Sex Differences in Relative Foot Length and Perceived Attractiveness of Female Feet: Relationships among Anthropometry, Physique, and Preference Ratings

Techniques and Applications of Lower Extremity Feminization and Masculinization

Background

Significant differences exist between feminine and masculine lower extremities, and this region contributes to gender dysphoria in transgender and nonbinary individuals.

Methods

A systematic review was conducted for primary literature on lower extremity (LE) gender affirmation techniques as well as anthropometric differences between male and female lower extremities, which could guide surgical planning. Multiple databases were searched for articles before June 2, 2021 using Medical Subject Headings. Data on techniques, outcomes, complications, and anthropometrics were collected.

Results

A total of 852 unique articles were identified: 17 met criteria for male and female anthropometrics and 1 met criteria for LE surgical techniques potentially applicable to gender affirmation. None met criteria for LE gender affirmation techniques specifically. Therefore, this review was expanded to discuss surgical techniques for the LE, targeting masculine and feminine anthropometric ideals. LE masculinization can target feminine qualities, such as mid-lateral gluteal fullness and excess subcutaneous fat in the thigh and hips. Feminization can target masculine qualities like a low waist-to-hip ratio, mid-lateral gluteal concavity, calf hypertrophy, and body hair. Cultural differences and patient body habitus, which influence what is considered "ideal" for both sexes, should be discussed. Applicable techniques include hormone therapy, lipo-contouring, fat grafting, implant placement, and botulinum toxin injection, among others.

Conclusions

Due to lack of existing outcomes-based literature, gender affirmation of the lower extremities will rely on application of an array of existing plastic surgery techniques. However, quality outcomes data for these procedures is required to determine best practices.

Normal tolerance limits for side-to-side differences in diameters of major lower limbs arteries of 228 healthy subjects

PURPOSE

To determine reference values and tolerance limits of between-side differences for the calibers of the common femoral artery (CFA), superficial femoral artery (SFA), popliteal artery (PA), dorsalis pedis artery (DPA), and posterior tibial artery (PTA).

MATERIALS AND METHODS

Calibers of arteries, defined as the largest distance between internal hyperechogenic lines of the intima-media complex of the arterial wall, were measured during the diastole phase determined from echo-tracking B mode ultrasound scanning and grey-scale ultrasound in 228 healthy volunteers aged 18-81 years (43.1 ± 16.7).

RESULTS

The mean, 95% confidence and tolerance limits covering 90% of population for left and right side of each artery were: CFA: 8.1 mm, 7.9-8.3 mm, 6.0-10.3 mm; 8.1 mm, 7.9-8.5 mm, 5.9-10.2 mm; SFA: 6.2 mm, 6.0-6.3 mm, 4.7-7.6 mm; 6.1 mm, 6.0-6.3 mm, 4.7-7.6 mm; PA: 6.1 mm, 6.0-6.2 mm, 4.6-7.6 mm; 6.1 mm, 5.9-6.2 mm, 4.5-7.6 mm; DPA: 2.0 mm, 1.9-2.0 mm, 1.2-2.7 mm; 2.0 mm, 1.9-2.0 mm, 1.2-2.8 mm; PTA: 2.1 mm, 2.0-2.1 mm, 1.4-2.8 mm; 2.1 mm, 2.1-2.2 mm, 1.4-2.8 mm, respectively. Tolerance limits for between-side differences and ratios were: CFA - 0.5-0.7 mm, 0.9-1.1; SFA - 0.5-0.6 mm, 0.9-1.1; PA - 0.5-0.5 mm, 0.9-1.1; DPA -0.4-0.4 mm, 0.8-1.2; PTA - 0.4-0.4 mm, 0.8-1.2. Regression analysis showed weight and age dependency of vessels diameters. There are no differences between men and woman in vessels size, except in DPA's, when body weight and age are taken into account in a regression analysis.

CONCLUSIONS

We estimated normal reference tolerance limits of side-to-side differences in diameters of lower limb arteries. The limits can inform an investigator what differences in diameters occur in healthy individuals, and hence can serve as cut-offs in diagnostic and screening strategies.

Perception and Deception: Human Beauty and the Brain

Human physical characteristics and their perception by the brain are under pressure by natural selection to optimize reproductive success. Men and women have different strategies to appear attractive and have different interests in identifying beauty in people. Nevertheless, men and women from all cultures agree on who is and who is not attractive, and throughout the world attractive people show greater acquisition of resources and greater reproductive success than others. The brain employs at least three modules, composed of interconnected brain regions, to judge facial attractiveness: one for identification, one for interpretation and one for valuing. Key elements that go into the judgment are age and health, as well as symmetry, averageness, face and body proportions, facial color and texture. These elements are all Costly Signals of reproductive fitness because they are difficult to fake. However, people deceive others using tricks such as coloring hair, cosmetics and clothing styles, while at the same time they also focus on detecting fakes. People may also deceive themselves, especially about their own attractiveness, and use self-signally actions to demonstrate to themselves their own true value. The neuroscience of beauty is best understood by considering the evolutionary pressures to maximize reproductive fitness.

The effect of leg-to-body ratio on male attractiveness depends on the ecological validity of the figures

Leg-to-body ratio (LBR) predicts evolutionary fitness, and is therefore expected to influence bodily attractiveness. Previous investigations of LBR attractiveness have used a wide variety of stimuli, including line drawings, silhouettes, and computer-generated images based on anthropometric data. In two studies, community samples of heterosexual women from the USA rated the attractiveness of male figures presented as silhouettes and as detailed computer-generated images with three different skin tones (white, black, and an artificial grey). The effects of LBR depended on the image format. In particular, a curve-fitting analysis indicated that the optimally-attractive LBR for silhouettes was fractionally below the baseline, whereas the optima for more detailed computer-generated images was approximately 0.5 s.d. above the baseline and was similar for all three skin-tones. In addition, the participants' sensitivity to changes in the LBR was lowest for the silhouettes and highest for the grey figures. Our results add to evidence that the most attractive LBR is close to, but slightly above, the population mean, and caution that the effects of limb proportions on attractiveness depend on the ecological validity of the figures.

Taiwanese adult foot shape classification using 3D scanning data

This study classifies the foot shapes of Taiwanese using 3D foot scanning data from 2000 males and 1000 females. Nine foot dimensions relative to foot length and absolute measures in the common foot length categories were applied to compare the gender differences. Using foot breadth in % foot length (% FL), ball of foot length in % FL and arch height in % FL as feature parameters, three foot shape types for males and females can be classified. Significant gender differences were found in seven of the nine foot dimensions. Females had greater ball of foot length than males (0.2% FL). When comparing feet of the same foot length, males had greater breadth, girth and height dimensions than females, except for toe height. In addition, ethnic differences in foot shape were also observed. The findings can provide very useful information for building gender-specific shoe lasts and designing footwear insoles.

PRACTITIONER SUMMARY

3D foot scanning data of 2000 males and 1000 females were classified into three different footshapes for males and females, respectively. Gender and ethnic differences on foot shape were also compared. The finding scan provide very useful information for gender-specific shoe last design and footwear production.

[Beauty judgment: review of the literature]

Esthetic judgments are surely subjective, but as surely, that does not preclude them being studied objectively through rigorous scientific methods. The factual basis of a science of esthetics is not to settle whether some person or image is "objectively beautiful" but rather to determine whether some representative set or sets of individuals judge or experience him/her/it as beautiful or unattractive. The aim of this paper is to review the definitional, theoretical and methodological aspects pertaining to the perception of facial/dental attractiveness by a group of representative individuals. The first part lays down the basic principles of the perception of facial/dental attractiveness: the perception involves a jury, a field of investigation and a test providing quantitative data; the following general determinants of beauty perception are reviewed: the average morphology, the judge's cultural background, the numerology, the judge's ethnical origin. Indirect determinants are the dentition, the osseous architecture and the muscular envelope. Some disruptive factors might alter the judges' facial perception. They might be qualified as either peripheral to the face or psycho-social factors. Peripheral factors include hair style and color, skin hue, wrinkles, lips color... Psycho-social factors cover the personality of the subject being evaluated, his/her intelligence or behavior. The second part deals specifically with the methodology used to determine facial attractiveness and to correlate this latter with a specific morphology. Typically such a study aims to determine average esthetic preferences for some set of visual displays among a particular jury, given a specific task to judge esthetic quality or qualities. The sample being studied, the displays, the jury or jurys, the rating procedure must all be specified prior to collecting data. A specific emphasis will be given to the rating process and the associated morphometrics, the ultimate goal being to discriminate morphologies judged as attractive among our patients.

Load distribution to minimise pressure-related pain on foot: a model

The optimal force distribution to minimise pain or discomfort at the foot-shoe interface is still not known. Most shoe-related products attempt to distribute the load uniformly without much consideration to the bony and soft tissue regions. An experiment was conducted to first determine the pressure pain threshold (PPT) and tissue deformation on the plantar surface of the foot. Circular probes of areas 0.5, 1.0 and 2.0 cm(2) at indentation speeds of 0.5, 1 and 2 mm/s showed that PPT depends on the location stimulated, area of stimulation and the indentation speed. The results also showed that tissue stiffness is quite low for small deformations ( < 4 mm), but significantly higher at large deformations (>4 mm). The stiffness at the larger deformation region was positively correlated with PPT (r = 0.63, p < 0.001). The data were further used to develop a model with PPT, deformation and stimulated area.

PRACTITIONER SUMMARY

Pressure at which there is an onset of pain is higher when a larger area of soft tissue is stimulated. Bony areas may be better suited to bear load on smaller areas to minimise pressure-related pain. Thus, manipulating supporting surface stiffness and surface contours can help minimise pain.

Relationships of toe-length ratios to finger-length ratios, foot preference, and wearing of toe rings

Sexually differentiated digit ratios of the hand (2D:4D and other) are currently widely studied, owing to their presumed role as a retrospective diagnostic window into prenatal androgen action. This study was only the second one (following McFadden & Shubel, 2002) to examine all 6 possible finger-length ratios (excluding the thumb) and all 10 possible toe-length ratios (including the big toe). Data from a sample of 59 male and 69 female Austrian adults (M age = 27 yr., SD = 7.9) were collected. Replicating the prior study, the majority of toe-length ratios exhibited significant sex differences, which was similar to finger-length ratios, but of weaker effect size. Ipsilateral correlations of toe-length and finger-length ratios were largely absent, except for those of corresponding or adjacent length ratios of the right body side among women. However, these associations were directionally opposite, such that among women, feminized finger-length ratios corresponded to masculinized toe-length ratios. Foot preference (among both sexes) and wearing of toe rings (among women) were not correlates of toe-length ratios. Discussed are implications of these findings for digit ratio research, along with ideas for further inquiry on this topic.

Digit Ratio (2D:4D) and Wearing of Wedding Rings

Digit ratio (2D:4D), a putative marker for prenatal androgen levels, and absolute finger length, a marker for pubertal androgen action, were not associated with wearing of wedding rings in a sample of 150 male and 199 female married individuals. This failure to replicate associations previously reported by Manning was true for both men and women, self-reported and spousal ring-wearing behavior, and one's own and spousal 2D:4D or absolute finger lengths. Supplemental findings included sex differences and age effects in the prevalence of wearing wedding rings (more frequent in women and the younger than in men and the older) and a sex bias when ring-wearing behavior within couples was discordant (men more frequently did not wear their wedding ring when their wives did than vice versa). Discussed are implications of the current findings and directions for future research into possible associations of 2D:4D with other aspects of body ornamentation.