








































Bioarchaeology International

Copyright © 2021 University of Florida Press

DOI: 10.5744/bi.2021.1010
Volume 5, Numbers 1–2: 1–20 

Two (Missing) Left Feet: Caring for Foot Amputees 
in Late Pre-Hispanic Túcume, Lambayeque  Peru 

Megann Phillips,a Vanessa Cruz,a Erin K. Martin,a Dylan R. Smith,a  
Bernarda Delgado Elias,b José Manuel Escudero Villalta,b  and J. Marla Toynea*

aDepartment of Anthropology, University of Central Florida, Orlando, FL 32816, USA
bMuseo de Sitio de Túcume, Lima, Peru
*Correspondence to: J. Marla Toyne, Department of Anthropology, University of Central Florida, 4000
Central Florida Blvd., Howard Phillips Hall Rm. 309, Orlando, FL 32816, USA

e-mail: J.Marla.Toyne@ucf.edu

ABSTRACT Understanding pre-Hispanic Andean medical practices through skeletal evidence of surgery has been the focus 
of a number of bioarchaeological investigations in recent years. Amputation is an especially interesting topic of 
research due to the variety of social contexts in which it might have occurred. Interpretations for amputation 
found on the north coast of Peru have included therapeutic intervention, punitive measures, and ritualistic 
dismemberment. Here, we present two new cases of successful left foot amputation in young adult females exca-
vated from Huaca Las Balsas (Late Intermediate Period, A.D. 1100–1470) and Huaca Las Abejas (Late Horizon, 
A.D. 1470–1535) at the ancient religious and administrative center of Túcume. Chronologically, they are the
latest cases of pre-Hispanic amputation published to date. Contextual evidence supports a therapeutic motiva-
tion for the procedure, as individualized burial treatment and placement within a cemetery group of social
elites is not consistent with punitive or ritualistic action. Modification of the malleoli, extensive bone prolifera-
tion covering the talar articulations, and asymmetrical cortical bone thickness of the tibiae and fibulae
(revealed radiographically) suggest the return of some functional mobility using the affected limb after healing. 
This long-term recovery is evidence of access to quality medical care and accommodation of functional impair-
ment within the amputees’ communities. The presented research uses the bioarchaeology of care approach to
explore the lived experiences of these amputees and their social identities, making an important contribution
to the anthropology of disability across cultures and time periods.

Keywords: amputation; ancient medical practice; bioarchaeology of care; disability; skeletal trauma; surgery

Comprender las prácticas médicas andinas prehispánicas a través de evidencia esquelética de cirugía ha sido el 
foco de una serie de investigaciones bioarqueológicas en los últimos años. La amputación es un tema de investi-
gación especialmente interesante debido a la variedad de contextos sociales en los que podría haber ocurrido. 
Las interpretaciones para la amputación que se encuentran en la costa norte del Perú han incluido la inter-
vención terapéutica, las medidas punitivas y el desmembramiento ritual. Aquí, presentamos dos nuevos casos 
de amputación exitosa del pie izquierdo en hembras adultas jóvenes excavadas desde Huaca Las Balsas (Período 
Intermedio Tardío, A.D. 1100–1470) y Huaca Las Abejas (Horizonte Tardío, D.C. 1470–1535) en el antiguo centro 
religioso y administrativo de Túcume. Cronológicamente, son los últimos casos de amputación prehispánica 
publicados hasta la fecha. La evidencia contextual apoya una motivación terapéutica para el procedimiento, ya 
que el tratamiento y la colocación individualizados del entierro dentro de un grupo cementerio de élites sociales 

Received 30 June 2020;  
Revised 5 October 2020;  

Accepted 30 October 2020



Caring for Foot Amputees in Late Pre-Hispanic Túcume2

Limb amputation is one of the oldest known surgi-
cal procedures (Markatos et  al. 2019; Sachs et  al. 
1999), documented by both historical and archaeo-
logical record. It is defined as the intentional re-
moval of a limb, either partially or completely 
(Marcovitch 2009:28). The earliest possible evidence 
of this practice dates to the Neandertals buried in 
Shanidar Cave, Iraq, over 40,000 years ago (Stewart 
1977), and archaeological evidence of both success-
ful and unsuccessful ancient amputations has been 
found globally. Examples exist in England (Mays 
1996), Portugal (Fernandes et  al. 2017), France 
(Buquet-Marcon et al. 2007), Bulgaria (Zäuner et al. 
2013), South Africa (Van der Merwe et al. 2010), and 
Egypt (Dupras et al. 2010; Nerlich et al. 2000). More-
over, amputation remains as medically relevant to-
day as it was in the past. Although surgical practices 
have evolved significantly, with advances in anes-
thetic, imaging, and operative technologies, the re-
moval of an appendage is a life-altering procedure 
that continues to be used in the treatment of trauma 
(Ahmad et  al. 2019; Barla et  al. 2017; Moini et  al. 
2009), circulatory and neuropathic issues (Nanwani 
et  al. 2019), localized infections (Boffeli 2015), and 
other conditions (Zhao et al. 2020).

This article expands current understandings of the 
history and social implications of amputation by pre-
senting two new cases from Túcume, Peru, dated to 
the Late Intermediate Period (A.D. 1100–1470) and 
Late Horizon (A.D. 1470–1532). These cases evidence a 
regional continuity of surgical practices that endured 
for hundreds of years between the Moche culture 
(A.D. 100–700) and the Inca empire (A.D. 1470–1532). 
Additionally, utilization of the bioarchaeology of care 
approach (Tilley 2015; Tilley and Cameron 2014)  
allows these cases to be framed as reflections of 

community care practices and lived experiences of 
amputees in north coastal Peru. The bioarchaeology 
of care is essential to understanding the nuances of 
chronic functional impairment in the past—an im-
portant contribution to modern disability studies.

Although functional impairment, healthcare, and 
disability are separate concepts that should not be con-
flated, they are often intertwined. This analysis of am-
putation at Túcume explores the possibility that the 
survival of Andean amputees in the distant past was 
aided by community members and urban infrastruc-
ture. However, it simultaneously acknowledges the po-
sition of amputees as agentive community members 
that might or might not have actually been considered 
disabled. In contrast to previously discovered cases of 
pre-Hispanic amputation in the region, skeletal and 
mortuary evidence from Túcume suggests that ampu-
tation occurred as a form of medical intervention, and 
accommodation of resulting physical limitations fell 
within contemporary cultural norms.

Bioarchaeology of Care

The bioarchaeology of care (Tilley 2015; Tilley and 
Cameron 2014) is an emerging interpretive frame-
work in bioarchaeology that emphasizes the role of 
community in the lives of impaired or disabled indi-
viduals. This can involve the provision of medical care 
for acute or chronic ailments, general task assistance, 
and emotional support offered to a person with a lim-
iting condition either directly (often by kin) or indi-
rectly within an accommodating sociopolitical 
structure. The identities of impaired or disabled indi-
viduals are highly dependent on cultural context and 
are situationally malleable, and not all functionally 

no es consistente con la acción punitiva o ritualista. La modificación de los maléolos, la extensa proliferación 
ósea que cubre las articulaciones talares y el grosor óseo cortical asimétrico de las tibias y los peronés (revelados 
radiográficamente) sugieren el regreso de cierta movilidad funcional utilizando la extremidad afectada después 
de la curación. Esta recuperación a largo plazo es evidencia del acceso a atención médica de calidad y aloja-
miento de deterioro funcional dentro de las comunidades de amputados. La investigación presentada utiliza la 
“bioarqueología de la caridad” para explorar las experiencias vividas de estos amputados y sus identidades so-
ciales, haciendo una contribución importante a la antropología de la discapacidad a través de las culturas y 
períodos de tiempo.

Two huacas, both alike in dignity,

(In fair Túcume, where we lay our scene),

From ancient ground break new amputees,

Where literal dirt made our hands unclean.

—Modified for contextual purposes from Shakespeare (1597:1)



Caring for Foot Amputees in Late Pre-Hispanic Túcume 3

impaired people identify as disabled or require signif-
icant structural accommodation to complete essential 
tasks (Byrnes and Muller 2017; Kasnitz and Shuttle-
worth 2001; Reid-Cunningham 2009). However, sur-
vival and quality of life of a person with impaired 
functional abilities often rely on interpersonal and 
structural accommodation. This includes healthcare 
access, which is often dependent on socioeconomic 
status (Becker and Newsom 2003; Kristiansson et al. 
2009; Walters and Suhrcke 2005), and cultural per-
ceptions of impairment (Rösing 1999).

The bioarchaeology of care has become an invalu-
able framework to guide paleopathological analysis 
because of its ability to integrate social theory related 
to identity and compassion (Tilley 2015; Tilley and 
Schrenk 2017). Due to the intangibility of emotions 
such as compassion (Dettwyler 1991), some bioar-
chaeologists shy away from the more ephemeral as-
pects of the approach. However, regardless of 

emotional consideration, the bioarchaeology of care 
has proven its utility in a wide variety of social con-
texts that range from hunter-gatherer groups (Tilley 
and Oxenham 2011; Tilley 2015) to recent historical 
institutions (Tremblay Critcher 2017; Wesp 2017).  
Previous examples of the bioarchaeology of care in 
Peru include publications that address trepanation 
(Jolly and Kurin 2017), crippling Thoracic Outlet 
Syndrome (Palma Málaga and Makowski 2019), and 
chronic post-injury osteomyelitis (Sutherland 2019) 
as conditions that affected individuals and their care-
takers in late pre-Inca cultures of central and 
south-central parts of the country.

Amputation in Pre-Hispanic Peru

The history of the bioarchaeology of care in Peru is 
currently limited, considering the relatively  

Table 1. Presently Published Examples of Pedal Amputation from Pre-Hispanic North Coast Peru.

Site
Time Period  
and Culture Individual Age and Sex Side Suggested Motivation

Túcume1 Late Horizon, H. Las Abejas, unit XA, 
Ent. 1

Young adult female Left Medical/therapeutic amputation

Chimú-Inca

Túcume1 Late Intermediate H. Las Balsas, unit IB, 
Ent. 1

Young adult female Left Medical/therapeutic amputation

Period, Lambayeque

Castillo de Huarmey2 Middle Horizon, Imperial tomb, 
Individual XY

Young adult male Left Ritual amputation

Wari

Castillo de Huarmey2 Middle Horizon, Imperial tomb, 
Individual XX

Middle adult female Left Ritual amputation

Wari

El Brujo3 Early Intermediate West Sector, Tomb 4 Middle adult male Both Intentional amputation

Period, Moche

El Brujo3 Early Intermediate Huaca Cao, BRU  
M98-4

Adult male Left Intentional amputation

Period, Moche

Mocollope3 Early Intermediate MOC98-1 Young adult female Right Intentional amputation

Period, Moche

Mocollope4 Early Intermediate — Unknown adult Both Punitive amputation

Period, Moche

Huacas de Moche5 Early Intermediate Plataforma Uhle, Tomb 
48

Young adult male Left Not considered

Period, Moche
1Present study
2Więckowski (2016)
3Verano et al. (2000)
4Vélez López (1913)
5Chauchat et al. (2009)



Caring for Foot Amputees in Late Pre-Hispanic Túcume4

Figure 1. Map of north coast of Peru showing locations of sites mentioned in the text. Map created by Toyne.



Caring for Foot Amputees in Late Pre-Hispanic Túcume 5

recent definition of this theoretical paradigm, and 
there is much room for expansion. This article seeks 
to continue the regional application of the bioarchae-
ology of care with the analysis of amputees from Pe-
ru’s north coast. The cases presented provide an 
important extension of previous discussions of 
pre-Hispanic Peruvian amputation practices by pro-
viding fresh evidence for surgical practices, motiva-
tions, and effects on long-term identity and social 
integration.

Previously identified cases of pre-Hispanic pedal 
amputation include those published by Vélez López 
(1913), Alva and Donnan (1993), Verano (1997), Ver-
ano et al. (2000), Chauchat et al. (2009), and Więck-
owski (2016) (Table 1). Some of these examples of foot 
removal, all of which were found on the north coast 
of Peru, are presumed to have been well-healed ante-
mortem amputations due to bony remodeling of the 
affected area. However, other examples of missing 
feet in the bioarchaeological record are less easily  
interpretable. Although Verano (1997) and Alva and 
Donnan (1993) note that a footless “guard” was placed 
at the entrance to Tomb I and at the entrance to Tomb 
II at Sipán (an elite Moche burial site), the poor pres-
ervation of these skeletons inhibited observation of 
their distal lower leg bones. It is therefore unclear 
whether the missing feet of these tomb guardians  
reflect antemortem amputation or postmortem 
removal.

Of the individuals who do provide evidence for an-
temortem foot amputation, the earliest were found at 
the site of Mocollope, the El Brujo complex, and the 
Huacas de Moche complex (Fig. 1). All of these early 
cases are associated with the Moche culture  
(A.D. 100–700) (Chauchat et  al. 2009; Vélez López 
1913; Verano et  al. 2000). The contextual evidence 
does not suggest that these individuals were inten-
tionally amputated to serve as tomb guardians. While 
the motivation is unknown, it is evident that each in-
dividual survived long enough to support substantial 
remodeling of the ankle joint after removal of the 
foot. The amputees found at the Castillo de Huarmey 
(Więckowski 2016) (Fig. 1), associated with the Wari 
culture (A.D. 600–1100), also seem to have been long-
term survivors of amputation. However, they ulti-
mately served as tomb guardians. They were buried 
in a distinct location in the floor of the antechamber 
to the Wari imperial mausoleum of elite women.

The placement of footless individuals as apparent 
guardians at the entrance to elite tombs suggests a sym-
bolic or spiritual importance of feet and foot amputa-
tion among the Moche as well as the Wari. This 
possibility is supported by the frequent depiction of 
isolated feet and foot amputees in Moche ceramics  
(Paico Vílchez and Paico Zumaeta 2020; Vélez López 1913)  

and the appearance of isolated feet in Wari ceramics 
(Trigo Rodríguez and Hidalgo Rocabado 2012; Więck-
owski 2016). However, although a general cultural fas-
cination with feet and foot removal is suggested by this 
type of artistic expression, ceramics might also lend 
evidence to punitive or therapeutic theories regarding 
the motivations underlying amputation. For example, 
amputees depicted by the Moche sometimes have a 
mutilated nose and lips, which could be interpreted  
either as punitive maiming or as a symptom of a patho-
logical condition such as nasal leishmaniasis (Verano 
et al. 2000). Amputation of the foot (or feet) could have 
been an additional punitive measure or intended as a 
treatment for a pathological condition that affected 
hands and feet. As it is depicted in ceramics, amputa-
tion motivated by advanced leishmaniasis, or a similar 
condition, is considered unlikely due to the unaffected 
appearance of non-amputated extremities. Nonethe-
less, this does not rule out other medical reasons for 
amputation in the ceramic or bioarchaeological 
record.

Non-punitive amputation that is not ideologically 
motivated is suggested by the burial of some individ-
uals in traditional, non-guardian burial contexts. 
This includes the burial contexts of amputees found 
at El Brujo and Mocollope (Verano et al. 2000), Hua-
cas de Moche (Chauchat et  al. 2009), and Túcume 
(this publication).

Archaeological Context

Túcume is an extensive archaeological complex  
located within the La Leche River Valley, approxi-
mately 30 kilometers north of the modern Lam-
bayeque regional capital of Chiclayo. Initially 
associated with the Lambayeque culture (A.D. 900–
1350), the history of Túcume covers more than 400 
years of occupation and three major shifts in political 
control (Heyerdahl et al. 1995; Shimada 1981, 2009). 
Monumental construction at Túcume commenced 
during the Late Intermediate Period at the site (A.D. 
1050), and it continued for roughly three centuries 
until the region was incorporated into the north 
coastal Chimú empire around A.D. 1350 (Heyerdahl 
et al. 1995). Around A.D. 1470, the Inca empire that 
was rapidly expanding from Peru’s southern high-
lands conquered the Lambayeque Valley region. The 
Inca appear to have used Túcume as their primary 
regional administrative center until the arrival of the 
Spanish in A.D. 1532, when the site was burned and 
ultimately abandoned (Covey 2008; Narváez Vargas 
1995b; Sandweiss 1995).

The administrative and religious core of the  
complex consists of 26 truncated adobe pyramids 



Caring for Foot Amputees in Late Pre-Hispanic Túcume6

(Fig. 2)—called huacas due to their status as sacred 
pre-Hispanic monuments. These huacas were built 
during the Lambayeque occupation around a steep 
rocky outcropping named Cerro La Raya (Delgado 
Elías and Narváez Vargas 2016; Narváez Vargas 
1995b; Narváez Vargas and Delgado Elías 2011; Sand-
weiss 1995). They vary greatly in size and structural 
complexity due to their differential uses for adminis-
trative, ceremonial, and elite residential purposes. 
Huaca Las Balsas and Huaca Las Abejas are among 
those found in the southwestern sector of the archae-
ological complex. They appear to have functioned as 
residences and mortuary monuments for associated 
cemeteries containing social elites (Delgado Elías 
and Narváez Vargas 2016; Narváez Vargas 1995a; 
Narváez Vargas and Delgado Elías 2011).

Huaca Las Balsas is a moderately sized platform 
mound, measuring approximately 35 × 25 m, with a 
height of approximately 4.5 m (Narváez Vargas and 
Delgado Elías 2011). Despite its smaller size, Huaca 
Las Balsas has been the subject of much archaeologi-
cal inquiry due to the presence of intricate carved 

murals on its walls. The murals depict maritime 
scenes, including divers collecting Spondylus and an-
thropomorphic bird figures sailing on wooden rafts 
(balsas). Along with these murals, which inspired the 
huaca’s modern name, the main features of the con-
struction include superficial residential structures, 
cooking areas, two descending ritual platform areas, 
and a small platform containing eight burials. These 
Lambayeque burials (approximately A.D. 1240–1300) 
include adult males and females as well as juvenile in-
dividuals, and grave associations indicate middle 
elite social status (Delgado Elías and Narváez Vargas 
2016; Narváez Vargas and Delgado Elías 2011).

Huaca Las Abejas measures approximately  
57 meters in length and width and 8 meters in height. 
The initial architectural survey revealed three con-
struction phases of ritual platforms and a ramp, likely 
from the Late Intermediate Period (A.D. 900–1470) 
(Escudero Villalta 2018). Unlike Huaca Las Balsas, 
excavations have yet to identify residential structures 
or burials on top of Huaca Las Abejas. However, a 
small cemetery to the north of the huaca contained 

Figure 2. (a) Burial of Case 1 (Las Balsas, unit IB, Entierro 1) shown in situ with extended body position. (b) Burial of Case 2 (Las Abejas, unit XA, 
Entierro 1) shown in situ, seated and flexed with a few grave goods. (c) Map of the Túcume archaeological complex, with Huaca Las Abejas and Huaca 
Las Balsas circled. Figure created by Toyne.



Caring for Foot Amputees in Late Pre-Hispanic Túcume 7

28 well-preserved human burials that are of a similar 
demographic profile to the burials excavated from 
Huaca Las Balsas. The interred individuals were of 
middle elite status, although they have been dated to 
the Late Horizon (approximately A.D. 1470–1532) 
based on associated ceramic materials and the seated, 
flexed burial positioning that are characteristic of 
Chimú-Inca occupation (Escudero Villalta 2018).

Materials and Methods

Toyne conducted osteological analysis of the skele-
tons in the field in 2009 and 2014, including metric 
and morphological observations, following the stan-
dards established by Buikstra and Ubelaker (1994) 
and Ubelaker (1999). Biological assessment of age at 
death and sex were estimated based on morphologi-
cal characteristics of the os coxae and crania. Stature 
was estimated using tibial condylomalleolar length 
(CLT) using the regression equation proposed  
by Pomeroy and Stock (2012) (stature = 57.748  
+ 2.800CLT), which was recommended for regional 
accuracy by Anzellini and Toyne (2020). Macroscopic 
observations of pathological bone modification were 
recorded based on visual examinations, including ev-
idence for traumatic damage, bone remodeling, and 
inflammatory response (Ortner 2012). Other patho-
logical changes observed include cranial modifica-
tion, dental pathology, and osteoarthritic joint 
changes. Finally, key skeletal elements (right and left 
humeri, femora, and tibiae) were transported to the 
Econor diagnostic imaging clinic in Lambayeque, 
Peru, where standard film, single-plane radiographs 
were taken.

Analysis of these individuals was conducted 
according to standard bioarchaeology of care 
guidelines (Tilley 2015; Tilley and Cameron 2014). 
The following sections of this report document 
the process of bioarchaeology of care analysis 
through four prescribed steps. These steps ensure 
appropriate consideration of functional impair-
ment and the healthcare that might have been 
necessary for an impaired person’s survival.  
They include: (1) description, diagnosis, and doc-
umentation of the pathological condition from 
skeletal and other bioarchaeological evidence; (2) 
determination of whether or not an individual 
would have received medical and/or other care 
from their community; (3) construction of a 
model of care that might have been necessary for 
an impaired individual’s survival; and (4) inter-
pretation of the model of care in a broader social 
context.

Description, Diagnosis, and Documentation

Description of Case 1: Las Balsas, Unit IB, Entierro 1

This individual (female, between 30 and 40 years) 
was buried atop Huaca Las Balsas in a simple pit. 
The skeleton was in an extended position with slight 
flexing of the legs, positioned with the head to the 
south (Fig. 2). This burial was part of the group of 
eight burials, including a camelid. Radiocarbon 
dates from nearby Entierro 5 produced a date  
between cal A.D. 1240 and 1300 (720 +/– 40 B.P.), 

Figure 3. The almost-complete skeleton of Case 1 (Las Balsas, unit IB, 
Entierro 1). Photo by Toyne.



Caring for Foot Amputees in Late Pre-Hispanic Túcume8

which corresponds to the Lambayeque occupation 
of the Late Intermediate Period.

Grave position and associations of the individual 
from Huaca Las Balsas are similar to materials recov-
ered from other Lambayeque-style burials at the site 
(Narváez Vargas 1995a). For individuals identified as 
female based on skeletal indicators, burial treatment 
generally consisted of interment in the extended or 
slightly flexed position and accompaniment by a va-
riety of functional vessels and weaving-related items. 
In this particular grave, there were four gourd bowls, 
one small ceramic cooking pot, two small copper 
beads near the cranium, and 68 spondylus shell beads 
near the right and left wrists. The weaving-related 
items found in the grave include three decorated 
wooden weaving loom pieces, a gourd needle con-
tainer, three copper needles, various balls of threads, 
and chalk. The body was wrapped in a poorly pre-
served, simple, brown cotton textile.

This individual was represented by an almost com-
plete, well-preserved skeleton with minor tapho-
nomic breakage and surface erosion (Fig. 3). Missing 
skeletal elements included the left calcaneus, talus, 
tarsal bones, metatarsal bones, and pedal phalanges 
(although these elements are thought to be missing 
due to pathological rather than taphonomic reasons). 
Using the non-pathological right tibia, stature was 
estimated to be 144.6 cm. This is slightly shorter than 
the average height of 147.9 cm (σ = 3.08 cm) that was 

calculated for the seven other adult females interred 
within similar burial contexts at Túcume.

The cranium is intact and exhibits a moderate de-
gree of cranial modification, showing flattening 
across the frontal and occipital bones that resulted in 
bilateral bulging of the parietal bones. Remodeled 
macroporosity on the posterior bones of the cranial 
vault is consistent with healed porotic hyperostosis. 
Observations of the dentition revealed a moderate 
degree of dental attrition that resulted in flat occlusal 
surfaces of all teeth, four well-healed alveolar sockets 
indicative of antemortem tooth loss, some hypoplas-
tic defects of the anterior dentition, and four alveolar 
abscesses that caused resorption of the maxilla. There 
was also a large carious lesion of the mandibular sec-
ond molar and minimal dental calculus on the labial 
surfaces of most teeth. In the postcranial skeleton, 
two small Schmorl’s nodes were observed on the su-
perior bodies of the ninth and twelfth thoracic verte-
brae. Minor osteophytic lipping affected the anterior 
body margins of the sixth through twelfth thoracic 
vertebrae.

The key pathological feature on the skeleton was 
the osteological (morphological and radiographic) 
modification of the distal portions of the left tibia 
and fibula (Fig. 4). Although fragility of the affected 
bone seems to have contributed to some postmortem 
fragmentation of relevant pathological features, vi-
sual observations of the medial malleolus of the tibia 

Figure 4. (a) Detailed anterior oblique view of the left distal tibia and fibula of Case 1 (Las Balsas, unit IB, Entierro 1). (b) Fragments of the distal artic-
ular surface of the tibia showing bone proliferation. Photos/figure by Toyne.



Caring for Foot Amputees in Late Pre-Hispanic Túcume 9

showed that it was not consistent with normal mor-
phology. The recovered fragments of the articular re-
gion demonstrate active bone proliferation. There 
was evidence of healed periosteal reaction along the 
posterior aspect of the midshaft of the tibia and an 
area of raised sclerotic bone at the attachment site of 
the flexor digitorum longus. On the fibula, irregular 
thickening of the distal metaphysis was present. 
There was also mild medial displacement of the lat-
eral malleolus, possibly the result of a healed fracture. 
The distal tibio-fibular and talar articular surfaces 

were completely remodeled so that no facet remained, 
and the fibular summit was rounded rather than py-
ramidal in shape. The attachments for the flexor hal-
lucus longus and soleus muscles along the left fibular 
midshaft also showed pronounced rugosity com-
pared to the right side.

Radiographs of both tibiae and fibulae (Fig. 5a) il-
lustrate the difference in cortical thickness and bone 
density between the right and left sides of the body. 
The cortical bone of the right tibial and fibular diaph-
yses are denser and thicker than the left tibial and 

Figure 5. (a) Anterior-view plain film radiograph of the tibiae and fibulae of Case 1 (Las Balsas, unit IB, Entierro 1). (b) Anterior-view plain film radio-
graphs of the femora of Case 1. (c) Anterior-view plain film radiographs of the humeri of Case 1. Figure created by Toyne.



Caring for Foot Amputees in Late Pre-Hispanic Túcume10

fibular diaphyses. This suggests use-related atrophy 
and reduced biomechanical forces applied to the left 
lower leg. Additional radiographs of the femora  
(Fig. 5b) and humeri (Fig. 5c) also demonstrate asym-
metrical bone thickness and density that is consistent 
with reduced limb use on the left side of the body. 
The appearance of reduced cortical density in the left 
humerus is what might be expected if this individual 
were using a crutch or cane, as one-sided crutch and 
cane use typically occurs contralaterally to the af-
fected lower limb (Edelstein 2019).

Description of Case 2: Las Abejas, Unit XA, Entierro 1

The second individual (female, approximately 30 to 
34 years) was buried in a circular pit in front of the 
Huaca Las Abejas platform. Stratigraphic registra-
tion and grave associations confirm that this burial, 
as well as the other 27 burials recovered together, date 
to the later fifteenth-century Chimú-Inca occupa-
tion. Burial position also supports this cultural affili-
ation, as the interred was situated in a seated and 
flexed body position, with the face collapsed down-
ward over crossed arms and legs (Fig. 2). Typical 
Chimú-Inca burial practices for middle elite people 
at Túcume consisted of wrapping bodies in layers 
textiles and then interring them in a seated, flexed 
position. Grave accoutrements for middle elite 
women typically included functional vessels and 
weaving tools as well as decorative accessories such 
as beaded jewelry.

As with other, better-preserved burials from Hua-
cas Las Abejas, the individual described in Case 2 
was likely wrapped in several layers of woven cloth 
textiles to create an egg-like bundle. However, only a 
few remnants of the burial fabrics remained at the 
time of excavation. The grave goods associated with 
this individual include a small ceramic bowl, two in-
tentionally damaged copper sewing needles, a weav-
ing loom end bar, 25 wooden spindles and threads of 
various colors within a gourd bowl, and a small ball 
of dark brown wool. Copper and shell beads were 
found near the wrists. The grave context also in-
cluded a small, simply decorated jar that contained 
the seeds of the bichayo (Capparis crotonoides) shrub, 
a plant indigenous to the north coastal region of Peru 
and commonly used for firewood and animal fodder. 
The flower and leaves of this plant also have medici-
nal properties for treating skin rashes and other con-
ditions. When boiled, it can be drunk in a tea to treat 
bronchitis or inhaled under sauna-like conditions as 
a remedy for arthritis and bone aches (Bussmann and 
Sharon 2015).

The adult female skeleton was almost complete and 
generally well preserved (Fig. 6), although the left cal-
caneus, talus, tarsal bones, metatarsal bones, and 
pedal phalanges were absent. Termites caused exten-
sive taphonomic damage by burrowing into the mid-
shaft of the right femur and the distal portion of the 
left femur, possibly due to the presence of wooden 
materials within the grave (Huchet et al. 2011). There 
was also postmortem fragmentation of the left os 

Figure 6. The almost-complete skeleton of Case 2 (Las Abejas, unit XA, Entierro 1) from an anterior oblique view, showing termite damage to right 
femur. Photo by Toyne.



Caring for Foot Amputees in Late Pre-Hispanic Túcume 11

coxa, ribs, and scapula. Bone brittleness might have 
contributed to this postmortem fracturing, but oste-
oporosis was not observed. Using the right tibia, her 
stature was estimated to be approximately 144.6 cm, 
similar to the estimated stature of the Lambayeque 
individual from Huaca Las Balsas.

Observations of the dentition found moder-
ate-to-pronounced dental wear that resulted in flat-
tened cusps, as well as a thin layer of dental calculus 
covering almost all lingual and buccal tooth surfaces. 
The right maxillary first molar was lost antemortem, 
as indicated by a well-healed alveolus. Interproximal 
caries developed between the upper left premolars, 
and it appears that the third molars of the maxilla 
and mandible were congenitally absent. Observations 
of osteopathology revealed no porotic hyperostosis or 
cribra orbitalia on the bones of the cranium, but the 
cranial vault did demonstrate a moderate degree of 
fronto-occipital modification. There were also osteo-
arthritic changes to some joint surfaces, including 
those of the shoulders, hips, and right knee. These os-
teoarthritic changes included minor osteophytic lip-
ping and cortical thinning.

The individual demonstrated significant modifica-
tion to the distal articular surface of the left tibia and 
the distal epiphysis of the left fibula. The side-by-side 
comparison of the right and left lower leg bones is 

illustrated in Figure 7. In addition to healed periosteal 
reaction along the medial aspect of the tibia’s distal 
shaft, extensive bony proliferation densely filled the 
tibio-talar articulation, and the collicular features of 
the medial malleolus were remodeled. Only a small 
area of the original joint surface could be observed to 
indicate that there had been a normal facet prior to 
bony remodeling. Although the distal fibula presented 
with a fairly normal tibio-fibular articulation, there 
was alteration of the talar articulation. Bone prolifera-
tion filled the malleolar fossa and the apex was flat-
tened. There also appeared to be a sharply defined 
oval void between the two bones at their distalmost 
point of adjacency, perhaps encapsulating a pocket of 
soft tissue or a cyst-like feature that provided a barrier 
to bony proliferation in that specific area.

Radiographs of both tibiae (Fig. 8a) illustrate 
structural changes to cortical thickness and density 
in the bones of the left limbs. The midshaft of the left 
tibia demonstrated thin cortical bone and irregular 
distal cortical density, and radiographic translucence 
of the distal periarticular area is indicative of atrophy 
due to reduced weight-bearing. The left fibula demon-
strated similar characteristics. Radiography also  
revealed possible tendinopathy of the greater tro-
chanter (Fig. 8b) and some minor decreases in corti-
cal bone thickness of the right humerus relative to 

Figure 7. Detailed anterior oblique view of the distal tibia and fibula of Case 2 (Las Abejas, unit XA, Entierro 1). Photo by Toyne.



Caring for Foot Amputees in Late Pre-Hispanic Túcume12

what is observable in the left humerus (Fig. 8c). This 
observation is complemented by what appears to be 
localized demineralization of the subchondral region 
of the right humeral head. The osteochrondritic radi-
odensity of the left humeral head may be an artifact 
of imaging or perhaps some evidence of avascular ne-
crosis suggesting damage to the shoulder joint.

Differential Diagnosis

The individuals found at Huaca Las Balsas (Case 1) 
and Huaca Las Abejas (Case 2) likely had their left 
feet removed via disarticulation of the ankle joint 
several or many years before their deaths. The nature 
of the bone response at the distal ends of the left tib-
iae and fibulae is indicative of survival after surgical 

amputation, as opposed to congenital absence or in-
complete archaeological recovery of foot bones. Un-
affected diaphyseal morphology indicates maturation 
was not disrupted by unbalanced limb functionality, 
and thus the talus and other foot bones were likely 
removed after the individuals reached adulthood. Di-
aphyseal and distal metaphyseal morphology of the 
tibiae are normal, and abnormal bony proliferation 
within the talar articular cavity seems to have  
occurred over a previously functional joint surface in 
both cases. Although the distal left fibula of the indi-
vidual from Huaca Las Balsas shows significant me-
taphyseal remodeling due to an apparent fracture, 
the distal left fibula of the individual from Huaca Las 
Abejas is of normal morphology, except for the devel-
opment of a more bulbous epiphysis.

Figure 8. (a) Anterior-view plain film radiograph of the tibiae and fibulae of Case 2 (Las Abejas, unit XA, Entierro 1), picturing a right tibial midshaft 
cut for sampling and a left fibula with postmortem fragmentation. (b) Anterior-view plain film radiographs of the humeri of Case 2. Figure created  
by Toyne.



Caring for Foot Amputees in Late Pre-Hispanic Túcume 13

This amputation procedure seems to have been 
intentional and methodical. Accidental or traumatic 
amputation is unlikely as there is no evidence of  
severe trauma in either Case 1 or Case 2 to the mal-
leoli of the tibia and fibula, which constitute part of 
the ankle joint adjacent to the normal position of 
the talus. Although no cut marks are present on the 
distal lower leg bones to evidence surgical removal 
of the foot in either case, it is possible for a well-
trained healer to disarticulate the ankle joint by 
cutting only the soft tissue between the articular 
surfaces (Kirkup 2007; Markatos et  al. 2019).  
This would not leave cut marks on the bone sur-
faces. Additionally, if cut marks on the bone were 
made, it is very likely that bone remodeling would 
have obscured them over time.

In modern and historic contexts, intentional am-
putation has been performed as punishment or as a 
ritual practice (Adejumo and Olabisi Adejumo 2005; 
Bosmia et  al. 2014; Kirkup 2007; Mavroforou et  al. 
2014). Some have suggested these potential motiva-
tions for pre-Hispanic north coast Peruvian amputa-
tions (Kirkup 2007; Verano et al. 2000; Więckowski 
2016). However, the contexts in which the amputees 
from Túcume were buried does not indicate that 
their amputations were performed for a punitive or 
ideological purpose, as they were not interred in a de-
viant fashion (Murphy 2008; Shay 1985). Their burial 
location, body positioning, and grave accoutrements 
are typical of middle elite women’s burials during 
their respective time periods.

Evidence seems to suggest that the amputations 
were performed for therapeutic purposes. This con-
clusion is supported by the fact that, to date, no indi-
viduals with severe pathological conditions of the 
foot have been discovered at Túcume. Absence of 

evidence for foot trauma, disease, or malformation in 
unamputated feet suggests that such conditions 
might have typically been treated with amputation.

Although trauma, disease, or malformation can be 
causes for amputation, none of these conditions is 
strongly evidenced in the amputees from Túcume. 
The possible healed fracture identified on the distal 
fibula of the amputee from Huaca Las Balsas (Case 1) 
could indicate trauma that preceded, succeeded, or 
was associated with the amputation of the foot.  
Alternatively, a localized infection or a chronic dis-
ease that leaves few or no skeletal indicators could be 
to blame. For example, diabetes might have led to ul-
cer development that necessitated pedal amputation. 
Although there is no skeletal evidence for this condi-
tion (Biehler-Gomez et al. 2019; Dupras et al. 2010) in 
either Case 1 or Case 2, diabetes mellitus is the lead-
ing cause of non-traumatic lower limb and foot am-
putations in the modern world and in Peru specifically 
(Biehler-Gomez et  al. 2019; Villena 2015). Approxi-
mately 50% of foot amputations are attributed to the 
disease (Moulik et al. 2003), and it is known to have 
existed in antiquity (Dupras et al. 2010; Sanders 2002) 
outside of Peru.

Aside from diabetes, there are a number of other 
medical conditions that might have resulted in the 
removal of a foot. As noted in the introduction to this 
article, amputation is used in modern times as a 
treatment for trauma (Ahmad et al. 2019; Barla et al. 
2017; Moini et al. 2009), circulatory and neuropathic 
issues (Nanwani et  al. 2019), localized infections 
(Boffeli 2015), and necroses that result from frostbite 
or other factors (Zhao et al. 2020). Any of these con-
ditions might be considered a potential precursor to 
amputation in the young adult women buried at Túc-
ume, although necrosis that is specifically related to 

Figure 9. Oblique medial posterior view of the right femur of Case 1 (Las Balsas, unit IB, Entierro 1) illustrating musculoskeletal bone modification. 
Photo by Toyne.



Caring for Foot Amputees in Late Pre-Hispanic Túcume14

frostbite should be considered extremely unlikely in 
the relatively warm coastal desert environment of 
Túcume. Congenital defects of the foot, such as club-
foot, might also have been a reason for amputation 
(Wright 2011). However, unilateral congenital mal-
formations of the foot would have likely caused de-
velopmental consequences for the lower limbs due to 
asymmetrical weightbearing during development. In 
both Case 1 and Case 2, aside from reduced cortical 
density of the bones of the left leg, the morphology of 
the right and left lower limbs is symmetrical. This 
would seem to indicate that differential use of the 
lower limbs did not occur until skeletal maturity.

The Case for Care

Regardless of the reason, or reasons, for amputation, 
changes to the distal tibiae and fibulae suggest that 
the individuals were still probably capable of locomo-
tion (although locomotion might have been altered 
or required assistance). In both individuals, the slight 
loss of bone density in the affected left leg, as com-
pared to the right leg, suggests a shift to preferred use 
of the right leg for supporting body weight. However, 
remodeling seems to have occurred in response to 
some force applied to the end of the left lower leg 
bones. This would appear to suggest that, while they 
were not using their left legs in a normal ambulatory 
fashion, the amputated limb might have contributed 
limited weight-bearing while standing, walking, or 
performing other activities.

It is worth noting that the individual from Huaca 
Las Balsas (Case 1) additionally demonstrates remod-
eling and pronounced thickening of the muscular at-
tachment sites for the adductor magnus and biceps 
femoris muscles on the right femur (Fig. 9), possibly 
suggesting increased or irregular usage of the right 
leg. However, it is not clear if this change occurred as 
a result of biomechanical modification of the use of 
the lower limbs due to the amputation of the left foot. 
It could have also occurred separately due to another 
musculoskeletal injury.

Continued mobility after the amputation of the left 
foot could have involved the use of a crutch or pros-
thesis, which would have improved the efficiency of 
modified ambulation. Earlier Moche ceramic vessels 
depicting amputees often include crutches and cup-
like coverings for amputated feet (Checa 2010; Paico 
Vílchez and Paico Zumaeta 2020; Urteaga-Ballon 
1991; Vélez López 1913). Vélez López (1913) and 
Chauchat et  al. (2009) describe prosthetics made of 
wood found in a Moche archaeological context.  
The fact that no such materials were recovered from 
the graves of the amputees at Túcume does not rule 

out the possibility that they were used by these indi-
viduals during life. In fact, the asymmetrical cortical 
bone density of the humeri of both individuals could 
be a product of crutch use. Additionally, a wooden 
crutch or prosthetic might help to explain the termite 
activity in Case 2.

The unilateral amputation of a foot does not 
seem to have caused total immobility in the young 
adult females excavated from Huaca Las Balsas and  
Huaca Las Abejas (Case 1 and Case 2, respectively). 
However, it is important to acknowledge the long-
term consequences of amputation-related physical 
limitations that affected the lives of those with 
missing body parts. In these cases, amputation 
would have affected gait efficiency and left the indi-
viduals relatively less mobile than unamputated 
community members. It is possible that they walked 
with an uneven gait and likely could not participate 
in fast-paced or physically strenuous ambulatory 
activities. With or without the use of a crutch or 
prosthesis, ambulation would have required great-
er-than-average energy expenditure, leaving them 
unable to easily transverse Túcume’s urban core. 
Amputees might have relied on assistance and ac-
commodation from community members for es-
sential chores like food acquisition and other 
locationally tied economic exchanges. They also 
might have required assistance with pain manage-
ment after the amputation procedure, which in it-
self would have required the attention of a person 
who had some level of practical anatomical knowl-
edge and skill.

Unilateral amputation of the foot would not have 
prohibited these individuals from participating in 
typical gender-specific craft production activities, 
such as weaving, that do not involve strain on legs 
and feet. Cloth production would have probably af-
forded them some level of economic independence, 
in addition to their limited ambulatory independence 
with the use of a weight-bearing device. However, ev-
idence of an amputation that was probably therapeu-
tic in nature suggests that these individuals did, in 
fact, receive dedicated medical care at least once in 
their lives. Amputees likely relied on care and atten-
tion from kin, neighbors, and medical specialists 
during and after the surgery.

Modeling Care

Medical and emotional care for amputees

The lack of evidence for reduced social standing or 
greatly reduced quality of life after amputation in the 
two young adult females from Túcume suggests 



Caring for Foot Amputees in Late Pre-Hispanic Túcume 15

availability of surgical care, societal accommodation 
of physical impairment, and possible involvement of 
kin-based support systems in physical and emotional 
post-operative care. These amputees were evidently 
able to access the expert medical care needed to per-
form amputation by disarticulation, possibly due to 
their elite social status or wealth. Additionally, skele-
tal remodeling suggests that they were provided with 
appropriate medical and general care after the surgi-
cal procedure (Buquet-Marcon et  al. 2007; Van der 
Merwe et al. 2010; Zäuner et al. 2013).

The procedure itself would have required anatomi-
cal familiarity and skill in execution, suggesting that 
practitioners of amputation operated as knowledge-
able medical specialists and probably held unique po-
sitions in society, such as healers or shamans 
(Mendoza 2003). The apparent disarticulation proce-
dure that was performed at least twice during differ-
ent time periods at Túcume would have likely been 
executed similarly to a modern-day Syme amputa-
tion, which involves cutting a fish-mouth incision 
around the ankle joint so that the tarsal bones can be 
easily accessed and pulled apart (Yu and Hudson 
2001). The fatty flesh of the heel pad is later used to 
cover the end of the newly footless ankle.

In addition to the disarticulation of the ankle 
joint, the Syme procedure typically also involves the 
resection of the malleoli of the tibia and fibula (Yu 
and Hudson 2001), creating a more solid weight-bear-
ing surface. Neither of the cases discussed here show 
intentional removal of the malleolar portions, and 
clefted stubs depicted in Moche representations of 
amputees suggests this was not common practice on 
the Peruvian north coast in preceding centuries 
(Verano et al. 2000). Despite this inconsistency, the 
Syme procedure provides what is probably the best 
baseline for estimating pre-Hispanic amputation 
methodology.

A healer or shaman performing an amputation 
would have needed at least a basic understanding of 
how to stop bleeding during and immediately after 
the procedure. This might have been achieved 
through tourniquets, limb elevation, and/or bandag-
ing, as has been done historically in other parts of the 
world (Kirkup 2007). Blood loss could also have been 
reduced with the use of local plant-based remedies 
for bleeding and hemorrhaging (Bussmann and Sha-
ron 2006, 2015). Finally, cauterization or suturing 
might have been used to close the wound. Precedent 
for such practices exists elsewhere in the pre-His-
panic Andes (Cabieses Molina 2007; Mendoza 2003; 
Moodie 1929; Toyne 2015b).

Appropriate administration of naturopathic anes-
thetic and pain-relieving drugs (Bussman and Sha-
ron 2006, 2015; Martin 1970) would have greatly 

benefitted patient comfort during and after the surgi-
cal process. Other necessary short-term post-opera-
tive care would have included wound hygiene and 
provision of food and water when the physical exer-
tion required for self-care would have resulted in ex-
cessive pain or disruption to healing tissues. It would 
have likely involved changing bandages and admin-
istering anti-inflammatory and/or infection-combat-
ting drugs as well (Kirkup 2007; Pullen 2010). Some 
endemic plant species are used by local people in the 
modern day to ward off bacterial, viral, and parasitic 
infection, and these plants were likely used for the 
same or similar purposes in the distant past 
(Bussmann and Sharon 2006, 2015).

Another probable responsibility of ancient ampu-
tees’ caretakers was to aid in their efforts to relearn 
basic skills, such as walking (Kirkup 2007). Although 
rehabilitation after a unilateral Syme amputation is 
less challenging than doing so after an amputation 
procedure that more dramatically alters the limb, the 
amputees from ancient Túcume likely felt imbal-
anced and required interpersonal assistance while 
they adjusted to their new reality (Finkler et al. 2017). 
Assistance could have been given by people of close 
relation to the amputees, such as members of their 
immediate family. However, this is speculative. 
Short-term post-operative care might have also been 
performed by medical practitioners or other commu-
nity members.

Naturopathic treatments for pain and discomfort 
also probably played a role in amputees’ long-term 
care routines. The bichayo plant, for example, whose 
seeds were found in the burial context of the amputee 
from Huaca Las Abejas (Case 2), can serve as a rem-
edy for arthritis, bone aches, and skin irritations 
(Bussmann and Sharon 2015:127). Its presence in the 
grave of this individual could suggest that the plant 
became associated with her identity after frequent 
use, possibly as a solution to joint pain caused or ex-
acerbated by habitual compensatory movements after 
loss of the left foot. Use-related migration of the heel 
pad and subsequent ulceration (Bibbo 2013) or the 
cyst-like structure present at the amputated ankle 
joint might also have been a cause of discomfort that 
the amputee and her caretakers attempted to treat 
through the use of bichayo. Heel pad migration and 
ulceration are common in modern amputees whose 
feet were removed via the Syme procedure, in which 
the fatty heel pad is used to cover the newly footless 
ankle stub (Bibbo 2013), but it is unclear whether or 
not the surgeons of pre-Hispanic Túcume used the 
heel pad to cover the amputation wound.

Ultimately, it is important to note that the care 
necessary during post-amputation life includes phys-
ical as well as emotional support. Studies of 



Caring for Foot Amputees in Late Pre-Hispanic Túcume16

contemporary amputees show that amputation of 
lower extremities not only causes physical trauma, 
but also emotional and psychological damages. Pa-
tients often suffer from anxiety, depression, grief, and 
social discomfort associated with changes to body 
image (Liu et  al. 2010; Madsen et  al. 2016). Histori-
cally, these same post-amputation physical and psy-
chological struggles were documented in civil war 
soldiers recovering from amputation as they at-
tempted to come to terms with new limitations in 
functionality and shifts in their social identities 
(Bonnan-White et al. 2016; Miller 2015). It is impossi-
ble to know the emotional struggles of individuals 
who lived in the distant past, especially in societies 
not represented by written histories, but it is import-
ant to recognize that lived experiences encompass 
more than solely physical events. The social circles of 
the amputees from Huaca Las Balsas and Huaca Las 
Abejas likely provided important emotional support.

Implications of Care

Social integration of amputees

Despite physical impairment and its emotional con-
sequences, it is important to consider the fact that in-
dividuals affected by unilateral foot amputation 
might not have been classified as disabled within the 
societal norms of Late Intermediate Period and Late 
Horizon Túcume. Some modern scholars studying 
the anthropology of disability choose to make a clear 
distinction between impairment and disability, with 
disability being defined as the social stigma that is as-
sociated with psychological or physiological impair-
ment or malformation (Kasnitz and Shuttleworth 
2001). Ethnographic research on disability in a num-
ber of modern cultures has revealed that impair-
ment-related stigma is not applied according to 
universal standards.

Atypical functional phenotypes are sometimes 
even seen as supernatural or sacred. Rösing (1999), 
for example, relates several anecdotes of physical im-
pairments in the modern Andes that suggest recogni-
tion of disability is dependent on an impaired 
individual’s community contribution, and in some 
cases (such as those involving medicine men with 
crippled hands) impairment might actually be viewed 
as sacred. She presents the hypothesis that: “In the 
Andes having more disablement often means being 
less disabled. The reasons are, amongst others, the 
broader space allowed for compensation within the 
framework of the norms of reciprocity and represen-
tation, as well as the sacred legitimization resource” 
(Rösing 1999:40).

The distinction between impairment and stigma-
tized disability provides some interpretive implica-
tions related to burial practice and social identity. 
Social exclusion based on physical impairment could 
result in deviant burial—a burial style that deviates 
from the typical model (Murphy 2008; Shay 1985). In 
the Andes, deviancy is often argued through atypical 
body treatment, separate burial location, lack of asso-
ciated burial goods, or some combination of these 
characteristics. Most examples of deviant burial in 
Peru have been associated with sacrifice and warfare 
(Eeckhout and Owens 2008; Verano 1995). Although 
deviant burials of human sacrifices are found near 
the Temple of the Sacred Stone at Túcume (Toyne 
2015a, 2016), burials of this character have not been 
found elsewhere at the site.

The amputees at Huaca Las Balsas and Huaca Las 
Abejas were seemingly not stigmatized for their lost 
left feet. All indications in the mortuary record point 
toward a conclusion of social normativity rather than 
social deviancy for these young female amputees. In 
fact, it is possible that they might not even have been 
considered disabled. The apparently high level of so-
cial integration experienced by these individuals sug-
gests that they were not outcasts or criminals whose 
left feet were removed for punitive purposes, despite 
the depictions of amputees in Moche ceramics that 
seem to suggest punishment as one potential motiva-
tion of amputation (Vélez López 1913; Verano et  al. 
2000). Instead, they were probably individuals with 
unexceptional social positions and reputations whose 
feet were amputated as treatment for a medical 
condition.

Pre-Hispanic amputation as social practice

The amputations discussed in this paper might have 
had a ritual or sacred significance due to earlier de-
pictions of feet and individuals with amputated feet 
by Moche and Wari ceramic vessels, which suggest 
symbolic importance of the lower extremities. Such a 
conclusion could also be supported by the presence of 
footless guardians in grand Moche (Alva and Don-
nan 1993; Verano 1997) and Wari (Więckowski 2016) 
tombs. However, while valid parallels can be drawn 
between pre-Lambayeque art, pre-Lambayeque mor-
tuary symbolism, and the chronologically later am-
putation cases at Túcume, there is not a consistent 
pattern for ritually motivated amputation in these 
cases.

Andean gendered cosmologies could also be 
used to construct an argument for ritually or sym-
bolically motivated foot amputation at Túcume, 
although this is not strongly supported by contex-
tual evidence. The dualistic gendered symbolism 



Caring for Foot Amputees in Late Pre-Hispanic Túcume 17

of Andean cosmology denotes parallelism and 
complementarity that is ref lected in religious and 
political practices (Silverblatt 1987; Vogel 2018). 
Therefore, pre-Hispanic Andean religious rituals 
often involved separate but parallel spatial organi-
zation within sacred spaces (Silverblatt 1987).  
This included the body. In pre-Hispanic Andean 
cosmology, the left side of the body and the feet 
were often characterized as feminine, while the 
right side and head were characterized as mascu-
line (Baumann 1996). The appearance of two young 
adult women of similar social standing with left-
side foot amputations at Túcume could potentially 
indicate a gendered ritualistic practice. However, 
other known cases of pre-Hispanic pedal amputa-
tion on the Peruvian north coast are inconsistent 
with this pattern (Table 1). At other sites, male in-
dividuals are found with bilaterally or unilaterally 
amputated right and left feet, as are females 
(Chauchat et  al. 2009; Vélez López 1913; Verano 
et al. 2000; Więckowski 2016).

This research, in concert with the amputation 
cases published by Verano et al. (2000) and Chauchat 
et  al. (2009), show that non-symbolic amputations 
occurred in pre-Hispanic north coast Peru. Motiva-
tions for foot removal were likely diverse, and medi-
cine might not have been the only reason that these 
surgeries were performed. Nonetheless, there do ap-
pear to be some shared characteristics between am-
putees. All presently known cases of amputation in 
the ancient Andes have been identified on the north 
coast of Peru, all have occurred in individuals who 
survived the procedure to die as adults, and all seem 
to have been buried as relatively high-status people 
(or were buried alongside them). This evidence sug-
gests that amputation-related medical knowledge has 
deep roots in earlier cultures. Also, access to medical 
care such as amputation might have been an elite 
privilege that was not accessible to people of lower 
status.

Conclusion

The medical history and post-amputation care prac-
tices of the young adult females with amputated left 
feet found at Huaca Las Balsas and Huaca Las Abejas 
provide new evidence for medical knowledge, socie-
tal conceptions of functional impairment and dis-
ability, and broader patterns in amputation in 
pre-Hispanic north coastal Peru. This research 
demonstrates that pedal amputation via disarticula-
tion at the ankle joint has an even longer and more 
dynamic regional history than has been previously 
published.

The Lambayeque and Chimú-Inca amputees from 
Túcume illustrate a regional continuity of medical 
knowledge that transcends major sociopolitical dis-
ruptions and power transitions over hundreds of 
years between Moche regional dominance and the 
arrival of the Spanish. Additionally, the evidence 
shows that amputation had a multidimensional and 
perhaps contextually specific social significance in 
Lambayeque and later cultures of the Peruvian north 
coast. While past bioarchaeological and ceramic evi-
dence has suggested that amputation was used for 
punitive and symbolic reasons, amputation at  
Túcume seems to have been a primarily therapeutic 
practice. These female foot amputees appear to have 
been integrated members of society who were able to 
access advanced surgical care and then survive for 
years afterward—through care and accommodation 
by community members—without severe social  
stigmatization despite newly limited physical 
functionality.

This research sheds new light on amputation as a 
community practice in pre-Hispanic north coast 
Peru. However, perhaps more importantly, it lends 
new temporal and cultural depth to broader anthro-
pological understandings of functional impairment 
and healthcare. The experiences of elite-status ampu-
tees at Túcume should fuel further thought about the 
ways in which class status, community support, and 
other variables affect medical care and social accom-
modation for functionally impaired people.

Acknowledgements

We thank Alfredo Narváez Vargas for his long-term 
commitment to archaeological explorations at Túc-
ume. Daniel Sandweiss has also been a great col-
league. Excavations at Huaca Las Balsas were 
completed under the authorization of the National 
Directorial Resolution No 812/INC, 2009, and at 
Huaca Las Abejas, the National Directorial Resolu-
tion No 288-2017/CGPA/VMPCIC/MC. We also are 
extremely grateful for the decades-long support and 
friendship of Oswaldo Chozo Capuñay, manager of 
the archaeological collections at the Museo Túcume, 
and the many archaeologists, staff, and workers.  
We would like to specifically thank Mila Cancino 
and Felix Angel Gutierrez. For contributions in the 
lab, Toyne thanks Stefani Wai, Paige Douglas, Taylor 
Remley, and Wesley Garrett. Radiographic assistance 
came from Dr. Mislav Čavka, Dr. Fabio Cavelli, and 
Dr. Fabrice Dedouit, Zagreb. Finally, we are grateful 
for the valuable feedback from reviewers.



Caring for Foot Amputees in Late Pre-Hispanic Túcume18

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