Ancient Human’s Healed Foot Fracture Shows Prehistoric Nursing in Israel

Unless he hopped to the hunt, this young adult couldn’t have survived its foot injury without help from the prehistoric community, archaeologists say

Stalagmites and stalactites in Manot Cave
Ariel David

Archaeologists digging in a cave in northern Israel have unearthed the prehistoric remains of a young adult’s foot, with faint signs of a serious fracture that healed remarkably well.

The remains, dated to between 36,000 to 38,000 years ago, provide fresh evidence of advanced social and possibly medical skills of our early human ancestors, which likely started developing hundreds of thousands of years ago.

In this case, the community must have nursed this individual back to health from a debilitating injury that can take months to heal.

The left foot bones were recovered in various stages between 2014 and 2017 by excavations in Manot Cave, a site in the Western Galilee that has yielded a treasure trove of paleolithic finds

An international team of researchers recently reported on this pedal discovery in the Journal of Human Evolution, noting they were particularly intrigued by the second metatarsal bone, which is located in the mid-foot.

The arrows point to the marks left on the bone by the Lisfranc fracture. At the bottom, a CT scan image
Sarah Borgel

This particular bone displayed the faint but telltale scarring left by a healed fracture that this person (we have no idea if it was a he or a she) suffered earlier in life.

“This individual died years later of unknown but likely unrelated causes,” explains Dr. Hila May, a physical anthropologist at Tel Aviv University who led the study. “The person was still young at death, so the fracture probably occurred in childhood as result of a fall or something being dropped on the foot.”

CT scans of the bone confirmed the hypothesis and helped the researchers identify the injury as a so-called Lisfranc fracture, in which a metatarsus is dislocated from the adjacent tarsus bone. 

This painful trauma is named after Jacques Lisfranc de St. Martin, a French Napoleonic-era surgeon who first described the injury in an unfortunate cavalryman who had to have his foot partially amputated. Today, the most serious Lisfranc fractures require surgery, but even less severe cases can take six to 12 weeks to heal, during which patients must wear a cast and keep their weight off the damaged limb.

“What we see here is someone who was effectively immobilized for a period of time and would have needed help to survive,” May says. “We don’t know a lot about how prehistoric societies worked, so these finds give us a window into their mechanisms of social solidarity and support.”

3D reconstruction of the left foot bones found in Manot Cave
Ariel Pokhojaev
LisFranc fracture
James Heilman, MD.

While the injured teen may have been able to hop around using a stick as a makeshift crutch, he or she would have been unable to put weight on the foot because of the pain and would have been completely dependent on the rest of the group, says Prof. Israel Hershkovitz, a physical anthropologist who co-directs the dig at Manot Cave.

“This means the society had enough resources to support people who were disabled, temporarily or permanently,” Hershkovitz says.

It is also possible that the cave dwellers had some basic medical knowledge and knew to set a splint for the injured foot, using a bone or a piece of wood, to immobilize the limb and promote healing. “Otherwise, the fracture would not have healed so well,” he says.

Hybrids from Europe

The foot definitely belonged to a Homo sapiens, though it does display some anatomical features that were typical of Neanderthals, the researchers say. This dovetails with previous studies of other human remains found at Manot, which concluded that the cave was inhabited by a hybrid sapiens-Neanderthal population.

Inside Manot
Ariel David

This population probably descended from groups of sapiens who had migrated out of Africa through the Levant and on to Europe. There they intermingled with Neanderthals – just as they were going extinct – before moving back to the Levant some 40,000 years ago.

Today, apparently all humans still carry a small percentage of Neanderthal DNA, though in much smaller amounts than our distant ancestors in Manot, says Hershkovitz. (Sub-Saharan Africans were recently revealed to also have a very faint Neanderthal signal, which is believed to originate in a hybrid sapiens-Neanderthal who returned to Africa from Europe.)

“The Neanderthal genetic component was much stronger than today, because since then more groups of sapiens have come out of Africa and they didn’t have Neanderthal genes, so slowly the Neanderthal elements were diluted in the gene pool and mostly disappeared,” Hershkovitz explains.

To be clear, the healed broken foot in Manot is not the first or the oldest evidence that our ancestors cared for the sick and the disabled. Signs of compassion and altruistic support have been discovered not only among Homo sapiens but also among Neanderthals, who seemed capable of caring even for those with the most serious disabilities. 

The most known case perhaps is that of Shanidar Cave, a site in Iraqi Kurdistan that contains Neanderthal remains dating to two periods, 45,000 and 70,000 years ago, and possible evidence of ritual burial. There, among some 10 skeletons, archaeologists found the remains of one individual who survived to around age 50 despite having accumulated multiple disabilities during his life, including a withered arm, partial blindness and deafness resulting from head trauma in his youth, and deformities in his legs. Most researchers believe this person could not have survived to such a ripe old age, by Paleolithic standards, if he hadn’t been cared for by the rest of the group.

Flint tools and animal bone finds from Manot Cave
Ariel David

Similar care must have been given to a Neanderthal found in La Chapelle-aux-Saints in France, who survived tooth loss, chronic periodontal disease and crippling arthritis in multiple joints, and there are quite a few other examples.

Toothless in Georgia

There are even signs of earlier compassionate care provided by other members of the homo evolutionary tree. Back in 2005, archaeologist David Lordkipanidze and colleagues reported on the discovery in Georgia of the 1.77-million-year-old skull of a hominin who had lost all but one of its teeth.

Since the empty tooth sockets were refilled by bone growth it has been assumed that the individual lost his teeth years before dying and may have been dependent on others for sustenance

Another interesting case is the skull of a child who died aged roughly 11 about 400,000 years ago, and was found in the Sima de los Huesos, a prehistoric bone pit in Spain’s Atapuerca Cave. The child likely suffered not only facial distortion but cognitive and motor damage due to craniosynostosis - premature closure of a skull suture, which causes immense pressure on the growing brain. Her survival almost to teenagehood could also imply compassionate care. 

So, while the discovery of the healed fracture at Manot is not unique, it adds to the growing body of evidence that shows that prehistoric hominins were anything but primitive brutes, researchers say.

“They didn’t leave people who were sick to die somewhere, they took care of those who were weaker,” Hershkovitz says. In fact, he adds, the creation of complex societies that led hominins to cooperate on difficult tasks and mutually support each other when an individual faltered is probably the main reason for the survival of these groups, and ultimately proved to be the key to the success of our species.

The first and, in the foreground, second metatarsals found in Manot Cave
Ariel David