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 1954.  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 (an 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.

Dashcam footage of meteorite fragment in the sky over Lexington, South Carolina.

The cosmic intruder crashed through the roof of a house on 26 June, 2025 and although there were no injuries, Fox News reported the fragment left a hole in the floor “about the size of a large cherry tomato”.  Analysis determined the rock was from the asteroid belt between Mars and Jupiter and as well as the dramatic fireball many captured on their dashcams, it would briefly have broken the sound barrier as it entered Earth’s atmosphere.  It was also very old, dating from slightly before the formation of the Solar System’s rocky inner planets (one of which is Earth) some 4.56 billion years ago and such fragments are of interest to many branches of science because they represent a small part of the “basic building blocks” of those planets and can thus assist in understanding the processes active during the Solar System’s earliest days.  Curiously (to those not trained in such things), the cosmologists explained “such a small fragment didn’t present a threat to anyone” which seems strange given its impact left a small crater in a floor, one implication being one wouldn’t wish for such a thing to hit one’s skull.  That the impact happened in Georgia, a state adjacent to Alabama where a half-century earlier the unfortunate Ms Hodges was struck, may make some add “meteorite fragments” to their list of “exposome factors south of the Mason-Dixon Line” but the sample size is too small for conclusions to be drawn and the events are mere geographic coincidences.

Ms Knapp with Malibu.

It transpired things were no safer north of the Mason-Dixon Line.  The Peekskill meteor of 1992 entered the skies over New York, striking Michelle Knapp's (b 1974) 1980 Chevrolet Malibu.  Warm to the touch and smelling like sulfur, the rock was "bowling ball–sized" (about 12 inches (300 mm) in diameter) and was dense, the mass some 27 lb (12¼ kg), the origin traced to our solar system’s main asteroid belt (between Jupiter & Mars); the average cosmic velocity during its travel here would have been about 31,600 mph (50,885 km/h).  Slowed by Earth’s atmosphere, the meteorite began to break up over Kentucky, the shard travelling at 164 mph (264 km/h) at the point of impact with Ms Knapp’s Malibu.  It could have been more dramatic, the fuel tank only inches away; hitting that might have produced a Pintoesque combustion.  So it was a bad day for Ms Knapp but she sold the Malibu (purchased a year earlier from her grandmother for US$400) to the wife of a meteorite collector for US$25,000 so there was that.  More pleasing still, she received US$50,000 for the rock, reflecting the increased value of the things since Ms Hodges received US$25 for the one that in 1954 left a severe bruise on her thigh.  In the narrow technical sense, many people have been struck by objects from space (an estimated 40+ tons of the stuff arrives every day) but most fragments are dust particles, too small to be noticed.  Anatomically modern humans have been walking the planet for perhaps 300,000 years and we’ve been (more or less) behaviourally modern 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 folk have been murdered by the Freemasons than 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.

Chevelle's finest hour: 1970 Chevrolet Chevelle SS 454 LS6.  The 450 HP (horsepower) 1970 LS6 is remembered for having Detroit's highest advertised power rating of the original muscle car era.  Although a handful of 1966 Corvettes in 1965 left the factory with "450 HP" stickers on their air-cleaners, they were identical to the 425 HP units and quickly the line was "re-stickered".

Introduced in 1964 as a trim level of the Chevrolet Chevelle, the Malibu became the most successful of the line and with the release of the fourth-generation model in 1978, the Chevelle name was retired with the range re-branded as Malibu.  That RWD (rear-wheel-drive) platform continued until 1997 when a fifth generation (FWD (front-wheel-drive)) model using the name was released, a further four iterations released until production ended in 2025; it was the last sedan built by Chevrolet in the US, the body-style on which the brand had for eight decades built its reputation.  The Chevelle was Chevrolet’s first “intermediate” model and was instantly a “sweet spot” in the market, being a “goldilocks size” that was remarkably close to the classic “tri-five” models of 1955-1957, the last generation before the sudden gains in size and weight of the US full-size cars that stimulated demand for smaller imports and prompted the industry to create their own “small”, compact” and “intermediate” ranges.  By 1978, rising fuel prices saw the intermediate size become the new “full-size” so the Malibu was re-positioned as what used to be a “compact”.  The 1978 Malibu was also a footnote in how capitalism works.  When released, it was noted the rear side-windows were fixed.  According to Chevrolet, because of the down-sizing, the “feature” was added to ensure rear-passenger width was maintained; without a window and the associated retracting mechanism, the arm-rests could be integrated into the door trim.  That was of course true but cynics were quick to point out it would also encourage buyers to pay extra for air conditioning.  So it proved, sales of the option spiking among buyers of fourth generation Malibus.

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, based originally on the length of a shod foot and the idea in Europe endured for centuries although, until the 1800s, there were few attempts at standardization (even within the one jurisdiction).  Things (mostly) were by the twentieth century standardized (the needs of machines and modern commerce dictated that), 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", codifying the avoirdupois system of weight and length then used in all those nations, a set (although largely supplanted by the metric system (except in the US)) that 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.  Podophilia & podophile are nouns and podophilic is an adjective; the noun plural is podophiles.

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) that appeared in his posthumously published Table Talk (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 was 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 that 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 (and thus perhaps "bias", even if unconscious) of the Lord Chancellor who reached his decisions 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).  These days, such folk probably wish each other taken not by a camera but a shark.

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, outcomes depending on personal discretion rather than the application of 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”), principles & concepts that 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 the at least 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 APA (American Psychiatric Association) in 1987 published the revised third edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM-III-R), fetishism usually was 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 long 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 being it appeared to suggest a diagnostic distinction between partialism and fetishism was no longer clinically meaningful or necessary.  The recommendation was 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.

Lohanic footage: 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 the French fétiche, from the Portuguese feitico, from facere (to make) which begat factitious (created; artificial).  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) and it was in the late nineteenth century the lexicon of modern psychiatry began to be assembled.  However, in the literary record, surviving from the seventh century AD are 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 in whom an object or body part has the power to captivate and enthral presumably has from the start been part of the human condition.

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 the 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 cognoscenti 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 surfacing provocatively from the pink bath-water 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. 

OnlyFans, a place for podophiles.

A genuine phenomenon, OnlyFans is a niche player in the gig economy but the niche is big and if not quite the oldest in the world, it's been around a while.  Something of an early-adopter of techniques embracing the implications of AI (artificial intelligence), while "feet" is just one of many genres serviced, OnlyFans is able to engage in "category proliferation" at little more than marginal cost because the site works on a "bolt-on" principle.  The business model works because the platform's content exclusively is user-generated with revenue streams provided by PPV (pay-per-view) customers and monthly subscriptions with creators collecting the bulk of the payments, OnlyFans essentially "clipping the ticket" on the way through their gateway.  OnlyFans was one of the "plague winners" in the disruptions wrought by the lockdowns imposed during the COVID-19 pandemic but the earnings profile of the content creators is a highly exaggerated curve, a relative handful finding it most lucrative while for most it's at best a hobby or side-hustle; for OnlyFans that's OK, they still clip the ticket.  Although best known for creators posting sexually explicit content, in 2021 (in response to political pressure) it was announced things would be "sanitized" with NSFW (not suitable for work) material purged site-wide.  Such was the outcry from the creators and customers that plan survived not even a week, cynical analysts concluding the original announcement had been made to provoke the revolt, OnlyFans knowing nothing quietens tiresome politicians as quickly as mass public discontent.  The OF content creators are an imaginative lot and some are said to make "feet" NSFW so those wanting a purely anatomical experience are recommended to search with caution.

Foot Finder

When OnlyFans attained critical mass it encouraged the growth of an ecosystem of sites acting as "third party intermediaries" servicing those who for whatever reason preferred their transactions to be handled with a guarantee of anonymity (if curated with care, one’s own feet on an OnlyFans page should be similarly anonymous).  Content providers are known as “sole traders” while in the jargon the third party operators run “parasitic sites” which may sound harsh but the use does mirror the analogous use in biology.  Amusingly, although the internet doomed many other platforms with business models dependent on revenue from advertisers (notably the print media, in the West, many magazines and all but a handful of newspapers driven extinct or taking "an unconscionable time a-dying"), FootFinder (above, left) clearly sees value still in physical, three-dimensional mobile advertising and a large fibreglass foot (above, right) atop a Kei car (diminutive, small displacment Japanese vehicles sold mostly in the JDM (Japanese Domestic Market) certainly must attract attention.  As long ago as the 1950s, there were those predicting there would one day be a world-wide system (at least one encompassing the Western world) of real-time interconnectivity (ie the concept of the internet) but most seemed to envisage it as people having portals (with acid-green screens) through which to look-up stuff in databases or receive text-based content such as news reports or educational instruction.  In short, a world of "few uploaders and many downloaders".  It's doubtful many imagined "mass-upload" models such as YouTube and definitely not OnlyFans; while many would have assumed users would become interactive, Foot Finder would not have occurred to many as a template.  How, 50 years from now, podophiles will be indulging their particularism may be just as unpredictable.

The ultimate hood (bonnet) ornament between the NACA ducts: Connie Kreski (1946-1995) and 1969 Shelby American Mustang GT500.

By 1969 the Shelby Mustangs had become far-removed from the raw-boned 1965 originals (described memorably as “brand new, clapped-out racing cars”) and it would be the last year of production (although unsold cars were re-titled as 1970 models for a final season swansong).  The later cars do however remain collectables and none more so than the (then uniquely) pink one Ms Kreski received after being named Playboy magazine's 1969 PotY (Playmate of the Year).  So a pink Shelby Mustang is a rarity and Ms Kreski was of course lovely but the eyes of podophiles will be drawn to her bare feet and true aficionados will admire her Morton's toe (also as Royal toe or Greek foot), a congenital condition in which the second toe is longer than the big toe, the consequence of a shorter first metatarsal bone.  Her case was slight enough probably to have been asymptomatic but she may have noticed increased pressure on the joint beneath the second toe if wearing especially unsympathetic shoes (as the stilettos sometimes worn by Playboy's models sometimes were).  The condition was first described by US orthopedic surgeon Dudley Joy Morton (1884–1960) in the paper Metatarsus atavicus: the identification of a distinct type of foot disorder which appeared in the Journal of Bone & Joint Surgery (Boston), 1927, volume 9.  It was among the conditions he grouped as Morton's triad (known also as Morton's syndrome or Morton's foot syndrome).

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 be influenced by “extraneous aspects” (such as her face).

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 conduct, 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, before AIDS had been listed as a pandemic.

Most Beautiful Legs competition, Palisades Amusement Park, New York, 1951.  Note the judge crouching to achieve 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”.

Raising then dashing a podophile's hopes: This sign does not suggest stopping because there are 200 feet to enjoy; it is a road-safety waring sign advising motorists a Stop Sign is at the intersection 200 feet (61 metres) ahead.

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 in Europe” though the paper reported the trend faded to oblivion with the end of what is now believed to have been an epidemic of gonorrhoea.  After 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” that 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 and an “elongated second toe” became 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”.  

Sometimes, statistical methods are purely lineal: Technicians recording (rounding up to the nearest centimetre) the metrics of 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 pandemic 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 magazines in the field 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”.

Highly qualified content provider Busty Buffy (b 1996), whose feet seem never to command the attention they deserve.

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 to the same extent 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.  Many good things happen in Florida; everybody knows that.

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 "most beautiful body part" competitions belong to equity. 

The AIDS pandemic 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 condition fading from public consciousness, foot particularism appears still to be flourishing, the absence of foot-focused 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 that 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 (b 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 a concern about STIs induces the brain to be stimulated to think about feet, purely because of the effect of directly adjacent electrical activity.