W/OPE-450-AU Ste/Mey/koc/mc *Orthopedic shoe for preventing excess pressure loads' The invention relates to an orthopedic shoe for preventing excess pressure loads on pressure-sensitive foot soles according to the preamble of claim 1. Orthopedic shoes of this kind can be used in particular, but 1o by no means exclusively, in the treatment of diabetics. The shoes according to the invention are suitable for treating pressure-sensitive foot soles in general. For diabetics, prevention of excess pressure loads on the feet is of enormous therapeutic importance. On average, one in five people in the age grnp between 20 and 70 v5 require treatment for vein problems or suffer from pathological venous changes that cause symptoms and for which treatment may become necessary, The cause for this is commonly an oftentimes major weakness of the connective tissue leading to a weakeniing of the venous walls and thus to insufficient closure of the venous valves, This causes a reduction 20 of the venous return from both legs into the body. In Gernmny alone, there are about 5 million diabetics among whom a so called diabetic foot is prevalent in a more or less pronounced manner, in consequence. this means that open wounds may develop on the foot sole of the forefoot which often become infected and many times end in 25 amputation of the foot, The causes of the diabetic foot lie in stenoses and potential occlusions of larger arteries and smaller arterial capillaries occurring in the arteral vascular system because of the diabetic metabolic state. As a result, the tissue. in particular the skin, is no longer supplied with a sufficient amount of oxygen and partially dies 2 off, leading to open areas of skin. Owing to the reduced function of the arterial capillaries in particular, the skin nerves are no longer properly supplied and a diabetic polyneuropathy develops This means that the patients lose sensitivity in the malnourished area of the skin. 5 accompanied by a significantly reduced sensitivity to pain, so that anatomically predicted pressure points are no longer registered and the skin is basically damaged without pain, Since the patients feel no pain in the overstrained areas of the skin, the damage to the skin is oftentimes not noticed at all or, in any case, far too late. 10 From DE 10 2010 022 329 Al. a generic shoe with a rigid sole and convexly rounded sole portions is known, which is of the type that can be worn in particular by diabetics. For fixing th.e foot in the shoe the fixation of the heel area in particular is of highest importance in generic shoes because the foot substantially does not roil during walking owing is to the rigidity of the sole. Instead, the shoe rols on the rounded sole portions, the rear part of the sole having to be lifted with respect to the rolling point beneath the ball of the foot when walking forward. When the rear portion of the sole is lfted in this manner, significant forces are active between the fixing means of the shoe on the one hand and the foot 20 on the other hand so as to prevent the heel from wobbling in the shoe, Such wobbling of the heel in the shoe would cause undesiredrelative motions of the foot with respect to the inner side of the sole which night cause injuries and wounds., For fixing tihe heel in the shoe, DE 10 2010 022 329 At proposes a Y 25 shaped insert whose lower end is attached to the sole and whose two upper branches span across the heel on the one hand and the dorsum of the foot on the other hand, This Y-type fxation means has proved to be poorly suitable for a fixation of the foot in the shoe with as little play as possbie, This is in particular because no sufficient tightening pressure 30 can be applied in the area of the heel when tightening the fixation means so that the heel starts to slightly wobble in the shoe. If the support 3 pressure in the area of the dorsum of the foot is excessively increased to compensate the insufficient pressure in the area of the heel, wearing comfort is reduced and undesired blood ne nay alsoone-iors occur. Starting from this state ot the art, it is therefore the object of the present invention to propose a new orthopedic shoe that can be adapted to different foot shapes in the area of the heel so as to reduce or entirely prevent excess pressure loads on pressure-sensitie feet., Throughout this specification, unless the context requires otherwise, the word "comprise" and variations such as "comprises" and "comnprisig m will be understood to imply the inclusion of a stated integer or group of integers but not the exclusion of any other integer or group of integcrs, This object is attained by an orthopedic shoe according to the teaching of claim . Advantageous embodinents of the invention are the subject-inatter of the 15 dependent claims. It should he noted that reference nunibers and letters appearing between parentheses in the claims identifying features described in the emnbodinient and illustrated in the accompanying drawings. are provided as an aid to the reader as an exemplification of the inatter claimed., The 20 inclusion of such reference munrbers and letters is not to be interpreted as placing any lirnitations on the scope of the claims Specifically, in accordance with the inventionh is provided an orthopedic shoe for preventing excess pressure loads on pressur sensitive foot soles, in particular those of diabetics, the shoe having a 25 rigid sole which substantially precludes bending of the forward joint of the foot during walking, and the sole, in the area of the toes and/or in the area of the heel, having a convexly rounded sole portion which allows the rigid sole to roll, and the shoe having a shaft, and fixation reans being provided on the shaft, by means of which the foot can be fixed in 4 the shoe, and the fixation means having a heel strap which extends from the left instep across the back of the heel bone to the right instep and the fixation means comprising a dorsal strap, which extends across the dorsun of the foot and has a pulling means which can be tensioned 5 across the dorsuni for size adjustment, characterized in that the dorsal strap is attached in a load transmitting manner with a left and a right connecting element to the left and right portion of the heel strap, the connecting elements each having a distance to the two ends of the heel strap attached laterally to the shoe 10 and a distance to the center of the heel strap spanning across the heel bone Preferably the orthopedic shoe is characterized in that in the direction of the longitudinal axis of the shoe, the connecting elements are arranged between the center of the heel strap spanning across the heel bone on the 15 one hand and the two ends of the heel strap attached laterally to the shoe on the other hand, Preferably the two ends of the heel strap are attached to the shoe in respective pivot bearings, most preferably riveted thereto with a respective fixing rivet. 20 Preferably the shaft has a shell made of a supple upper material, said shell covering the foot at least in sections, the heel strap extending at least in sections along the outer side of the shell Preferably the heel strap is not connected to the shell in the left and right portion between the center of the heel strap spanning across the 25 heel bone on the one hand and the two ends of the heel strap arranged laterally on the shoe on the other hand, Preferably the center of the heel strap spanning across the heel bone is not connected to the shell made of a supple upper material and is in particular fixed in its height by a flap protruding upward from thw shell.
Preferably the heel strap is produced from a rigid material, the heel strap, in the area of the connecting elements, having a matter weakening, most preferably a wedgeshaped inden ation, by means of which the stiffness of the heel s t rap is decreased transversally to its 5 longitudinal axis, Preferably the sole comprises an outer sole and an inner sole, the outer sole being produced from an elastically damping material, and the inner sole being produced from a more rigid material than the outer sole, Preferably the inner side of the sole facing the foot and the inner side of 10 the shaft facing the foot are formed to be axially symmetric with respect to the longitudinal axis of the shoe, and the shoe can be worn optionally on the left or on the right foot, Preferably the pulling means for tightening the dorsal strap is formed in hre manner of a tension strap, the tension strap being fixed with a fixing 15 end to the dorsal strap and being deflected in a deflection loop attached to the dorsal strap, and the effective tightening length of the tension strap between the fixing end and the deflection loop being adjustable by means of a hook and loop fastener, Preferably two delection loops are provided on the dorsal strap the 20 fixing end of the tension strap being attachable with a coupling means optionally to the right or left deflection loop of the dorsal strap, Preferably the hook tape or loop tape of the hook and loop fastener on the fixing end of the tension strap covers the outer side of the coupling neans associated with the fiing end, 25 Preferably on the inner side of the sole facing the foot, an orthopedic inne shoe sole is arranged, at least one space being formed between the top side and the bottom side of the inner shoe sole, a pad distributing pressure peaks at least in partial areas being arranged in said space, 6 whose deformable pad casing is filled with deformable filling bodies which are mobile relate to one another Preferably the pad casing has at least one dea-ration opening, through which air present in the pad can escape to the outside when pressure is S applied, Preferably the pad is divided into individual pad segnients, wherein in particular one pad segment is arranged in the toe area of the foot, and/or one pad segment is arranged in the area of the forefoot joint of the foot and/or one pad segment is arranged in the area of the metatarsus and 10 tarsus of the foot and/or one pad segment is arranged in the heel area of the foot. Preferably between at least two adjacent pad segments, a spacing groove is provided which allows a relative motion ofthe adjacent pad segments Preferably the pad segments are formed to be at least partially uS comnmunicative, air and/or filling bodies being able to pass through passage openings between two comnunicating pad segments. The shoe according to the invention is based on the idea that fixation means cornprise a heel strap which extends from the left instep across the back of the heel bone to the right instep, and coirmprise a dorsal strap 20 which extends across the dorsum of the foot and has a puffing means. According to the teaching of the invenion it is provided that the dorsal strap is attached in a loadtransmitting manner with a left and a right cointeeting element to the left and right portion of the heel strap, the connecting elements each having a distance to the two ends of the heel 25 strap arranged laterally on the shoe and to the center of the heel strap spanning across the heel bone. By means of such a fixation means, it is possible to optimally fix the heel of the foot to the sole of the shoe according to the inventions. Tis is because the tensioning forces are transmitted at the connecting elencats in a loadtransmitting manner into the two portions of the heel strap when the pulling means of the dorsal strap is tensioned for size adjustment. Since the two ends of the heel strap are attached to the shoe, the tensioning forces transmitted into the heel strap at the connecting elements cause a pulling force to act on the 5 center of the heel strap spanning across the heel bone, Thus, the heel strap applies itself in a form-fitting manner around the heel of the foot and fixes the heel in the shoe by means of a form fil. The tensioning force applied to the heel by the heel strap can be adjusted by the user by varying the tensioning force exerted by the pulling means. Owing to the to formlit adjustable in its tension between the heel strap on the one hand and the heel of the user on the other hand, an optimal fit is set, which prevents the heel from slipping out with respect to the ;soe. Thus, when walking forward, the heel remains fixed in a substantially play-free manner in the shoe also during rolling of the rigid sole and undesired 15 relative motions between the sole of the foot and the nner soie of the shoe are minimized or entirely precluded. The arrangement of the two connecting elements at which the pulling forces are transnttd into the heel strap, relative to the center of the heel strap spanning across the heel bone on the one hand and to the two 20 ends of the heel strap fixed laterally to the shoe on the other hand is of great significance with regard to an optimal adjustment of the fit of the shoe in the area of the heel. This is because the mechanical leverage and pulling ratios change depending on the arrangement of the two connecting elements on the heel strap, It has proven particularly 25 advantageous in this context that, in the direction of the longitudinal axis of the shoe, the connecting elements each are arranged between the center of the heel strap spanning across the heel bone on the one hand and the two ends of the heel strap attached laterally to the shoe on the other hand. This means in other words that, when viewing the shoe in the 30 lateral profile, the connecting elements are arranged between the back of the heel on the one hand and the two attachment points of the heel strap on the other hand. The heel strap can extend straighty or slightly curved 8 between the two attaer.1chent points on the one hand and the center of the heel strap spanning across the heel bone on the other hand, By arranging the connecting elements between the center of the heel strap on the one hand and the ends of the heel strap on the other hand, ft is achieved that, 5 when the pulling means is tensioned, the heel strap pulls the two connecting elements of the two lateral portions of the heel strap out of its straight or slightly curved shape in the direction of the dorsum of the foot and in doing so. high attachment forces can be applied at the heel strap under relatively low adjusting forces on the pulling means owing to 10 the pulling and leverage ratios, For the user, this means a high ease of use because he/she only needs to apply relativelylow forces at the pulling means of the dorsal strap to tension the heel strap. As described before, the two lateral portions of the heel strap are pulled together and upward in the direction of the dorsum of the foot when the is pulling means is tensioned and the center of the heel strap is thus tensioned forward in the direction of the toes This adjusting motion of the heel strap causes a light relative rotation of the heel strap about the attachment point in the area of the attachment points on the two lateral ends of the heel strap This slight rotation can be compensated by a 20 deformation of the heel strap in the area of the attachment points, given a sufficiently elastic material, In that case, however, the user has to apply an additional tensioning force to elastically deform the heel strap in the area of the two attachment points. To avoid this additional tensioning force, it is therefore particularly advantageous if the two ends 25 of the heel strap are attached to the sole in pivot bearings. For this purpose, the two ends of the heel strap can be riveted to the sole with a fixing rivet, for exanpte. The pivot bearing permits a substantially force-free rotation of the ends of the heel strap about the attachment point, wherein, at the same time, the necessary tensioning forces can be 30 transmitted into the sole via the pivot hearing, 9 The shaft of the shoe according to the invention is intended to fix the foot on the sole of the shoe. To this end, the shaft of the shoe surrounds the top side of the foot at least in sections. For example, the shaft can be composed of various bands, an open. shoe, e g, a sandal, thus being 5 formed. Alternatively or additionally, the shaft can comprise a shell made of a supple upper material. Said upper material may be synthetic materials, such as Gore-Tex textile material, or leather. The upper material then covers the foot at least in sections and increases the wearing comfort, For the shoe according to the invention, it is provided o in this context that the heel strap extends at the outer side of the shell. If the shoe according to the invention is equipped with a shell made of a supple upper material, it is advantageous if the heel strap is not connected to the shell in the left and right portion between the center of the heel strap spanning across the heel bone on the one hand and the two 1s ends of the heel strap arranged laterally on the shoe on the other hand. but instead extends freely across the supple upper material. Due to the fact that the heel strap on the one hand and the shell on the other hand are not connected to each other, in particular not sewn together, the heel strap can be freely repositioned across the upper material of the shell 20 when the pulling means on the dorsal strap is tensioned so that the upper material is not deformed in spite of the adjustment of the heel strap and a formation of folds is avoided, Further, it is particularly advantageous if the center of the heel strap spanning across the heel bone is not connected to the shell made of a 25 supple upper material, either, As a result, the heel strap is then directly connected to the shoe, in particular to the sole of the shoe, only at the two ends. All other parts of the heel strap can be repositioned freely across the supple upper material of the shell and thus realize an optimal form fit between the heel strap on the one hand and the heel on the other 30 hand, To fix the height of the center of the heel strap in the area of the heel relative to the shell, a flap protruding upward can be provided on 10 the shell, The heel strap then extends across the attachment area of the flap protruding upward so that the heel strap is precluded from slipping downward too far, To be able to easily transmit the necessary forces in the heel strap of the 5 shoe according to the invention, the heel strap should be produced from a mechanically sufficiently stiff material, such as a plastic hoop of suitable thickness However such a heel strap made of a material of increased stiffness has the disadvantage that the heei strap exhibits significant resistance against its deformation in the point of articulation 10 of the two connecting elements during tensioningof the heel strap because the rigid material must be elastically deformed at least slightly in the point of articulation of the connecting elements, To avoid these undesired counterforces, which are necessary for deforming the heel strap in the area of the points of articulation of the two connecting 1s elements, it is particularly advantageous if the heel strap has a material weakening, in particular a wedge-shaped indentation, in the area of the points of articulation of the two connecting elements, By means of this material weakening, the stiffness of the heel strap can be reduced transversally to its longitudinal axis in the area of the points of 20 articulation of the two connecting elements so that the resistance of the heel strap against deformation during tensioning of the heel strap is reduced, The structure of the sole of the orthopedic shoe is basically optional as long as on the whole the sole has sufficient rigidity and the motion of 2 the foot while walking therefore does not exceed a tolerable degree, To be able to ensure high walking comfort in addition to the necessary rigidity, it is particularly advantageous if the sole comprises an outer sole and an inner sole made of different materials, The outer sole can then be produced from an elastically damping material so as to realize 30 the desired walking comfort. The inner sole is produced from a rigid material. The rigidity of the inner sole can then be selected high enough, irrespective of the material of the outer sole, for the sole at large to have the rigidity necessary for use on an orthopedic shoe, Many users require use of the orthopedic shoe on only one foot because the second foot is not pathologically watered This fact, however 5 significantly increases the necessary production costs because the users only require one shoe, while the nufacturer has to provide shoes both for the left and for the right feet in different shoe sizes. To be able to reduce the necessary number of varieties and the accompanying production. costs, it is therefore particularly advantageous if the inner 1o side of the sole and of the shaft facing the foot is formed axially symmetric with respect to the longitudinal axis of the shoe. This axial symmetry of the inner side of the shoe makes it possible to wear the shoe optionally oi the left or on the right foot. For supplying the different users, all that is required then is to offer the shoe in different shoe sizes i$ th shoe then being wearable optionally on the left or on the right foot The type of pulling means with which the shoe according to the invention is fixed on the foot of the user is bascally optional. Preferably, the pul ling means can be formed in the manner of a tension strap. Said tension strap is fixed wih one end, namely the fixing end, on 20 the one side of the dorsal strap. On the opposite side of the dorsal strap, a deflection loop is attached, in which the tension strap can be deflected starting from its fixing end and in doing so spans across the dorsum with variable length, On the free end of the tension strap, a hook or loop tape is provided, which, following the adjustment of the necessry tenionin 25 length of the tension strap, is placed on a hook or loop tape provided in the area of the fixing end and is thus fixed. If the shoe according to the invention is designed to be axially synimetric and can be worn optionally on the left foot or on the right foot, it is particularly advantageous if the fixing end and the deflection 30 loop of the tension strap are fixed in a detachable manner by means of respective coupling means. By alternately detaching the coupling means 12 on the fixing end and on the deflection loop, the arrangement of the fixing end on the right or left side of the shoe can be changed As a result, it is possible to provide for the free end of the tension strap to run from the inside to the outside in each ease despite the axially 5 symmetric design of the shoe by resplugging the two coupling means, This means in other words that by re-plugging the coupling means of the tension strap, an adjustment can take place to the effect that the shoe can be worn on a left foot or on a right foot. To be able to fix the hook tape of the pulling means in an adjustment 1o area as large as possible, it is particularly advantageous if the hook tape or loop tape of the hook agnd loop fastener on the fixing end of the tension strap covers the outer side of the coupling means associated with the fixing end. The shoe according to the invention can be preferably combined with an 1 orthopedic inner shoe sole. Preferably, the inner shoe sole has a pad distributing pressure peaks in the space between the top side and the bottom side of the inner shoe sole namely in the area beneath the forefoot joint, the deformable pad casing of said pad being filled with defornable iing bodies which are mobile relative to one another. A 20 pad of this kind with a defornable pad casing and filling bodies contained therein which are deformable and mobile relative to one another allows the shape of the pad to consistently adapt to the changing shape of the foot sole in the area of the forefoot joint. This is because the shape of the pad is determined by the arrangement of the mobile 25 filling bodies in the pad casing. If now the shape of the foot sole or the position of the foot sole on the inner shoe sole changes, the shape of the pad can be easily adapted to this change by shifting of the mobile filling bodies. The shifting of the filling bodies continues until largely complete pressure compensation is achieved. This means in other words 3 that the filling bodies are shifted in the pad easing until the shape of the pad optimally fits the shape of the foot sole again and thus all pressure peaks between the foot sole and the inner shoe sole have been largely dissipated or entirely eliminated. During the subsequent wearing of the inner shoe sole 4 the defornability of the filling bodies or rather the deformability of the pad casing provides optimal damping. The shifting 5 of the filling bodies in the pad casing to a certain degree also causes a type of massaging motion of the inner shoe sole on the skin of the foot sole, which stimulates blood Circulation. This in turn has a positive effect with regard to avoiding open areas on the skin of the foot soie of diabetics. To enable an optimal shape adaptation of the pad filled with the mobile filling bodies to the shape of the foot sole, it is required that no air pockets form inside the pad casing. Such air pockets would move within the pad casing as a function of the pressure load and would thus continuously change the pressure state and cause undesired pressure is peaks. According to a preferred embodiment of the inner shoe sole according to the invention, it is therefore provided that the pad casing has at least one deacration opening through which the air present in the pad can escape to the outside when pressure s applied. As a result the deaeration opening ensures that complete pressure compensation takes 20 place between the inside of the pad casing and the ambient atmosphere. The formation of undesired air pockets within the pad casing is thereby avoided. To be able to at least temporally fix the shape of the pad filled with the filling bodies, an evacuation device may be provided on the pad casing. 25 By means of this evacuation device, the air present in the pad casing can be evacuated to a point where negative pressure forms in the pad casing. This negative pressure pulls the deformable pad casing against the deformable filling bodies and thus the relative position between the individual filling bodies is fixed, B ventilating the evacuation device, So the negative pressure can be released from the pad casing and a new 14 shape of the pad can be adjusted by shifting of the filling bodies in the pad casing The adjustment of the shape of the inner shoe sole by shifting of the mobile filling bodies present in the pad casing is based on the shifting of 5 the filling bodies upon loading. In that course, filling bodies in the area of high pressures are shifted into areas of lower pressures until all areas of the foot sole exhibit a substantially similar pressure load Owing to the anatomic deformation of the foot sole and the respective accomnpanying pressure load, very long shifting paths may occur in the to shifting of the filling bodies, which cannot be travelled within a reasonable time anymore. In particular if the entire foot sole is to be supported by a single pad easing and the mobile filling bodies contained tterei.n, very long shifting paths may occur so that a reformation of the pad within reasonable time frames cannot be expected. To avoid such Li shifting paths of inacceptable length and to be able to adapt the pad geometry specifically to the different areas of the foot sole, it is particularly advantageous if the pad is divided into at least two pad segments The shape of the individual pad segments and in particular the filling level of the individual pad segments can then be adapted to the 20 respectively different requirenenis in the different areas of the foot sole. The number of pad segments and the areas of the foot sole in which they are arranged are basically optional. According to an advantageous embodiment, it is provided that a pad segment is arranged on the one hand in amanrier according to the invention in the area of the forefoot 25 joint of the foot and/or in the toe area of the foot and/or in the area of the metatarsus and tarsus of the foot and/or in the heel area of the foot. In particular, an embodiment version with a total of four pad segments in the toe area and in the area of the forefoot joint area and in the area of the metatarsus and tarsus and in the heel area is especially advantageous. 3f A rolling motion of the inner shoe sole occurs in the shoe during the walking motion of a user of the orthopedic inner shoe sole This rolling 15 motion of the inner shoe sole may cause undesired shifting effects of the filling bodies in the pad casing, To minimize these undesired shifts it is particularly advantageous if a spacing groove is arranged between adjacent plad segments Said spacing groove allows a relative motion of 5 the adjacent pad segments when the inner shoe sole is rolling during walking and thus minimizes the shifting effect on the mobile filling bodies in the individual pad segments, With regard to a strongest possible minimization of the undesired shifting effect caused by the roiling motion of the inner shoe sole, it is lo particularly advantageous if the spacing groove between adjacent pad segments extends in a curved shape along its longitudinal axis, The curve of the curved spacing groove should extend in a concave manner around the heel of the inner shoe sole and thus point with its center portion in the direction of the forefoot. B If the inner shoe sole has several pad segments, it may be desirable to have the filling bodies travel variably between the individual pad segments so as to be able to vary the filling level of the individual pad segments, for example. In this way, it is in particular possible to adapt the properties of the inner shoe sole to the requirements of different 20 users, To realize this kind of adaptation of the inner shoe sole according to the invention, it is provided according to a preferred embodiment that the pad segments are formed to be at least partially communcative, air and/or filling bodies being able to pass through at least one passage opening between two communicating pad segments. By shifting the 25 bodies through the passage openings the filling level of individual pad segments can be varied and changed, Moreover, air can be conveyed through the passages between the individual pad segments so that in particular not every Single pad segment must have a dea-ration opening and/or an evacuation device. 30 To avoid shifting of filling bodies between the communicating pad segments during the use of the inner shoe sole, it is particularly 16 advantageous if the cross-section of the passage opening is selected appropriately relative to the cross-section of the filling bodies. The cross-section of the passage opening should be at least large enough relative to the cross-section of the filling bodies for the filling bodies to 5 pass through the passage opening between the communicating pad segments in the unloaded state, At the same time, the cross-section of the passage opening should be small enough relative to the cross-secton of the filing bodies that the filling bodies cannot be shifted through the passage opening in the loaded state of the inner shoe sole. to To provide wearing comfort and a transition that is as free of pressure peaks as possible in particular in the area of the spacing grooves, it is particularly advantageous if an additi onal elastic pressure distribution layer, in particular made of foamed m3ateri is arranged on the side of the inner shoe sole facing the foot Since this additional pressure is distribution layer only has to cushion small pressure peaks, it can be formed correspondingly thin and is not subject to the otherwise occurring signs of wear and to the accompanying undesired impression in the inner shoe sole A preferred embodiment of the invention is schematicaly illustrated in 20 the drawings and will be explained in the following by way of example In the figures: Fig I shows a shoe according to the invention in a lateral view from the left" Fig. 2 shows the shoe according to Fig I in a lateral view from the 25 right; Fig. 3 shows the shoe according to Fig. 1 in a lateral view from behind: 17 Fig 4 shows the rear fixation means for fixing the foot in the shoe according to Fig I with the pulling means attached thereto in a perspective view; Fig, 5 shows the rear fixation means according to Fig. 4 after the assembly of the pulling means in a perspective view; Fig. 6 shows the fixation means according to Fig, 4 in a lateral view; Fig, 7 shows the fixation means according to Fig, 6 after the assembly of the pulling means; 10 Fig, 8 shows the top aide of an inner shoe sole in a perspective view from the top; Fig 9 shows the bottom side of the inner shoe sole according to Fig. 8 in a perspective view from the top; Fig, 10 shows a longitudina section through the inner shoe sole according to Fig. 9 in a perspective view from the top: Fig, It shows the bottom side of the inner shoe sole according to Fig. 9 in a view from the top; Fig, 12 shows the inner shoe sole according to Fig, II in a eross section along the section line A-A. 20 Fig. I shows an orthopedic shoe 01 for preventing excess pressure loads on pressure-sensitive foot soles according to the teaching of the invention, such a shoe being intended in particular for diabetics. The shoe 01 has a basic structure composed of a rigid walking sole 02 and a shaft 03, The walking sole has convexly rounded sole portions 04 and 05 25 in the area of the toes and in the area of the heels, respectively. The rounded sole portions 04 and 05 allow the shoe to roll with its bottom sole side during walking so that the user has an approximately normal gait despite the rigidity of the walking sole 02, The shaft 03 provided for fixing the foot on the walking sole 02 comprises a front fixation means 06 and a rear fixation means 07. Further, the shaft 03 comprises a shell 08 inade of a supple upper material, such as leather or a textile material $ Respective pulling means 09 and 10 are provided on the front fixation means 06 and on the rear fixation means 07 to allow the user to adjust the size of the shoe 01 to his/her individual requirements By way of the pulling means 09., the front portion of the shoe 01 is fixed in the area of the forefoot, whereas by means of the pulling means 10, a size 10 adiustrment in the area of the rmetatarsus and the heel is possible, The two pulling means 09 and 10 each are formed as tension straps which have a loop and hook fastener on their inner side, by means of which they allow a size adjustment of the pulling means 09 and 10. The rear fixation means 07 in its basic structure is composed of a heel 15 strap 11 and a dorsal strap 12 attached thereto The dorsal strap 12 can be tensioned with variable length across the dorstu of the user s foot by way of the pulling means 1 0. The pulling mea-ns 10 forms an integral part of the dorsal strap 12. The heel strap II extends starting from its first end 13, which is attached with a fixing rivet to the sole 02 (fixing 20 rivet 14 and end 13 illustrated in hidden manner in Fig. I and Fig. 2) across the left instep toward the cap 15 covering the heel honeln its center, the heel strap 11 spanning across the heel bone is deflected and then extends back across the right instep toward the second end 16, which is in turn attached to the sole 02 in a pivoting manner by means of 25 a rivet 17 (see Fig, 2). The dorsal strap 12 with the pulling neans 10 is attached in a load-transmitting manner to the left and right portion of the heel strap 11 by means of connecting elements 18 and 19. The connecing elements 18 and 19 have a distance to the ends 13 and 16 of the heel strap 1 1 and a distance to the center 20 of the heel strap, the 30 center spanning across the heel bone in the area of the cap 15. The left portion 1 1a of the heel strap 11 and the right portion II b of the heel 19 strap iI extend in a curved shape from the attachment points in the area of the ends 13 and 16 to the center 20 of the heel strap I. , If now the dorsal strap 12 is tensioned across the dorsin of the user's foot by a length adjustment of the pulling means 10, the corresponding pulling 5 forces are transmitted through the connecting elements 18 and 19 into the heel strap 11, Since the heel strap 11 is connected to the shoe 01 namely to the sole 02, only at its ends 13 and 16, the center 20 of the heel strap II is displaced forward when puling forces are applied and thus ensures an optimal form fit of the cap 15 on the heel bone of the h user, In this context, the portions I a and Ilb and the center 20 of the heel strap I1 are not connected to the upper material of the shell 08. which nakes possible a relative motion between the upper material of the shel1 08 and the heel strap 1I1 As can be seen in Fig, I and Fig, 2, the connecting elements 18 and 19 1s each are arranged in the direction of the longitudinal axis of the shoe between the center 20 of the heel strap 11 on the one hand and the two ends 13 and 16 of the heel strap I1 arranged laterally on the shoe on the other hand. This arrangement of the connecting elements 18 and 19 in the direction of the longitudinal axis between the center 20 on the one 20 hand and the ends 13 and 16 on the other hand leads to an optimal force transmission of the pulling forces exerted by the dorsal strap 12 into the heel strap 11 Owing to the leverage ratios, even a relatively low pulling load in the dorsal strap 12 causes a high pulling load in the heel strap 11 so that the application even of relatively low forces on the pulling means 25 10 can cause a very tight fixation of the foot in the shoe 01 by the heel strap i, This high effectiveness of force is additionally increased by the fact that the ends 13 and 16 are pivotomounted by means of the rivets 14 and 17 and the heel strap II is not otherwise connected to the upper material of the shell 08, To further improve the effectiveness of force of S t te rear ftxation means 07, the heel strap 11 comprises, in the area of the two connecting elements 18 and 19. a respective material weakening 21 which is formed in the manner of a wedge-shaped indentation. This 20 material weakening w weakens the two portions 11 a and 1 b of the hee strap 1I with the left and right point of articulation of the hee strap it with respect to their rigidity so that the heel strap 1i can buckle more easily in this exact point under the tensile load of the heel strap iA. A 5 deformation of the heel strap 11 outside of these two areas with the intentional material weakening is substantilly prevented in this marner. Fig, 3 shows the shoe 01 in a view front therear, One can recognize how the heel strap I1 is spanning with its center 20 across the shoe 01 in the area of the heel hone, For fixing the height of the heel strap 11 in the o area of its center 20, a flap 22 is provided on the cap , the free end of said flap 22 protruding upward. The connecting seam between the cap IS and the flap 22 reliably prevents the heeltrap 11 from slipping downward further than permissible, Fig 4 and Fig. 5 show the rear fixation means 07 prior to its attachment is to the sole 02. The ends 13 and 16 with the attachment holes provided therein for passage of the fixing rivets 14 and 17 are visible, Further, one can see the heel stra p portions IIa and 11 b with the inte mediate center 20, The dorsal strap 12 consists of two deflection loops 23,.24 and the pulling means 10. The deflection loops 23 and 24 are formed 20 integrally with the connecting elements 18 and 19 on the heel strap 11. The pulling means 10 can be optionally fixed in a detachable manner to the deflection loop 23 or 24 by way of a coupling means 25 which engages with two wings behind the deflection loop 23 or 24 in a for-n fitting manner in its recess. After the coupling means 25 has been 25 plugged into the recess of the deflection loop 23 or 24, the coupling means 25 must be turned by about 90 degrees. The coupling means 25 is attached to the fixing end 26 of the pulling mears 10, For use of the pulling mean: 10, after the coupling means 25 is fixed to the first deflection loop 23, the pulling means 10 is threaded 30 with its free end 27 through the second deflection loop 24 and is guided back to the fixing end 26, A hook and loop fiastener with a loop tape and a functionally complementary hook tape is provided on both sides of the pulling means 10 so that the tension length of the pulling means 10 can be fixed by placing the hook tape on the loop tape. In Fig. 6 and Fig. 7. the free end 27 on the opposite side of the dorsal 5 strap 12 is visible, One can recognize that the free end 27 of the pulling means 1.0 completely covers the coupling means 25 and comes to rest with its entire surface on the functionally complementary hook or loop tape lying beneath on the fixing end 26. Owing to the fact that the hook tape completely covers the coupling means 25, a higher range of 10 variation in the adjustment of the length of the pulling means 10 is made possible. The coupling rneans 25 allows attaching the pulling organ 10 with its fixing end 26 optionally to the first deflection loop 23 or to the second deflection loop 24, Since the shoe 01 is otherwise formed to be 2s completely axially symmetric with respect to its longitudinal axis and thus can be worn optionally on the left or on the right foot with equal function, the optional attachment of the fixing end 26 to the first deflection loop 23 or the second deflection loop 24 allows a side-spe"cific appearance of the shoe 02, The versions illustrated in Fig. I and Fig. 2 20 are intended to be worn on the right foot, for example, By re-plugging the coupling organ 25 to the respectively other deflection loop 23 or 24, the shoe 01 can be readjusted in such a manner that it is intended to be worn on the left foot. Fig. 8 shows an orthopedic inner shoe sole 101 which can be arranged 25 within the shoe 0 1 on the sole 02 Fig. 8 iIlustrates the inner shoe sole 101 with its top side 102 in a perspective view from.i the top. The inner shoe sole 101 can be arranged in a detachable manner in the shoe 01 according to the invention of the given shoe size and serves to improve pressure distribution on pressure-sensitive foot soles, in particular on 30 those of diabetics. 'The properties of the inner shoe sole 101 in the shoe 01 are particularly advantageous because a pressure distribution as even 22 as possible on the foot is highly desirable in view of the very tight fixation of the foot in the shoe 01, Fig, 9 shows the inner shoe sole from its bottom side 103 in a perspective view from the top- It is visible that a pad 104 distributing s pressure peaks with four pad segments 105 6 10 108 is present between the top side 102 and the bottom side 103, The structure of the pad 104 with the four pad segments 105 to 108 can be taken from the longitudnal section according to Fig. 10. The defornable pad casing 109, which is made of a PU film surrounds a Io plurality of defonnable filling bodies 110 which are mobile relative to one another, These filling bodies 110 can be shifted witrespect to one another so as to consistently readapt the shape and contour of the pad 104, As is visible from Fig. 9, between the individual pad segments 105, 106. 107 and 108, there are passages I II for funning passage openings 15 112 between the respectively adjacent pad segments. The filing bodies 110 can pass through the passage openings 112 between the adjacent pad segments 105, 106, 107 and 108, allowing a variation in particular of the filling level of the individual pad segments 105 to 108, Moreover, the air in the individual pad segments 105 to 108 can flow through the passage 20 openings 112 and can then escape into the ambient atmosphere through dearation openings 120 forced in the wall of the casing 109 in the area of the passages 111, Fig. .11 shows the inner shoe sole 101 with its bottom side 103 in a frontal view from the top, Three spacing grooves 113, 1.14 and 115 are 25 visible, which separate the four pad segments 105 to 108 from each other and allow a relative motion of the respectively adjacent pad segments 105 to 108. The spacing grooves 113 to 115 each extend in a curved shape concavely around the heel of the inner shoe sole 101. The passages 111 between the 30 adjacent pad segments 105 to 108 each extend transversally to the 23 spacing grooves 113 to 115, By arranging the deaeration openings 120 at the side of the passages 111 facing the bottom side 103, it is ensured that the deacration openings 120 are not closed even if the inner shoe sole is loaded because the passages I1 I are arranged in a retreating manner with respect to the bottorn side 103 within the spacing grooves 113 to 115. Fig 12 shows the inner shoe sole 101 in a crosssection along the section line A-A. The passage opening 112 between the pad segments 106 and 105 is visible, through which the filing bodies 10 can pass between the adjacent pad segments. The cross-section of the passage 0 opening 112 relative to the cross-section of the only schematicaly indicated fi ling bodies I 10 is selected exact such that passage of the filThig bodies 1 10 is possible in the unloaded st and is pe eluded in the loaded state of the inner shoe sole 101. The pad segments 105 to 108 of the inner shoe sole 101 are formed by 15 two layers 116 and 117 made of a PU film. The layer 116 has a substantially plane layout. In contrast, the layer 1 17 is formed three dimensionally, by deep-drawing of the PU film, for example, and forms four chambers 118 corresponding in their form to the pad segments 105. When producing the inner shoe sole 101, first, the three-dinensinafly 20 molded layer i17 is filled with the filling bodies 110 and then the layer 116 is sealed to the layer 117 in the contact areas Py sealing the two layers 116 and. I17, the chambers 118 with the filling bodies 110 contained therein are closed To ensure a pressure distribution as free of pressure peaks as possible for the user also in the area of the spacing 25 grooves 113 to 115, at last, a pressure distribution layer 119 made of foamed material is applied to the top side of the layer 116,