEI (diversity, equity and inclusion).  It's a bit of a stretch but as a Lord Chancellor might have put it, beauty contests are a thing of the common law while the body part competitions belong to equity. 

The AIDS epidemic of course remains afoot although advances in treatment have made it manageable for most, at least in developed economies though there are concerns how cuts to foreign aid will affect outcomes in poorer regions, especially sub-Saharan Africa and the Pacific islands.  Despite the epidemic fading from public consciousness, foot particularism appears still to be flourishing, the absence of the foot-focus print titles an indication of the general industry shift to digital content rather than any decline in interest and the count of related internet pages is said to be in the millions.  To explain the phenomenon which has for centuries re-occurred, the neurology community has also become involved.  In Phantoms in the Brain: Probing the Mysteries of the Human Mind (1998), neurologist V.S. Ramachandran (b 1991) and science journalist Sandra Blakeslee (born 1943) offered the theory of a link with brain areas for the feet and the genitals being physically close, their speculation being there may be some “neural crosstalk between the two”, the idea being a concern about STIs induces the brain to be stimulated to think about feet, purely because of the effect of directly adjacent electrical activity.