AU5190199A

AU5190199A - Medical device for applying a cyclic therapeutic action to a person's foot

Info

Publication number: AU5190199A
Application number: AU51901/99A
Authority: AU
Inventors: Roni Bibi; Eli Levy; Dan Manor; Ascher Shmulewitz
Original assignee: Medical Dynamics USA LLC
Current assignee: Medical Dynamics USA LLC
Priority date: 1998-07-30
Filing date: 1999-07-30
Publication date: 2000-02-21
Anticipated expiration: 2019-07-30
Also published as: KR20010079580A; WO2000006077A2; EP1100427A2; WO2000006077A3; AU768942B2; CA2338903A1; CN1315850A

Description

WO 00/06077 . PCT/IL99/00419 MEDICAL DEVICE FOR APPLYING A CYCLIC THERAPEUTIC ACTION TO A PERSON'S FOOT FIELD OF THE INVENTION The invention is in the field of medical devices for applying a cyclic therapeutic action to a subject's lower limbs, and in particular to his feet. BACKGROUND OF THE INVENTION 5 Many subjects suffering from a number of medical conditions including inter alia peripheral arterial and venous disease, hypertension, diabetes and deep vein thrombosis are treated by way of medical devices with one or more inflatable bladders for applying a cyclic therapeutic action to a subject's lower limbs, and in particular to his feet, for urging venous blood io flow from his feet and legs to his heart. Venous blood flow can be urged by stimulation of one or both of two physiological mechanisms, namely, his calf s venous muscular pump and emptying of his foot's venous plexus. Medical devices for stimulating one or both of these mechanisms are illustrated and described inter alia in US Patent 15 2,531,074, US Patent 3,454,010, US Patent 3,683,897, US Patent 3,789,836, US Patent 4,003,374, US Patent 4,696,289, US Patent 4,945,905, US Patent 4,989,589, US Patent 5,117,812, US Patent 5,354,260, US Patent 5,396,896, US Patent 5,443,440, WO 88/09653, DE 30 09 408, and SU 0 1452-523. In particular, GB 2 213 784 illustrates and describes a medical device 20 with a platform with four staggered, non-overlapping inflatable bladders disposed therealong to solely underlie a subject's heel, his plantar arch, his metatarsals, and his toes. The inflatable bladders are each provided with a plastic tube for connecting to a pressure source. The tubes are relatively rigid and since they extend under a subject's foot they can be felt when he stands 25 and therefore they are a cause of discomfort.

WO 00/06077 . 2 . PCT/IL99/00419 SUMMARY OF THE INVENTION In accordance with a first aspect of the present invention, there is provided a medical device for applying a cyclic therapeutic action to a subjects foot, the device comprising a platform with at least one 5 independently actuable inflatable bladder to solely underlie the subject's foot, an inflatable bladder converging towards a laterally extending neck portion with an aperture raised with respect to said platform on accommodation of a subject's foot inside the medical device. The medical device preferably has four inflatable bladders staggered 10 along its platform in a non-overlapping fashion to solely underlie a foot's heel, its plantar arch, its metatarsus, and its toes, respectively, whereby a travelling compression wave can be cyclically applied to a foot's underside. The inflatable bladders are so dimensioned and the spacing apart therebetween is such that that they are substantially co-extensive with a foot's 15 underside. In addition, the platform is preferably formed with an arched plantar arch support for permanently supporting a foot's plantar arch and an arched toe support for permanently supporting a foot's toes at their bases. Two basic embodiments of the medical device are envisaged: boot-like footwear designed to look like and be worn as conventional slippers worn in 20 the home thereby precluding a person from having to change footwear for treatment purposes and, a normally flat, one-piece foldable wrap for more extended treatment periods, for example, when a subject is sleeping. In accordance with a second aspect of the present invention, there is provided a medical device for applying a cyclic therapeutic action to a 25 subject's foot, the device comprising boot-like footwear for accommodating a subjects entire foot, and at least one inflatable bladder permanently disposed in said footwear and being in fluid communication with a pressure source for selectively applying pressure to the foot's underside, WO 00/06077 3. PCT/IL99/00419 characterized in that said footwear has an externally accessible connector member permanently and directly attached to an exterior surface thereof, said connector member being in permanent fluid communication with said at least one inflatable bladder and in selectively disconnectable fluid 5 communication with said pressure source. In accordance with a third aspect of the present invention, there is provided a medical device for effecting dorsiflexion of a subject's foot, the device comprising a platform for supporting the subject's foot, and having an inflatable bladder for cyclically elevating the foot's front portion solely 10 relative to said platform from a normal position thereatop whereby the foot's front portion is flexed relative to the foot's remaining portion overlying said platform, said inflatable bladder having a first compartment overlying said platform and a second compartment hingedly connected to said first compartment along a trailing edge of said inflatable bladder directed towards 15 the subject's heel and limiting means for limiting the maximum height of an edge of said second compartment remote from said trailing edge on inflation of said inflatable bladder whereby said inflatable bladder assumes an inflated triangular shaped configuration tapering towards the subject's heel. The particular design of the inflatable bladder is such that it enables a 20 relatively high maximum height for a relatively small volume as say compared with a generally isosceles shaped inflatable of comparable dimensions, thereby enabling a high cycle rate even with a relatively small compressor. In accordance with a fourth aspect of the present invention, there is 25 provided a medical device for effecting dorsiflexion of a subject's foot, the device comprising a platform for supporting the subject's foot, and having a wedge shaped support tapering towards the subject's heel for permanently supporting the foot's front portion in a flexed position relative to the foot's remaining portion overlying said platform; and an inflatable bladder mounted WO 00/06077 - 4 PCT/IL99/00419 on said support for cyclically elevating the foot's front portion relative thereto from a nonnal position thereatop. In accordance with a fifth aspect of the present invention, there is provided a medical device for applying a cyclic therapeutic action to a 5 subject's foot, the device comprising a platform for supporting the subject's foot, and having an arched plantar arch support for permanently supporting the foot's plantar arch; and an inflatable bladder for cyclically elevating the foot's front portion relative to said platform from a normal position thereatop whereby the subject's foot effects a rocking motion about said plantar arch 10 support acting as a fulcrum-like member. In accordance with a sixth aspect of the present invention, there is provided a kit for installation on a wheelchair having a pair of foot supports for supporting a wheelchair bound subject's feet, the kit comprising: a rechargeable battery operated compressor; a pair of medical devices capable 15 of being in fluid communication with said compressor and mountable on a foot support, each medical device capable of applying a cyclic therapeutic action to a subject's foot; and a controller for controlling the operation of the medical devices. By virtue of the kit of the present invention, a wheelchair bound 20 subject can still undergo his everyday normal activities whilst receiving therapeutic treatment for poor venous blood flow by way of dorsiflexion of his feet and/or application of a travelling compressive wave to his feets' underside. In accordance with a seventh aspect of the present invention, there is 25 provided a medical device for effecting plantar flexion of a subject's foot, the device comprising a mounting member for mounting the medical device on the subject's leg, an elongated support member attached to said mounting member and downward depending for overlying at least a proximal portion of the foot's anterior surface, an inflatable bladder extending along the underside WO 00/06077 - - PCTIIL99/00419 of said support member; and a resiliently flexible foot restraining member attached midway along said support member for encircling the foot's plantar arch. BRIEF DESCRIPTION OF THE DRAWINGS 5 In order to understand the invention and to see how it may be carried out in practice, preferred embodiments will now be described, by way of non-limiting examples only, with reference to the accompanying drawings, and in which: Fig. 1 is a pictorial view of a medical device implemented as boot-like 10 footwear; Fig. 2 is a transparent pictorial view of the boot-like footwear of Figure 1; Fig. 3 is a transverse cross sectional view of the footwear of Figure 1 along line III-III in Figure 1 with an inflated inflatable bladder for applying 15 pressure to a foot's metatarsal region; Fig. 4 is an exploded view of the boot-like footwear of Figure 1; Fig. 5 is a top view of a medical device implemented as a normally flat, one-piece, foldable wrap for accommodating a subject's foot; Fig. 5 is a pictorial view of the foldable wrap of Figure 5 20 accommodating a subject's foot; Fig. 7 is a schematic side view of the medical devices of Figures 1 and 5 showing modifications thereof; Fig. 8 is a graph showing a heel-to-toe inflation sequence of the inflatable bladders of the medical devices of Figures 1 and 5; 25 Fig. 9 is a pictorial view of a medical device for dorsiflexion of a subject's foot; Fig. 10 is a perspective view of the inflatable bladder of the medical device of Figure 9; WO 00/06077 . 6 _ PCT/IL99/00419 Figs. lIA and 11B are side views of the medical device of Figure 9 during operation; Fig. 12 is a schematic side view of an alternative medical device for dorsiflexion of a subject's bare foot; 5 Fig. 13 is a schematic side view of another alternative medical device for effecting dorsiflexion of a subject's bare foot; Figs. 14A and 14B are schematic side views of a medical device for effecting a rocking motion of a subject's foot about aplantar arch support; Fig. 15 is a pictorial view of a wheelchair fitted with a kit for effecting 10 dorsiflexion of a wheelchair bound subject's feet; and Figs. 16A and 16B are side views of a medical device for effecting plantar flexion of a subject's foot. DETAILED DESCRIPTION OF THE DRAWINGS With reference now to Figures 1-4, a medical device 1 is 15 implemented as boot-like footwear 2 designed to accommodate a subject's left foot, the footwear 2 being constituted by a vamp 3 made of fabric-like sheet material and a sole 4. The vamp 3 has left and right hand vamp halves 6 and 7 stitched together along their common edges except for their uppermost front portion 8 for enabling a subject's foot to be easily inserted into the 20 footwear 2 and withdrawn therefrom. The vamp's heel portion 9 is strengthened by way of a heel patch 11 whilst a flap 12 with Velcro-type hook fasteners 13 for mating with Velcro-type loop fasteners 14 on the right hand vamp half 7 (see Figures 3 and 4) is provided for fastening the footwear 2 on a subject's foot when accommodated therein. 25 The flap 12 defines a generally triangular shaped pocket 16 having an aperture 17 adjacent an externally accessible connector member 18 secured to the left hand vamp half 6 towards the footwear's heel portion 9 by way of a tab 19 engaging a buckle-like member 21 provided along one side of the WO 00/06077 . 7 PCT/IL99/00419 connector member 18 (see Figure 4). The connector member 18 is adapted for selective connection to a complementary connector member 22 in permanent fluid communication with a pressure source 23 under the control of a controller 24. The connector members 18 and 22 are of the quick release 5 self alignment magnetically latched type and have a first pair of magnets 26A and 26B at one end thereof and a second pair of magnets 27A and 27B at the other end of thereof. The pairs of magnets 26A, 26B and 27A, 27B are polarized such that the connector member 22 can only be attached to the connector member 18 in a single pre-determined manner. 10 The pressure source 24 has four outlet ports 28A-28D which are in fluid communication with four ports 29A-29D on the upstream side of the connector member 22 which, on connection of the connector member 22 to the connector member 18, are in turn in fluid communication with four ports 3 1A-3 ID on the downstream side of the connector member 18 which are in 15 turn in fluid communication with four inflatable bladders 32A-32D for independently inflating and deflating the inflatable bladders 32A-32D in accordance with a pre-determined heel-to-toe or toe-to-heel sequence. The inflatable bladders 32A-32D are adhered to the top side of a platform 33 and are staggered therealong in a non-overlapping fashion for 20 applying pressure to the underside of a foot's toes, metatarsal region, plantar region, and heel, respectively. The inflatable bladders 32A-32D have laterally extending neck portions 34A-34D directed toward the left hand vamp half 6. The neck portions 34A-34D have apertures 35A-35D which are raised relative to the platform 33 and are connected to the four ports 3 1A-3 ID via 25 plastic tubes 36A-36D which extend between the juncture between the left hand vamp half 6 and the sole 4, and through the pocket 16 to the connector member 18. In this manner, the tubes 36A-36D are normally concealed from view and are so disposed that their presence is not felt by a subject when walking which would otherwise cause him some discomfort.

WO 00/06077 _ g PCT/IL99/00419 The platform 33 is interdisposed between a relatively pliable upper sole member 37 and a more rigid lower sole member 38 of an inner sole construction 39 which is in turn interdisposed between the vamp 3 and the sole 4. The upper sole member 37 is peripherally attached to the vamp 3 and 5 the lower sole member 38 is peripherally attached to an underside of the upper sole member 37 and is initially provided with a lengthwise extending slit 39 through which the platform 33 is inserted into a receiving pocket 41 defined between the upper and lower sole members 37 and 38 (see Figure 3). The footwear 2 looks like conventional boot-like slippers except for lo the connector member 18 which is unobtrusively disposed on its innermost surface and can be worn instead of them. A subject can readily attach the connector member 18 to the connector member 22 by merely bringing the latter into proximity with the former whereupon the pairs of magnets 26 and 27 effect a tight sealing connection therebetween for undergoing treatment. 15 After the treatment, the connector member 22 can be readily detached from the connector member 18 by displacing his foot away from the former. With reference now to Figures 5 and 6, a medical device 50 is similar to the medical device 1 except that it is implemented as a normally flat, one-piece, foldable wrap 51 having a central portion 52 supporting the 20 platform 33, left and right vamp portions 53 and 54, and a heel restraining member 56. The medical device 50 has the same platform 33 with the four inflatable bladders 32A-32D disposed thereon, the inflatable bladders 32A-32D converging towards neck portions 34A-34D with apertures 35A-35D which in this case are raised above the platform 33 when the wrap 25 51 is wrapped around a subject's foot to accommodate same. The apertures 35A-35D are fitted with tubes 36A-36D in fluid communication with the connector member 18 for connection to the pressure source 23. The wrap 51 is normally employed for long treatment periods, for example, when a subject is sleeping, however, by virtue of the arrangement of tubes 36A-36D, a WO 00/06077 _ g PCT/IL99/00419 subject having his feet accommodated in wraps 51 can stand up without feeling any discomfort. With reference now to Figure 7, a medical device 60 is similar to the medical device 10 and differs therefrom in that its platform 33 is formed with 5 an arched plantar arch support 61 of height hi for permanently supporting the foot's plantar arch and an arched toe arch support 62 of height h 2 for permanently supporting the foot's toes at their base. The support 61 typically has a maximum height above the platform 33 of between about 0.7 cm and 1.2 cm and preferably about 1.0 cm whilst the support 62 typically has a Io maximum height of between about 0.3 cm and 0.7 cm and preferably 0.5 cm above the platform 33. The supports 61 and 62 provide a number of advantages including affording a more comfortable fit in a similar manner to orthopedic inner soles, facilitating the need for a smaller pressure source 23, and for enabling a more rapid attainment of a predetermined pressure in their 15 associated inflatable bladders 32C and 32A. With reference now to Figure 8, the chart shows a heel-to-toe sequence for inflating and deflating the inflatable bladders 32A-32D which in contradistinction to the conventional distal to proximal direction of a travelling compression wave for effecting venous blood return. The 20 heel-to-toe sequence in effect mimics a subject's walking for naturally stimulating his calf s venous muscular pump and his foot's venous plexus. With reference now to Figures 9-11, a medical device 70 for effecting dorsiflexion of a subject's foot includes a platform 71 with a heel support 72, a foot strap 73 and an inflatable bladder 74. The inflatable bladder 74 is 25 disposed at one end of the platform 71 for solely underlying a foot's front portion, and is connected to a pressure source 76 under the control of a controller 77 for cyclically inflating it from a generally flat configuration (see Figure 1lA) to a wedge shaped configuration (see Figure 11B) tapering toward the platform's other end.

WO 00/06077 .10- PCT/IL99/00419 The inflatable bladder 74 includes a three section cover 78 having sections 78A, 78B and 78C. the former two being formed as a pouch 79 for receiving a generally square single inflatable cell 81 whilst the latter one is a restraining member for limiting the maximum height of the inflated wedge 5 shape. The inflatable cell 81 is divided into two equal sized compartments 81A and 81B by two seams 82A and 82B lateral of a central portion 83 enabling fluid communication between the compartments 81A and 81B. Each compartment 81A and 81B has a rigid member 84 lying thereatop, and the compartment 81B is provided with an inlet port 86 which also serves to 10 inflate the other compartment 81 A. With reference now to Figure 12, a medical device 90 is similar to the medical device 70 and also includes the arched plantar arch support 61 for effecting a cyclic dorsiflexion of a subject's foot combined with a rocking motion about the plantar arch support 61. 15 With reference now to Figure 13, a medical device 100 is similar to medical device 90 and also includes a wedge shaped support 101 tapering towards a foot's heel for permanently supporting a foot's front portion in a flexed position relative to the foot's remaining portion overlying the platform 72, thereby facilitating better dorsiflexion which occurs with a more flexed 20 position of a foot's front portion. The support 101 subtends an included angle c of about 300 relative to the platform 72, and has a simple inflatable member 102 disposed thereon for effecting cyclic dorsiflexion of the subject's foot combined with a rocking motion about the plantar arch support 61. With reference now to Figures 14A and 14B, a medical device 110 has 25 a platform 111 with an arched plantar arch support 112 and a pair of inflatable bladders 113 and 114 disposed lateral thereto and in fluid commuincation with a pressure source 116 under the control of a controller 117 for effecting a rocking motion of a subject's foot about the plantar arch support 112 by way of the cyclic alternate actuation of the inlation bladders 113 and 114 for WO 00/06077 _ 1 PCT/IL99/00419 respectively elevating the foot's heel relative to the platform 111 whilst the foot's front portion is thereatop and elevating the foot's front portion relative to the platform 111 whilst the foot's heel is thereatop, thereby effectively rendering dorsi-plantar flexion of the subject's foot for facilitating emptying 5 of the foot's venous plexus and activating his calf s venous muscular pump to pump venous blood from the subject's foot and leg towards his heart. The support 112 typically has a maximum height h 3 above the platform 111 of between about 1 cm and about 3 cm and preferably about 2 cm. With reference now to Figure 15, a wheelchair 120 having left and 10 right foot supports 121A and 121B is fitted with a medical system 122 for effecting dorsiflexion of a wheelchair bound subject's feet. The medical system 122 includes a rechargeable battery operated compressor 123, a controller 124 and two medical devices 126A and 126B. The compressor 123 and the controller 124 are carried on a rack 127 and the medical devices 126A 15 and 126B are respectively mounted on the wheelchair's foot supports 121A and 121B whereby the medical system 122 is fully portable and therefore does not preclude the subject from continuing his everyday activities. With reference now to Figures 16A and 16B, a medical device 130 for plantar flexion of a subject's foot has a mounting member 131 for mounting 20 the medical device 130 on a subject's leg. A support member 132 is substantially rigidly attached to the mounting member 131 for disposition along most of the subject's foot's anterior surface. An inflatable bladder 133 extends along the underside of the support member 132, and is in fluid communication with a pressure source 134 under the control of a controller 25 136. A resiliently flexible foot restraining member 137 attached about midway along to the support member 132 encircles the subject's foot's plantar arch whereupon cyclic inflation and deflation of the inflatable bladder 137 effects cyclic plantar flexion of the subject's foot thereby facilitating emptying of his foot's venous plexus and activating his calf s venous WO 00/06077 - 12 - PCT/IL99/00419 muscular pump to pump venous blood from the subject's foot and leg towards his heart. Various modifications and changes may be made in the configurations 5 described above that come within the spirit of the invention. The invention embraces such changes and modifications coming within the scope of the claims appended hereto. For example, an inflatable bladder disposed under a foot's plantar arch can be divided into two inflatable bladders respectively disposed under a plantar arch's medial portion and its lateral portion. The 10 medical devices 90, 100, 110 can also be provided with a heel support 72, and a foot strap 73. The wheelchair 120 can be provided with a medical system for applying any suitable cyclic action to a subject's feet by way of one of the medical devices described herein.

Claims

1. A medical device for applying a cyclic therapeutic action to a subject's foot, the device comprising a platform with at least three 5 independently actuable inflatable bladder staggered therealong to solely underlie the subject's heel, his plantar arch and his foot's -front portion including its metatarsals and its toes, respectively, whereby a travelling compressive wave can be cyclically applied to his foot's underside only characterized in that each inflatable bladder converges towards a 10 laterally extending neck portion with an aperture raised with respect to said platform on accommodation of a subject's foot inside the medical device.

2. The device according to claim 1 wherein each neck portion is directed toward the median side of the medical device.

3. The device according to either claim 1 or 2 wherein the medical 15 device is fashioned as boot-like footwear having an externally accessible connector member permanently and directly attached to an exterior surface thereof, said connector member being in permanent fluid communication with said at least one inflatable bladder and in selectively disconnectable fluid communication with a pressure source. 20

4. The device according to claim 3 wherein said connector member is disposed toward the footwear's heel.

5. The device according to claim 3 wherein said boot-like footwear includes an inner sole construction with said platform interdisposed between upper and lower sole members. 25

6. The device according to claim 5 wherein said upper sole member is peripherally attached to a vamp of said footwear, and said lower sole member is peripherally attached to an underside of said upper sole member and is initially provided with a lengthwise extending slit through which said WO 00/06077 - 14 - PCT/IL99/00419 platform is inserted into a pocket defined between said upper and lower sole members.

7. The device according to either claim 1 or 2 wherein the medical device is fashioned as a normally flat, one-piece foldable wrap. 5

8. The device according to any one of claim 1 to 7 wherein said inflatable bladder underlying his plantar arch includes a pair of inflatable bladders under a plantar arch's medial portion and its lateral portion.

9. The device according to any one of claims 1 to 7 wherein said platform is provided with four inflatable bladders staggered therealong to 10 solely underlie the subject's heel, his plantar arch, his metatarsals, and his toes.

10. The device according to any one of claims 1 to 9 wherein said at least one inflatable bladder are staggered along said platform so as to be substantially co-extensive with a foot's underside. 15

11. The device according to any one of claims 1 to 10 and further comprising an arched plantar arch support for permanently supporting the foot's plantar arch.

12. The device according to claim 11 wherein said plantar arch support has a maximum height above said platform of between 0.7 cm and 1.2 cm. 20

13. The device according to any one of claims 1 to 12 and further comprising an arched toe support for permanently supporting the foot's toes at their bases.

14. The device according to claim 13 wherein said toe support has a maximum height above said platform of between 0.3 cm and 0.5 cm. 25

15. A medical device for applying a cyclic therapeutic action to a subject's foot, the device comprising boot-like footwear for accommodating a subject's entire foot, and a platform with at least one inflatable bladder WO 00/06077 - 15 - PCT/IL99/00419 mounted thereon and being in fluid communication with a pressure source for selectively applying pressure to the foot's underside, characterized in that said footwear has an externally accessible connector member permanently and directly attached to an exterior surface 5 thereof, said connector member being in permanent fluid communication with said at least one inflatable bladder and in selectively disconnectable fluid communication with said pressure source.

16. The device according to claim 15 wherein each inflatable bladder converges towards a laterally extending neck portion with an aperture raised 10 with respect to said platform.

17. The device according to claim 16 wherein each neck portion is directed toward the median side of said footwear.

18. The device according to any one of claims 15 to 17 wherein said connector member is disposed toward the footwear's heel. 15

19. The device according to any one of claims 15 to 18 wherein said footwear includes an inner sole construction including said platform interdisposed between upper and lower sole members.

20. The device according to claim 19 wherein said upper sole member is peripherally attached to a vamp of said footwear, and said lower sole member 20 is peripherally attached to an underside of said upper sole member and is initially provided with a lengthwise extending slit through which said platform is inserted into a pocket defined between said upper and lower sole members.

21. The device according to any one of claims 15 to 20 wherein said 25 platform has at least three independently actuable inflatable bladders staggered therealong to solely underlie the subject's heel, his plantar arch and his foot's front portion including its metatarsals and its toes, respectively, whereby a travelling compressive wave can be cyclically applied to his foot's underside only. WO 00/06077 . 16 PCT/IL99/00419

22. The device according to any one of claims 15 to 20 wherein said platform is provided with four inflatable bladders staggered therealong to solely underlie the subject's heel, his plantar arch, his metatarsals and his toes.

23. The device according to any one of claims 15 to 22 wherein said at 5 least one inflatable bladders are along said platform so as to be substantially co-extensive with a foot's underside.

24. The device according to any one of claims 15 to 23 and further comprising an arched plantar arch support for permanently supporting the foot's plantar arch. 10

25. The device according to claim 24 wherein said plantar arch support has a maximum height above said platform of between 0.7 cm and 1.2 cm.

26. The device according to any one of claims 15 to 25 and further comprising an arched toe support for permanently supporting the foot's toes at their bases. 15

27. The device according to claim 26 wherein said toe support has a maximum height above said platform of between 0.3 cm and 0.5 cm.

28. A method for applying a cyclic therapeutic action to a subject's foot, the method comprising the steps of: 20 (a) providing a medical device with a platform for supporting the subject's foot, and having at least three independently actuable inflatable bladders respectively staggered therealong to solely underlie the subject's heel, his plantar arch and his foot's front portion including his metatarsals and his toes, respectively; and 25 (b) cyclically inflating the inflatable bladders for applying a travelling compressive wave to his foot's underside in a heel-to-toe direction. WO 00/06077 - 17 - PCT/IL99/00419

29. A medical device for effecting dorsiflexion of a subject's foot, the device comprising a platform for supporting the subject's foot, and having an inflatable bladder for cyclically elevating the foot's front portion solely relative to said platform from a normal position thereatop whereby the foot's 5 front portion is flexed relative to the foot's remaining portion overlying said platform, said inflatable bladder having a first compartment overlying said platform and a second compartment hingedly connected to said first compartment along a trailing edge of said inflatable bladder directed towards the subject's heel and limiting means for limiting the maximum height of an 10 edge of said second compartment remote from said trailing edge on inflation of said inflatable bladder whereby said inflatable bladder assumes an inflated triangular shaped configuration tapering towards the subject's heel.

30. The device according to claim 29 wherein said compartments are constituted by a single inflatable cell. 15

31. The device according to either claim 29 or 30 wherein said inflatable member is mounted on a wedge shaped support tapering towards the subject's heel for permanently supporting the foot's front portion only in a flexed position relative to the foot's remaining portion overlying said platform.

32. The device according to claim 31 wherein said support subtends an 20 included angle a of about 300 relative to said platform.

33. The device according to any one of claims 29 to 32 and further comprising an arched plantar arch support for permanently supporting the foot's plantar arch.

34. The device according to claim 33 wherein said plantar arch support 25 has a maximum height above said platform of between 0.7 cm and 1.2 cm.

35. A medical device for effecting dorsiflexion of a subject's foot, the device comprising a platform for supporting the subject's foot, and having a wedge shaped support tapering towards the subject's heel for permanently WO 00/06077 - 18 - PCT/IL99/00419 supporting the foot's front portion in a flexed position relative to the foot's remaining portion overlying said platform; and an inflatable bladder mounted on said support for cyclically elevating the foot's front portion relative thereto from a nonnal position thereatop. 5

36. The device according to claim 35 wherein said support subtends an included angle a of about 300 relative to said platform.

37. The device according to either claim 35 or 36 wherein said inflatable bladder has a first compartment overlying said platform and a second compartment hingedly connected to said first compartment along a trailing 10 edge of said inflatable bladder directed towards the subject's heel and limiting means for limiting the maximum height of an edge of said second compartment remote from said trailing edge on inflation of said inflatable bladder whereby said inflatable bladder assumes an inflated triangular shaped configuration tapering towards the subject's heel. 15

38. The device according to claim 37 wherein said compartments are constituted by a single inflatable cell.

39. The device according to any one of claims 35 to 38 and further comprising an arched plantar arch support for permanently supporting the foot's plantar arch. 20

40. The device according to claim 39 wherein said plantar arch support has a maximum height above said platform of between 0.7 cm and 1.2 cm.

41. A medical device for applying a cyclic therapeutic action to a subject's foot, the device comprising a platform for supporting the subject's 25 foot thereon with an arched plantar arch support for permanently supporting his plantar arch; and an inflatable bladder for cyclically elevating his foot's front portion relative to said platform from a normal position thereatop whereby his foot effects a rocking motion about said plantar arch support acting as a fulcrum-like member. WO 00/06077 - 19 - PCT/IL99/00419

42. The device according to claim 41 wherein said plantar arch support has a maximum height above said platform of between 1 cm and about 3 cm.

43. The device according to either claim 41 or 42 and further comprising an arched toe support for permanently supporting his foot's toes at their bases. 5

44. The device according to claim 43 wherein said toe support has a maximum height above said platform of between 0.3 cm and 0.7 cm.

45. The device according to any one of claims 41 to 44 and further comprising an inflatable bladder for cyclically elevating his foot's heel relative to said platform from a normal position thereatop. 10

46. The device according to claim 45 wherein said inflatable bladder has a first compartment overlying said platform and a second compartment hingedly connected to said first compartment along a trailing edge of said inflatable bladder directed towards the subject's heel and limiting means for limiting the maximum height of the edge of said second compartment remote is from said trailing edge on inflation of said inflatable bladder whereby said inflatable bladder assumes an inflated triangular shaped configuration tapering towards the subject's heel.

47. The device according to claim 46 wherein said compartments are constituted by a single inflatable cell. 20

48. A method for manipulation of a subject's foot, the method comprising the steps of: (a) providing a medical device including a platform for supporting the subject's foot thereon with an arched plantar arch support for 25 permanently supporting the foot's plantar arch, and an inflatable bladder for selectively elevating the foot's front portion relative to the platform from a normal position thereatop; and (b) cyclically elevating the foot's front portion relative to the platform whilst the foot's heel is thereatop, thereby effecting a rocking WO 00/06077 - 20 - PCT/IL99/00419 motion of the subject's foot about the plantar arch support acting as a fulcrum-like member.

49. A kit for installation on a wheelchair having a pair of foot supports 5 for supporting a wheelchair bound subject's feet, the kit comprising: a rechargeable battery operated compressor; a pair of medical devices capable of being in fluid communication with said compressor and mountable on a foot support, each medical device capable of effecting a therapeutic action to the subject's foot; and a controller for controlling the operation of the medical 10 devices.

50. The kit according to claim 49 wherein each medical device is capable of effecting dorsiflexion to a subject's foot.

51. The kit according to claim 49 wherein each medical device is capable of applying a travelling compressive wave to a subject foot's underside. 15

52. A medical device for effecting plantar flexion of a subject's foot, the device comprising a mounting member for mounting the device on the subject's leg, a support member substantially rigidly attached to said mounting member and downward depending for overlying at least a proximal 20 portion of the foot's anterior surface, an inflatable bladder extending along the underside of said support member; and a resiliently flexible foot restraining member attached midway along said support member for encircling the foot's plantar arch.