DE102008052517A1 - Orthosis for treating pathological deviation in hindfoot for extending intra-articular gaps of e.g. human body, has foot shell accommodating subtalar base plate and rotatable relative to leg shell in transversal plane between two directions - Google Patents

Abstract

The orthosis has a lower leg shell (1) for fixing an anklebone part in a mortise, and a foot shell (2) rotatable relative to the lower leg shell in a transversal plane between two directions. The foot shell accommodates a subtalar base plate, and is removably fixable in each of the directions. The foot shell is rotatable in a sagittal- and/or frontal planes, and is attached to a holder that is formed as a U-shaped step bracket. The bracket has side splints (3) attached to the lower leg shell, and closed ends provided below the foot shell.

Description

The The invention relates to an orthosis for extended holding, in particular Pull apart, flexible bony Structures of a body, especially an intra-articular Gap.

In front everything for Treatment procedures and surgical techniques related to flexible bony Structures, such as diseased, worn or operated joints, may be desirable be those bony ones Keep structures specifically relieved or even pull them apart can.

Known is for example the "fixator external "(frz;" outer holder ") to immobilize a bone fracture or bone extension. Here are pins on both sides of the fracture or of the fracture osseous Structure driven through the skin and other tissues into the bones and anchored there. Usually the pins are over Rods outside of the body firmly connected. Should a bone be lengthened, thus successive callus formation is stimulated again and again. there the pins are over the bars successively increasingly pushed apart. The Application of an external fixator is quite onerous.

Of the Invention is the object of the invention to provide a teaching, with the flexible bony structures kept particularly gently stretched, in particular pulled apart, can be.

The Task is solved by an orthosis for stretched holding, in particular pulling apart, flexible bony Structures of a body, especially an intra-articular Gaps, with a first fastening device for fixing the Orthosis on the body on one side of the bony Structure, a second fastening means for fixing the Orthosis on the body on the other side of the bony, in relation to the Streckerichtung Structure, and one the first attachment means and the second Fastening device interconnecting adjusting device, which is designed by its operation either a shortened or an extended one Distance between the first and the second fastening device manufacture.

preferred Embodiments of the invention are specified in the dependent claims and will be closer in the following explained.

The Invention is based on the observation that any flexible bony structures - not bony Fused structures - well fixed with an orthosis can be; also against the resistance of bands and muscles. Furthermore, the invention is based on the idea of an orthosis for one stretched hold on the two opposite sides of a flexible osseous Structure, each with a fastening device, so multipart interpreted and the fastening means via an adjustment for producing different distances between the fastening devices to connect with each other.

In front In particular, the orthosis does not require any intervention in the tissue. she can simply outwardly be created. In general, it will be especially easy Orthosis at shortened Distance between the fasteners apply and after to invest over the adjustment, if desired, the extended Make distance.

The flexible bony Structure can be kept still with the orthosis in the extended state become. By a sufficiently extended distance between the Fasteners may be the flexible bony structure between the Fasteners are also pulled apart; Not bony structures that have grown together are expanded.

The Pulling apart flexible bony structures can relieve these beneficial or the correct anatomical conditions can if necessary, be prepared.

Basically the orthosis beneficial to the human or animal Body used become.

flexible osseous Structures according to the invention are about any joints with intraarticular Cleft or pseudarthrosis, corresponding to a gap outgoing joints or fractures. In principle, any non-bony adulterated Structure stretched or pulled apart by the orthosis.

For example, the orthosis can advantageously be used for reduction, distraction or mobilization in the following indications:
Concerning the upper ankle joint, the lower ankle joint and the knee, for example, in the case of osseous arrondrosis dissecans (conservative and postoperative), postoperatively after cartilage transplantation, for interim treatment in endoprosthesis changes (septic) and in endoprostheses with postoperative mobilization problems.

Concerning the elbow in post-traumatic contractures and endoprostheses with postoperative mobilization issues.

Basically you can in the case of the Algodys Trophie (after M. Sudeck) for gentle application of a mobilization use the orthosis.

The Orthosis can be used for example on the extremities but also on the trunk be, for. B. after vertebral fractures or generally in a joint or spine-relieving manner. When appropriate Filigree construction is the orthosis also for use on the Feet, hands, toes or Fingers suitable.

Generally can the orthosis in osteoarthritis, postoperative treatment, healing or else in case of inflammation and / or pain useful or even targeted bone lengthening or axis correction.

in the Trap of a limb grip the fastening devices this sufficiently firmly proximal and distal to the affected bony Structure.

Preferably can over the adjuster not just a shortened and an extended one Distance, but several more distances, ideally even one Continuum of intervals, be adjusted between the fasteners.

Preferably The orthosis is designed to freely select distances between the first and the produce second fastening device, as far as this in a Interval from a minimum distance to a maximum distance fall.

These Design allows it about, the distance between the fasteners the Progress of a treatment nachzuführen accordingly.

at a preferred embodiment is a rail immovable in the direction of stretching, ideally rigid, connected to the first fastening device. The second fastening device can run in this track become. It can approximately opposite two metallic rails acting as rails attached laterally to the first attachment means and in Be aligned in the direction of the second fastening device. To guide the second fastening device in the rails can this each one elongated Gap in which the second fastening means approximately over guide pins intervenes.

A guide the relative movement of the fastening devices in the direction of stretch can be over a Realize rail structurally simple and stable.

Preferably the adjusting device comprises a switching spring device, ie a spring-loaded device which switches between different states. and can be switched. In a switching state is over the Switch spring device the shortened Distance between the fasteners set; in one other switching state of the extended Distance between these.

at the switch spring device may be a type of dead center spring act. The switching spring device can be about a working cylinder, in particular a gas spring.

A renewal or a shortening the adjuster can be extended by a working cylinder or retraction of the piston rod to be implemented. Will about the first fastening device facing away from the cylinder housing Attached to the end of the piston rod and the second fastening device on the cylinder housing, that's how the state changes of the working cylinder in distance changes between the fasteners down.

It is also preferred, an adjustment with a threaded rod use. Here, for example, the first fastening device be connected to the threaded rod such that no relative movement between the threaded rod and the first fastening device in the stretching direction possible is. The other fastening device can then be used for adjustment of the distance, about over a rotatably held nut, are guided along the thread. in principle can Also racks or screws used for the adjustment become.

Preferably the adjusting device is designed to adjust the distance between the first fastening device and the second fastening device make rigid. Once set, there should be a certain distance between the fasteners until the next setting change unchangeable be.

alternative For example, it is preferable to design the adjustment device so that the distance between the first attachment means and the second Fastening device is made resiliently yielding. Here the distance between the fasteners is also at a certain setting of the adjuster not fixed. If the orthosis is compressed in the stretch direction, the distance between compressed the fastening devices. Leaves the load behind, so The fastening devices are again via a spring device pressed apart. As a spring device, the adjustment can be about a spring or have a gas cylinder.

Becomes the distance produced resiliently, can also the force, with which the fastening devices are forced apart, be specified.

Further it is preferable for the fasteners anatomically form-fitting shell parts to use which the body on each side of the bony Structure at least in sections, ideally complete.

The Shell parts can made of carbon fiber reinforced Cast resin or a cast resin laminate getting produced. For the inner sheaths Polyethylene foam has proven itself.

A preferred embodiment is designed to hold, especially pulling apart, the ankle. This embodiment has a lower leg shell for fixing the orthosis to the lower leg on. Here, the lower leg shell is designed so that they the tibial plateau and the tibial condyles can be supported. Next, it has a footboard for fixing the orthosis to the foot with an at least partially annular Version for this on.

Of the Hindfoot includes especially the talus (talus) and heel bone (calcaneus). projected in the transverse plane are physiological talocalcaneal angles in the range of about 30 ° to about 35 °.

at certain deviations in the hindfoot Among other things, deviating talocalcaneal angles prevail. So this one is Angle in the so-called clubfoot smaller and larger at the kink foot.

It is known to have corresponding deviations in the hindfoot operative or conservative to treat.

to Conservative treatment of clubfoot is the so-called clubfoot plaster known. Here is basically a thigh plaster applied to a sufficient Redression of foot outward to achieve. So that the foot with the clubfoot plaster as a whole opposite the thigh outward can be redressed, the knee joint must be bent. It is also known to provide a suitably shaped and rigid orthosis.

Further In such a method, a redression of 70 ° to 80 ° deviates from the neutral zero position (see below), since the Turn over distributed different parts of the leg; this is a particular burden the ligament apparatus throughout the leg.

at the clubfoot treatment after Ponseti, a correction is made gradually over the successively carrying several, for example, three to eight, gypsum for each different redressions.

Prefers the orthosis is also used to treat pathological deviations in the Rearfoot designed, with an upper fixation device for fixing the anklebone role in the ankle fork and a foot part, which is set up to accommodate the subtalar footplate and relative to the upper fixation device in the transverse plane rotatable between at least two orientation and in each of the orientations solvable can be fixed. The fixing device can be the first fastening and the foot part of the correspond to the second fastening device; or the other way around.

The embodiment is based on the knowledge that the conservative correction of Angular position between the talus and the underlying subtalar foot plate, to which the heel bone belongs, especially the fixation of the anklebone role, as part of the ankle bone, in their embedding on the ankle fork requirement. This is done by the upper fixing device.

Further the embodiment is based on the idea, the subtalar foot plate rotatable relative to the fixed talc in the transverse plane and to be fixed in the orthosis if there is sufficient redression. For this purpose, the orthosis has a foot part, which is used to hold at least the subtalar foot plate, or even the whole foot, is set up and which relative to the fixing device of the orthosis rotatable in the transversal plane and in different orientations, at least in a malposition and in a correction position, solvable in the transverse plane can be fixed.

Becomes on a rotation of the foot part parked in the transversal plane, this does not mean that a corresponding Orthosis is limited to a movement in the transverse plane and may have no further components. Rather, it is under understood a rotation in the transverse plane every movement in which the projection into the transverse plane in the result at a Rotation participates. This applies analogously same for too mentioned below Twists of the foot part in other levels. Thus, in a preferred embodiment (see below), for example, with a forefoot rotation upwards also a Spitzfußkomponente be treated.

The Alignment of the foot part can be specified relative to the so-called neutral zero position. This position takes the foot in Normally, in the upright state of man.

To correct, for example, a clubfoot, the foot may be received in misalignment in the foot part and the ankle bone roll in the ankle fork are fixed over the fixation device. Subsequently, the foot can be rotated in the transverse plane to the outside and fixed there.

to Correction of a kink foot becomes the foot part turned inside. The aim is ultimately a physiological Angle between the heel bone and the talus. For treatment However, it offers, at least initially, a moderate overcorrection at. With sufficient redression while the foot part is fixed; this orientation of the foot part is maintained as long as the treatment requires.

Preferably is the foot part however, between more than two orientations in the transverse plane rotatable and releasably fixable in each of these orientations, ideally is the orientation of the foot part in the transversal plane even continuously adjustable and thereby solvable in each of its orientations fixable. The rotation of the foot part can be done through manual guidance at the distal end of the foot respectively.

All in all allows it this embodiment also pathological deviations in the hindfoot particularly targeted and easy to treat. Structures that are not close to the Corrective structures lie, are spared. At least at a cheap one Course of treatment can be dispensed with a plaster.

Further Is it possible, the redression of the foot in the course of treatment to adapt to the progress of the same. Especially unnecessary Here, if necessary, the application of several plasters one after the other.

In addition, the Orthosis a mooring in the malposition, what the manageability increases.

Especially advantageous is the possibility flexible in the treatment of pathological deviation in the hindfoot osseous Keep structures stretched or pull apart can. For example can in a postoperative clubfoot, the distance between the foot and upper fixing device to an optionally present swelling be adjusted. Is an osteoarthritis in connection with a Given deviations in the hindfoot, In addition to treating the correction, a permanent stretch can occur be meaningful in the stretch direction.

at a preferred embodiment The invention is the foot part in the transversal plane two-dimensional, ie in particular forward and behind and to the left and to the right, sliding and in each of these Positions detachable fixable. In this way it is possible, with any rotation of the foot part, adjust the orthosis so that the biomechanical pivot point in the Sinus Tarsi - in the middle between the furrow between the heel and heel bone - lies, according to its physiological position.

In this preferred embodiment, it is also possible in principle, in addition to a pulling apart of the fastening means whose position also transverse to the stretching direction relative to each other set (see. 8th ).

Possibly. can also be used advantageously already an orthosis, at the foot part only medio-lateral along a straight line transverse to the medial Plane movable and releasably fixed along this line.

Comparable to the language control in the turns, is under a shift understood in the transversal plane every movement, their projection in the transverse plane participates in a shift in the same.

Around To be able to use the orthosis even more flexible, it is preferred, they so to lay out that the foot part also in the sagittal and / or frontal plane rotatable and releasably fixable is, ie rotation in every spatial direction, such as the anatomical Axes following, is given. The corresponding turns can also be composed of other movements, such as a tilting and a translational movement. So the foot can be in the therapeutically required Be turned position without, for example, the anklebone in one To push wrong position. Ideally, the foot part also regarding these turns for a continuum of orientations releasably fixable. They are like that arbitrary pronations and supinations adjustable.

It should, however, especially in the sagittal plane, not too large deviations be set from the neutral zero position, otherwise the Risk for a dislocation is too high. So should the angle between the Foot and the lower leg, with simultaneous rotation in the transverse plane, 90 ° not to exceed significantly otherwise the ankle bone can jump out of the ankle fork. Different expressed preferably the angle between foot and Lower leg in the redressed state at most 120 °; better than 100 °.

The upper fixing device preferably has a shell part, or else a plurality of shell parts, for the lower leg, which clamps the inner and outer knuckles distally for the mechanical securing of the anklebone roll in a physiological position. About the clasp enough pressure for a sufficient fixation is issued practices. For this purpose, the shell part can be tied together with straps, possibly with Velcro. To protect the ankles, they can be protected with an annular polymer gel cushion and / or with a tubular inner shell. Even otherwise, the shell parts or parts can be provided to improve the comfort with inner sleeves. Inner sheaths are also called "liners" in orthopedic technology.

The Shell parts can made of carbon fiber reinforced Cast resin or a cast resin laminate getting produced. For the inner sheaths Polyethylene foam has proven itself.

Preferably has the foot part a shell part for holding the foot, or at least the subtalar footplate on. A secure grip granted about a foot part, which the foot, for example in the area of the metatarsal bones, annular encloses. This shell part can also be equipped with an inner shell. For one easy entry into the orthosis, the foot part heel side with a be provided removable flap.

at a preferred embodiment is the foot part attached to a bracket, which in turn is attached to the upper fixing device is attached. The holder is designed as a U-shaped treads, the two legs attached to the upper fixing device and whose closed end is under the foot part, being the foot part on the stirrup is rotatably supported by a hinge.

The Bracket can be about two laterally extending at the top Fixing device rigidly mounted rails to be realized. in the lower area can the rails are connected to each other and the treads bspw. one piece form. The stirrup is given a setting of the distance between the fasteners preferably fixed relative to the upper fixing device.

The footboard can also rotate on other parts of the orthosis by means of a joint supported be. Also a kickstand does not necessarily have to be given.

Preferably it is at the joint to a ball joint.

is a kickstand given, it is preferred, the joint displaceable in the transverse plane as well as detachable fixable on the stirrup to fix.

in the The invention is also intended to be based on exemplary embodiments be explained in more detail, without limiting the invention by the examples want:

1 shows a first orthosis according to the invention; applied to a lower leg.

2 says a second orthosis according to the invention.

3 shows side by side parts of an orthosis for the treatment of deviations in the hindfoot.

4 shows a front view of the orthosis 3 in assembled condition.

5 shows a rear view of the orthosis 4 ,

6 shows a side view of the orthosis from the 4 and 5 ,

7 shows in a rear view the lower portion of another orthosis for the treatment of deviations in the hindfoot

8th shows a side view of an orthosis for the treatment of pathological deviations in the hindfoot and pulling apart bony structures.

For same or mutually corresponding features are cross-figurative the same reference numerals are used.

1 shows in the foreground applied to a lower leg first orthosis according to the invention. An anatomically form-fitting multi-part lower leg shell 1 surrounds the lower leg just below the knee. The outer shell of the lower leg shell 1 consists of a cast resin laminate; It is lined with a polyethylene inner sleeve. The lower leg shell 1 is supported on the tibia plateau and the tibial condyles to provide a secure fit. With a lower leg shell 1 surrounding belt 40 This can be pressed to improve the hold on the lower leg.

The foot is made of an anatomically form-fitting foot shell 2 , consisting of the same cast resin laminate as the lower leg shell 1 , which surrounds the foot in the area of the metatarsal bones annular. An inner shell 9 made of polyethylene for embedding the foot is clearly visible here.

In the area of the heel or ankle you can see an external footrest suspension 60 which is a tilting of the foot shell 2 allowed relative to the transverse plane.

Side rails 3 lead from the foot shell 2 in the direction of the knee (only the right rail is visible 3 in the foreground; the left rail is hidden by the lower leg). The rails 3 are over the footrest suspension 60 so on the foot shell 2 attached so that they are immovable in the direction of stretch.

The side rails 3 ends approximately midway between the foot and the knee. In this area of the rails 3 There is a 5 cm long guide gap on each side 42 , The multi-part lower leg shell 1 grabs a guide pin on each side 43 in the appropriate guide gap 42 one. Be foot shell 2 and lower leg shell 1 shifted in the stretch direction against each other, so the movement is through the rails 3 and those in the corresponding guide column 42 engaging guide pins 43 guided.

The two rails 3 are approximately in the middle by a metal strap around the shin 54 connected with each other. A pneumatic working cylinder 50 is aligned substantially parallel to the direction of stretching and on the one hand to the bracket 54 attached and on the other hand higher up on the lower leg shell 1 , By moving a lever 52 on the pneumatic cylinder 50 can the piston rod 55 be extended. The lever 52 is lockable in two settings. In one of the settings is the piston rod 55 maximally extended; at the other setting is the piston rod 55 largely confiscated. Accordingly, at maximum extended piston rod 55 the foot shell 2 , mediated over the temple 54 and the rails 3 , and the lower leg shell 1 pressed apart. At the other adjustment of the lever 52 become the foot shell 2 and the lower leg shell 1 contracted again.

Instead of a working cylinder 50 can the distance between the foot shell 2 and the lower leg shell 1 also via a threaded rod, rack or via a worm gear (each not shown) can be adjusted. With appropriate embodiments, the distance between the foot shell 2 and the lower leg shell 1 can also be set freely selectable, as far as a minimum distance is not undershot or a maximum distance is not exceeded.

The distance between the foot shell 2 and the lower leg shell 1 gets over the working cylinder 50 set resiliently yielding. If the orthosis, for example, pulled together in the stretch direction, it will be slightly compressed due to the resilient-yielding distance setting. If the load decreases, the set distance is assumed again. About the working cylinder 50 , For example, a hydropneumatic cylinder, a force can be given, with which the fasteners can be forced apart, for example, 200 to 600 N. Smaller and larger values are basically also conceivable.

2 shows a further orthosis according to the invention. This, too, points out the orthosis 1 comparable, a corresponding lower leg shell 1 , Foot shell 2 and on the foot shell 2 fixed rails 3 on.

Unlike the orthosis 1 show the rails 3 here two guide gaps 42 on, in which the lower leg shell 1 via one guide pin each 43 intervenes.

Here, too, around the shin around the front bracket 54 used. Here, however, it is made of a cast resin laminate, and it also conceals the rails 3 in each case between the two guide gaps 42 ,

In the back part of the foot shell 2 you can see a heel flap 8th which can be removed for easy entry and exit.

The distance between the lower leg shell 1 and the foot shell 2 is also here via a pneumatic cylinder 50 set. About a lever 53 is also here a piston rod 55 pushed out of the cylinder or pulled into this. The lever 53 is eccentric on a locking plate 51 stored and is operated to the side. Both extended and retracted piston rod becomes the lever 53 by means of recesses (not visible) on the locking plate 51 fixed.

With the lever fixed 53 is the distance between the foot shell 2 and the lower leg shell 1 immutable set.

3 shows side by side parts of a disassembled orthosis for the treatment of deviations in the hindfoot. Top right is a lower leg shell 1 made of cast resin laminate to accommodate a lower leg shown. The lower leg shell 1 is designed to clasp the ankles and thus fix the ankle roll in the ankle fork. The ankles can thereby by a tube-shaped inner shell 10 be protected from polyethylene; additionally or alternatively also with an annular polymer gel pad (not shown).

The foot comes with a foot shell 2 held, which completely surrounds the foot in the metatarsal bone. The foot shell 2 is also with an inner shell 9 made of polyethylene. To get started in the foot shell 2 To facilitate, is the heel end of the foot shell 2 open. It comes with a cover to be screwed 8th closed after entry.

rails 3 are about a transition piece 3a to the kickstand 4 connected together so that an overall U-shaped configuration is formed. The transition piece 3a has a recess 5 on, a displaceable and detachable and fixable storage of the foot shell 2 to enable. The lower leg shell 1 is about the screw connection 11 between the side rails 3 attached.

A pan 6 with a flat side and a convex side is with its flat side on the transition piece 3a hung up. The pan is attached 6 on the transition piece 3a with a holding plate 7 below the stirrup, with the retaining plate 7 and the pan 6 screwed together and the corresponding screw (not shown) through the recess 5 round picks. When loosened screw is the pan 6 free in the plane of the transition piece 3a , ie in the transverse plane, displaceable, as far as the recess 5 allowed.

The foot shell 2 has a concave bulge 12 on which with the pan 6 corresponds. Will the foot shell 2 about the bulge 12 in the pan 6 put, so can the foot shell 2 about the bulge 12 along the surface of the pan 6 to be filmed in all levels; the bulge 12 acts as a joint head of a ball joint, so to speak. The footrest is fastened 2 in the pan 6 through one out of the pan 6 vertically upwardly pointing screw (not shown, this screw can be identical to that through the recess 5 be guided screw).

The bulge 12 has the sole side a hole (not shown) with a diameter of a few centimeters. On the hole, inside the foot shell 2 , a slidable receptacle (not shown) for the screw is removed from the pan 6 hung up. The receptacle may correspond in shape to a section of a spherical surface. When the screw is screwed into the receptacle and tightened sufficiently, the foot shell becomes 2 in the pan 6 fixed. If the screw is loosened, then the foot shell 2 about the bulge 12 in the pan 6 be turned in all spatial directions.

4 shows the orthosis from the in 3 parts shown; Assembled as described there. It is an orthosis for the treatment of a deviation in the hindfoot with a clubfoot component.

The foot shell 2 and the lower leg shell 1 are shown in the neutral zero position.

After tightening the orthosis, the foot shell 2 rotated outward along the direction of the arrow A in the transverse plane to correct the pathologically reduced angle between the heel bone and the anklebone. In order to achieve a sufficient Redression of the foot, is the outside rail 3 bulged 20 to be able to give the rotation A more space.

In 5 is the orthosis off 4 shown from behind. Arrows M, N indicate that the pan 6 on the stirrup 4 is slidably mounted in the transverse plane. Arrows B and C indicate rotations for producing a pronation or supination; the foot shell 2 is in the frontal plane, so rotatable about its length.

6 shows the same orthosis from its right side. Arrows D and E indicate the rotatability of the foot shell 2 up and down in the sagittal plane.

In 7 the lower section of another orthosis with ball joint is shown. The foot shell 2 is here about another joint 30 on the stirrup 4 abgestüzt. Again, this is the joint 30 along the stage 4 slidably; compare the arrows M, N. At the joint 30 it is a ball joint 30 , From the ball joint 30 goes a tilting in every direction carrying rod 31 which is also rotatable about its longitudinal axis. Fußschale 2 and carrying rod 31 are rigidly connected. Due to the rotatability about the longitudinal axis of the support rod 31 can the foot shell 2 be rotated in the transverse plane. By tilting the carrier rod 31 and moving the ball joint 32 in the transverse plane, the foot shell 2 also be turned in the other levels.

At the side of the ball joint 30 are screws 32 to recognize. If these are tightened, then the ball joint 30 set.

8th shows an orthosis for treating pathological deviations in the hindfoot and pulling apart bony structures. The upper part of this orthosis with lower leg shell 1 , Straps 40 , Guide column 42 in rail 3 , Guide pins 43 (not visible here), working cylinder 50 , Lever 52 , Hanger 54 and piston rod 55 corresponds essentially to the upper part of the orthosis 2 , The lower part of the working cylinder 50 is how in 2 , via piston rod 55 and the temple 54 on the rails 3 attached. The upper part of the working cylinder 50 is on the lower leg shell 1 attached (the connections between the bracket 54 and the working cylinder 50 or between the lower leg shell 1 and the working cylinder 50 are not explicitly drawn). Next is a foot shell 2 as in 2 available.

The lower section of in 8th Orthosis shown corresponds to that in the 3 and 6 shown embodiment. Here, too, form the rails 3 a stirrup 4 out. The stirrup 4 is down to a retaining plate 7 widened, on the, as explained above, a socket 6 is screwed on. Again, the foot shell 2 positive fit in the pan 6 movably attached.

The rails 3 at the lower end of the lower leg shell 1 or above the foot shell 2 a joint 70 on, leaving the lower part of the rails 3 can be tilted forward and backward relative to the upper part. The axis of rotation corresponds to the upper ankle joint. The space between foot shell 2 and lower leg shell 1 allows a corresponding movement. The joint 70 is detachable and fixable for every adjustable tilt angle. The detachable and fixable joint 70 may also include a motor for tilting and fixing. Alternatively to a motor having joint 70 can the foot shell 2 and the lower leg shell 1 be connected to each other via a drive, which via a rod the foot shell 2 and the lower leg shell 1 tackles. The rod is, for example, in the forefoot of the foot shell 2 and in the lower part of the lower leg shell 1 attached (not shown).

With the joint 70 the possibility for position correction is extended. In addition, over the joint 70 and possibly additionally existing motor mobilized the ankle. For example, stiffening after surgery, such as clubfoot surgery, can be prevented. Next can about the joint 70 and a corresponding motor also arthritis are treated. Here it is particularly advantageous that foot shell 2 and lower leg shell 1 can also be pulled apart. This simplifies exercise therapy and also avoids pain.

Overall, this orthosis allows all above-mentioned movements and rotations of the foot shell 2 relative to the lower leg shell 1 , In addition, in this orthosis lower leg shell 1 and foot shell 2 be pulled apart. In addition, the foot shell 2 over the joint 70 be tilted forward and backward.

1

Lower leg shell

2

Fußschale

3

lateral rail

3a

Transition piece

4

Ironing occurs

5

recess

6

pan

7

Retaining plate

8th

heel flap

9

interior Skin

10

interior Skin

11

screw

12

bulge

20

bulge

30

joint

31

carrying bar

32

screw

40

belt

41

belt

42

guide gap

43

guide pin

50

working cylinder

51

locking plate

52

lever

53

lever

54

hanger

55

piston rod

60

Fußschalenaufhängung

70

joint

A-E

direction of rotation

M, N

displacement direction

Claims (10)

Orthosis for stretched holding, in particular pulling apart, flexible bony structures of a body, in particular an intra-articular gap, with a first fastening device ( 1 . 2 ) for fixing the orthosis to the body on one side of the bony structure, a second fastening device ( 2 . 1 ) for fixing the orthosis to the body on the other side of the bony structure with respect to the stretch direction, and a first fastening device ( 1 . 2 ) and the second fastening device ( 2 . 1 ) adjoining adjusting device ( 50 ) which is designed, by its operation, optionally a shortened or an extended distance between the first and the second fastening means ( 2 . 1 ). Orthosis according to Claim 1, in which the adjusting device ( 50 ) is adapted to freely selectable distances, from a minimum distance to a maximum distance, between the first and the second fastening device ( 2 . 1 ). Orthosis according to Claim 1 or 2, in which the first fastening device ( 1 . 2 ) is immovably connected in the stretching direction with a rail and the second fastening device ( 2 . 1 ) is guided by the rail. Orthosis according to one of the preceding claims, in which the adjusting device ( 50 ) a switching spring device ( 50 ). Orthosis according to one of Claims 1 to 3, in which the adjusting device ( 50 ) comprises a threaded rod. Orthosis according to one of the preceding claims, in which the adjusting device ( 50 ) is designed to reduce the distance between the first fastening device ( 1 . 2 ) and the second fastening device ( 2 . 1 ) rigidly. Orthosis according to one of Claims 1 to 5, in which the adjusting device ( 50 ) is designed to reduce the distance between the first fastening device ( 1 . 2 ) and the second fastening device ( 2 . 1 ) produce resiliently yielding. Orthosis according to one of the preceding claims, in which the first fastening device ( 1 . 2 ) a first anatomically positive shell part ( 1 . 2 ) for at least partially enclosing the body and the second fastening device ( 2 . 1 ) a second anatomically form-fitting shell part ( 2 . 1 ) for at least partially enclosing the body. An orthosis according to claim 8 for the extension of the ankle, with a lower leg shell for fixing the orthosis to the lower leg by support on the tibial plateau and the tibial condyles and a Fußschale ( 2 ) for fixing the orthosis to the foot with at least a portion annular ring ( 2 ) for the foot. Orthosis according to one of the preceding claims for the treatment of pathological deviations in the hindfoot with an upper fixation device ( 1 ) for fixing the ankle roll in the ankle fork and a foot part ( 2 ) adapted to receive the subtalar footplate and relative to the upper fixation device ( 1 ) is rotatable in the transverse plane between at least two orientations and releasably fixable in each of the orientations.