DE102022126220A1 - Medical shoe insole for the conservative treatment of hallux valgus - Google Patents

Abstract

The invention relates to a medical shoe insole (32) for the conservative treatment of hallux valgus. It comprises a base body (34) and a pad section (36), the pad section (36) having an uneven protrusion (38) with a highest point (40). The pad section (36) is designed such that it can be arranged in a space (42) formed between the longitudinal arch (43) of a foot (10) deformed by hallux valgus and an insole of a shoe such that the longitudinal arch (43) of the foot (10) covers the pad section (36). According to the invention, the protrusion (38) extends towards the longitudinal arch (43) when the pad section (36) is arranged in the intermediate space (42), in such a way that it rises in the medial and distal direction and the highest point (40) of the protrusion (38) is located proximal to the osso sesamoidea pedis on the distal head (18) of the os metatarsal 1 (16)

Description

BACKGROUND OF THE INVENTION

1. Field of the invention

1. a) einen Grundkörper mit einem proximalen und einem distalen Ende,
2. b) einen Pelottenabschnitt, der eine ungleichmäßige Vorwölbung mit einem höchsten Punkt aufweist, wobei der Pelottenabschnitt derart ausgebildet ist, dass er in einem

zwischen dem Längsgewölbe eines durch einen Hallux valgus deformierten Fußes und einer Brandsohle eines Schuhs ausgebildeten Zwischenraum so angeordnet werden kann, dass das Längsgewölbe des Fußes den Pelottenabschnitt abdeckt.The invention relates to a medical shoe insole for the conservative treatment of hallux valgus, comprising

1. a) a base body with a proximal and a distal end,
2. b) a pad section having an uneven protrusion with a highest point, the pad section being designed such that it can be

The space formed between the longitudinal arch of a foot deformed by a hallux valgus and the insole of a shoe can be arranged in such a way that the longitudinal arch of the foot covers the pad section.

2. Description of the state of the art

Genetic predispositions, which can cause splay feet, for example, as well as wearing unsuitable footwear, can lead to misalignment of the toes and, as a result, to deformation of the entire foot. One of the most common toe misalignments is the so-called hallux valgus, or colloquially known as a bunion.

Hallux valgus is medically indicated when the position of the big toe (digitus pedis I or hallux) deviates towards the central longitudinal axis of the foot (valgic) in relation to its natural basic position. This so-called valgus position of the big toe is based on a deviation in the position of the first metatarsal bone (first metatarsal bone) away from the central longitudinal axis of the foot (varic). Due to this varic misalignment, the distal head of the first metatarsal bone protrudes clearly on the medial edge of the foot, which can cause painful bursitis when wearing shoes.

Hallux valgus is a progressive disease because tendons, especially the extensor hallicus longus muscle (long extensor tendon), no longer run centrally over the Articulatio metatarsophalangealis I (big toe joint), but laterally past it, thus increasingly displacing the big toe in a valgus direction.

Conservative medical treatment methods are known from the state of the art, which include the use of footwear that allows the toes significantly more freedom of movement than normal everyday footwear (so-called "barefoot shoes"). There are also shoe insoles, so-called splayfoot insoles, which can be inserted into normal everyday footwear and which, depending on the shoe insole used, attach to different anatomical points on the sole of the foot.

Such shoe insoles have a base body and often a pad section that is molded onto the base body. The pad section is often a cushion or a pillow that can be filled with a gel-like substance, for example. The pad section is usually designed in such a way that it can be positioned in a space between the longitudinal arch of the foot, i.e. the arch on the sole of the foot that runs lengthways along the foot, and an insole of a shoe, so that the longitudinal arch of the foot covers the pad section. The pad section then exerts a supporting force on corresponding anatomical points on the sole of the foot when walking and standing, which is intended to return the big toe to its normal position.

The disadvantage of these known treatment methods is that they have little to no therapeutic effect and surgery is often required to move the big toe from the valgus position to its normal position. However, even these special operations often only promise a reduced treatment success and the big toe remains in a slight valgus position after the operation.

SUMMARY OF THE INVENTION

It is therefore an object of the present invention to overcome the above-mentioned disadvantages of the prior art and to significantly increase the treatment success of hallux volgus.

• c) sich, wenn der Pelottenabschnitt im Zwischenraum angeordnet ist, die Vorwölbung zum Längsgewölbe hin erstreckt, derart, dass sie in medialer und distaler Richtung ansteigt und sich der höchste Punkt der Vorwölbung proximal der Osso sesamoidea pedis am distalen Köpfchen des Os metatarsale I befindet.

This task is solved in the shoe insole mentioned above by

• (c) when the pad section is arranged in the interspace, the protrusion extends towards the longitudinal arch in such a way that it increases in a medial and distal direction and the highest point of the protrusion is located proximal to the sesamoidea pedis at the distal head of the first metatarsal.

The Osso sesamoidea pedis are sesamoid bones that are located on the plantar side of the distal head of the first metatarsal bone in the tissue of the Musculus flexor hallucis brevis (short big toe flexor) are embedded. The osso sesamoidea pedis allows the musculus flexor hallucis brevis to exert an optimal leverage effect on the big toe.

The arrangement of the highest point of the protrusion of the pad section according to the invention causes the toes, in particular the big toe and the digitus pedis II, to spread away from each other. This effect occurs because the distal third of the first metatarsal bone is supported when walking and standing in such a way that the distal head of the first metatarsal bone moves in a valgus direction and thus the first distal phalanx of the pedis (big toe) moves in a varicose or medial direction. The big toe is therefore approximately brought into a normal position by using the shoe insole. The continued use of the shoe insole leads to a gradual improvement in the hallux misalignment.

The term “medial” refers to a longitudinal central axis of the foot and/or the shoe insole and the terms “distal” and “proximal” refer to a transverse central axis of the foot and/or the shoe insole, depending on the context in which they are used. “Medial” refers to the position starting from the longitudinal central axis of the foot and/or the shoe insole and/or an anatomical reference structure in the direction of the body or to the left of the longitudinal central axis. “Distal”, on the other hand, refers to the position starting from the transverse central axis of the foot and/or the shoe insole and/or an anatomical reference structure in the direction of travel (front). “Proximal” is defined as the opposite of “distal”, namely the position starting from the transverse central axis of the foot and/or the shoe insole and/or an anatomical reference structure in the opposite direction of travel (back).

• Der Pelottenabschnitt weist vier im Wesentlichen gleich große Sektoren auf, die durch eine Längsmittelachse und eine Quermittelachse des Pelottenabschnitts ausgebildet sind, wobei die Sektoren ausgehend von einem ersten medial-distal gelegenen Sektor im Uhrzeigersinn bis zu einem vierten medial-proximal gelegenen Sektor nummeriert sind. Der erste Sektor weist wiederum entlang parallel zur Längs- und zur Quermittelachse des Pelottenabschnitts verlaufender Geraden vier Untersektoren auf, die in derselben Art und Weise nummeriert sind. Der höchste Punkt der Vorwölbung befindet sich dann in einem ersten medial-distal gelegenen Untersektor des ersten Sektors.

The shoe insole can preferably be designed as follows:

• The pad section has four sectors of essentially the same size, which are formed by a longitudinal central axis and a transverse central axis of the pad section, wherein the sectors are numbered starting from a first medial-distally located sector in a clockwise direction up to a fourth medial-proximal sector. The first sector in turn has four sub-sectors, which are numbered in the same way, along straight lines running parallel to the longitudinal and transverse central axes of the pad section. The highest point of the protrusion is then located in a first medial-distally located sub-sector of the first sector.

Preferably, the medical shoe insole is designed such that, when the pad section is arranged in the intermediate space, the highest point of the protrusion is located medially on the distal head of the first metatarsal bone.

Preferably, the pad section is formed as a single piece on the base body. This reduces friction caused by seams on the sole of the foot, for example, and makes the shoe insole comfortable to wear.

To ensure that the metatarsophalangeal joints (MTPs) are not restricted in their freedom of movement and that the user has as natural a feeling as possible when wearing the shoe insole, it is advantageous if the pad section and/or the base body end proximal to the metatarsophalangeal joints when the pad section is arranged in the space between them, such that the metatarsophalangeal joints can move freely without restriction.

In order for the big toe, which points valgus inwards, i.e. hallux valgus, to be able to be brought into a normal position, it is necessary, as already mentioned above, according to the invention that the distal head of the first metatarsal bone, which points varicosely outwards due to the disease, is redirected towards a central longitudinal axis of the foot. The shoe insole is therefore advantageously designed in such a way that a strip-like elevation is arranged along an outer edge of the pad section, at least over a section of this outer edge, which slopes down towards the longitudinal central axis of the pad section and which, when the pad section is arranged in the gap, extends medially-distally along the outer edge and preferably acts on the corpus (body) of the first metatarsal bone.

The bar-like elevation then acts as a kind of splint for the big toe.

Preferably, in order to improve the effect immediately above, the shoe insert is designed such that the strip-like elevation at the distal end of the base body has a thorn-like bulge which, when the pad section is arranged in the intermediate space, extends in the distal direction and exerts a supporting force on the distal head of the first metatarsal bone in a direction towards a longitudinal central axis of the foot.

In order for the user of the shoe insole to have the most ergonomic and therefore comfortable wearing experience possible, it is advantageous if the strip-like elevation continuously transitions into the thorn-like bulge.

It is also advantageous if the highest point of the pad section is lower than the highest point of the bar-like elevation. This ensures the optimal splinting effect of the bar-like elevation and the thorn-like bulge on the distal head of the first metatarsal bone.

Preferably, a slot is formed along a longitudinal central axis and/or a transverse central axis of the pad section, through which a first loop runs for the purpose of attaching the medical shoe insole to the foot, which can be guided dorsally around the foot, and a second loop runs through which can be guided between the big toe and the digitus pedis II and dorsally around the big toe. This design makes it possible to provide essentially a standard size for the shoe insole and then to bring it into the position according to the invention and fix it in this position using the loops, depending on the specific anatomical conditions of the user.

Alternatively, the shoe insert can be attached with an adhesive to the insole or to a separate insole, e.g. a winter insole, in particular a flat (winter) insole.

Another advantage is when the shoe insole is designed in such a way that at least one magnet is arranged in or on the pad section in such a way that, when the pad section is arranged in the gap, it corresponds locally with an acupuncture point on the sole or edge of the foot, in particular the acupuncture points MP2 and MP3 of the spleen-pancreas meridian. By stimulating the acupuncture point, further effects can occur that are beneficial for the healing of the foot and the correction of hallux volgus.

BRIEF DESCRIPTION OF THE DRAWINGS

• 1 eine Draufsicht auf einen durch einen Hallux valgus deformierten Fuß;
• 2 eine Draufsicht auf eine erfindungsgemäße Schuheinlage gemäß einem ersten Ausführungsbeispiel;
• 3 eine perspektivische Ansicht der Schuheinlage gemäß dem ersten Ausführungsbeispiel;
• 4 eine Seitenansicht eines durch einen Hallux valgus deformierten Fußes, wobei die erfindungsgemäße Schuheinlage gemäß dem ersten Ausführungsbeispiel derart angeordnet ist, dass ein Pelottenabschnitt der Schuheinlage von einem Längsgewölbe des Fußes abgedeckt wird;
• 5 eine Draufsicht der Anordnung der Schuheinlage relativ zum Fuß von 4;
• 6 eine der 2 entsprechende Draufsicht auf die erfindungsgemäße Schuheinlage gemäß einem zweiten Ausführungsbeispiel.
• 7 eine perspektivische Ansicht des zweiten Ausführungsbeispiels der medizinischen Schuheinlage;
• 8 eine perspektivische Ansicht eines zweiten Ausführungsbeispiels der erfindungsgemäßen Schuheinlage in proximaler Richtung.

In the following, embodiments of the invention are explained in more detail with reference to the drawings. In these:

• 1 a top view of a foot deformed by a hallux valgus;
• 2 a plan view of a shoe insole according to the invention according to a first embodiment;
• 3 a perspective view of the shoe insole according to the first embodiment;
• 4 a side view of a foot deformed by a hallux valgus, wherein the shoe insert according to the invention according to the first embodiment is arranged such that a pad section of the shoe insert is covered by a longitudinal arch of the foot;
• 5 a top view of the arrangement of the shoe insole relative to the foot of 4 ;
• 6 one of the 2 corresponding plan view of the shoe insole according to the invention according to a second embodiment.
• 7 a perspective view of the second embodiment of the medical shoe insole;
• 8th a perspective view of a second embodiment of the shoe insole according to the invention in the proximal direction.

DESCRIPTION OF PREFERRED EMBODIMENTS

To illustrate the clinical picture of hallux valgus, the 1 a foot marked 10 in total, deformed by a hallux valgus.

In the figure, a central longitudinal axis A1 and a central transverse axis A2 of the foot 10 are provided with a separate reference symbol. Also separately designated are the big toe (digitus pedis 1), which is designated as a whole with 12, the ankle joint 14, the os metatarsale 1 16 (I. metatarsal bone), its distal head 18 and its corpus 20, the articulatio metatarsophalangealis 122 (big toe ankle joint), the pholax proximalis pedis l 24 (big toe proximal phalanx), the phalanx distalis pedis l 26 (big toe distal phalanx) and the digitus pedis II, all with 28. In addition, the osso sesamoidea pedis are each provided with the reference symbol 30.

In a hallux valgus there is a varus deviation of the first metatarsal bone 16, i.e. its long axis A3 deviates in a direction medial to the longitudinal central axis A1 of the foot 10. As a result, the tendons attaching to the phalanx distalis pedis l 26 no longer run over the articulatio metatarsophalangealis I 22, but laterally past it, whereby the long axis A4 of the phalanx distalis pedis l 26 is increasingly pulled into a valgus malposition, i.e. deviates towards the central longitudinal axis A1 of the foot 10. Due to this malposition of the big toe, the bursa attached to the distal head 18 of the metatarsal bone 116 usually swells.

In the 2 to 5 A first embodiment of a medical shoe insert 32 is now shown, in which 2 and 3 each isolated and in the 4 and 5 each in a relative position to the foot 10. The first embodiment will be described below with reference to these figures.

The medical shoe insole 32, which is designed for the conservative treatment of hallux valgus as described above, comprises a base body 34 with a proximal end 35a and a distal end 35b as well as a pad section 36. The pad section 36 and/or base body can be made of a plastic, for example by means of injection molding or 3D printing. Ideally, a comparatively rigid material is used for the pad section 36, since otherwise the therapeutic effect of the medical shoe insole is reduced. In addition, the pad section 36 and/or the base body 34 can be coated with an elastic material such as silicone or cork in order to ensure a good spring effect when walking and standing and thus a comfortable wearing feeling. For the same reason, the protrusion 38 can be formed by a pad or cushion that can be filled with a gel-like substance.

The pad section 36 has an uneven protrusion 38 which has a highest point 40. The pad section 36 is designed such that it can be arranged in a space 42 between a longitudinal arch 43 of the foot 10 and an insole of a shoe (not shown). The longitudinal arch 43 of the foot 10 then covers the pad section 36.

The pad section 36 has four essentially equally sized sectors 44a-d, which are formed by a longitudinal central axis A5 and a transverse central axis A6 of the pad section 36, wherein the sectors 44a-d are numbered starting from a first medial-distally located sector 44a in a clockwise direction up to a fourth medial-proximal sector 44d. The first sector 44a in turn has four subsectors 46a-d along straight lines G running parallel to the longitudinal and transverse central axes A5, A6 of the pad section 36, which are numbered in the same way. The highest point 40 of the protrusion 38 is located in the present example in a first medial-distally located subsector 46a of the first sector 44a.

When the pad portion 36 is arranged in the intermediate space 42, the protrusion 38 extends to the longitudinal arch 43 of the foot 10 such that it rises in the medial and distal direction and the highest point 40 of the protrusion 38 is located proximal to the osso sesamoidea pedis 30 at the distal head 18 of the os metatarsal 116.

This causes the toes, particularly the big toe 12 and the digitus pedis II 28, to spread away from each other. This effect occurs because the distal third of the metatarsal bone 116 is supported when walking and standing in such a way that the distal head 18 of the metatarsal bone 116 moves in a valgus direction and thus the phalanx distalis pedis l 26 (end phalanx of the big toe) moves in a varicose or medial direction.

In the present embodiment, the pad section 36 is formed in one piece on the base body 34. In addition, in the present embodiment, the base body 34 and the pad section 36 are essentially not visually and functionally distinguishable from one another and are covered entirely by the longitudinal arch 43. In embodiments not specifically shown, the pad section 36 can also be glued or sewn onto the base body 34 and the base body 34 can function in the form of a surrogate for or a support on the insole of the shoe (not shown).

As can be seen from the 4 and 5 As can be seen, the pad section 36 and the base body 34 end proximal to the metatarsophalangeal joints 22 when the pad section 36 is arranged in the intermediate space 42. This ensures that the metatarsophalangeal joints 22 retain their freedom of movement and are not impaired by the shoe insert 32.

In the example of the 2 to 5 The medical shoe insert 32 measures approximately 12 cm along its greatest longitudinal extension and approximately 5 cm along its greatest transverse extension. So that the pad section 36 can be ideally positioned beneath the longitudinal arch 43 and does not cause any impairment when walking or standing, it measures approximately 3 cm along its greatest vertical extension. In embodiments not specifically shown, these dimensions may also deviate by approximately 1 to 2 cm.

In the 6 to 8 A second embodiment of the medical shoe insole 32 is now illustrated.

In this embodiment of the shoe insert 32, a strip sloping towards the longitudinal center axis A5 of the pad section 36 is provided along an outer edge 48 of the pad section 36 over a section of this outer edge 48. like elevation 50 is arranged, which, when the pad section 36 is arranged in the intermediate space 42, extends medially-distally along the outer edge 48. This strip-like elevation 50 acts on the corpus 20 of the metatarsal bone 116 and thus supports it. Adjacent to the strip-like elevation 50, a groove-like depression 51 is formed, in which at least a section of the metatarsal bone 116 can be embedded.

The design variants described in relation to the first embodiment of the medical shoe insert 32 can also be present in the second embodiment. Furthermore, designs are also conceivable in which a flexible material can be applied in the groove-like depression 51 and/or on the strip-like elevation 50 in addition to a full coating with a flexible material or as an alternative to this. This can be achieved, for example, using a silicone cushion or a cork-like area.

Furthermore, in the second embodiment of the medical shoe insert 32, the strip-like elevation 50 at the distal end 35b of the base body 34 has a thorn-like bulge 52 which, when the pad section 36 is arranged in the intermediate space 42, extends in the distal direction and exerts a supporting force on the distal head 18 of the metatarsal bone 116 in a direction towards a longitudinal central axis A1 of the foot.

In the present case, the strip-like elevation 50 continuously merges into the thorn-like bulge 52. When the pad section 36 is arranged in the intermediate space 42, an improved supporting force acts on the distal head 18 of the metatarsal bone 116 in comparison to the shoe insert 32 according to the first embodiment.

In the present case, the strip-like elevation 50 and the thorn-like protrusion 52 have the function of a guide rail for the first metatarsal bone 16 and a correction rail for the entire big toe 12.

For example, in the second embodiment, the highest point 40 of the protrusion 38 of the pad section 36 is located lower than a highest point 54 of the strip-like elevation 50. This advantageously ensures that the strip-like elevation 50 and the thorn-like bulge 52 can function optimally as a support rail for the first metatarsal bone 16.

In embodiments of the shoe insert 32 not specifically shown, a slot is formed along a longitudinal center axis A5 of the pad section 36, through the base body 34 and the pad section 36, through which a first loop runs for the purpose of fastening the medical shoe insert 32 to the foot 10, which can be guided dorsally around the foot 10, and a second loop that can be guided between the big toe 12 and the digitus pedis II 28 and dorsally around the big toe 12. In a further embodiment not specifically shown, the slot runs along a transverse center axis A6 of the pad section 36. Further embodiments not specifically shown include both a slot running along the longitudinal center axis A5 and a slot running along the transverse center axis A6.

Furthermore, in embodiments not specifically shown, at least one magnet is arranged in or on the pad section 36 such that, when the pad section 36 is arranged in the intermediate space 42, it corresponds locally to an acupuncture point on the sole of the foot.

Claims (9)

Medical shoe insert (32) for the conservative treatment of a hallux valgus, comprising a) a base body (34) with a proximal end (35a) and a distal end (35b), b) a pad section (36) which has an uneven protrusion (38) with a highest point (40), wherein the pad section (36) is designed such that it can be arranged in a gap (42) formed between the longitudinal arch (43) of a foot (10) deformed by a hallux valgus and an insole of a shoe such that the longitudinal arch (43) of the foot (10) covers the pad section (36), characterized in that c) when the pad section (36) is arranged in the gap (42), the protrusion (38) extends towards the longitudinal arch (43) such that it rises in the medial and distal direction and the highest point (40) of the protrusion (38) is located proximal to the sesamoidea pedis on the distal head (18) of the first metatarsal bone (16). Medical shoe insole (32) according to Claim 1 , characterized in that the pad section (36) is formed integrally on the base body (34). Medical shoe insole (32) according to Claim 1 or 2 , characterized in that, when the pad section (36) is arranged in the intermediate space (42), the pad section (36) and/or the base body (34) end proximal to the metatarsophalangeal joints (22). Medical shoe insert (32) according to one of the preceding claims, characterized in that along an outer edge (48) of the pad section (36) at least over a section of this outer edge (48) there is arranged a strip-like elevation (50) sloping towards a longitudinal central axis (A5) of the pad section (36), which, when the pad section (36) is arranged in the intermediate space (42), extends medially-distally along the outer edge (48). Medical shoe insole (32) according to Claim 4 , characterized in that the strip-like elevation (50) at the distal end (35b) of the base body (34) has a thorn-like bulge (52) which, when the pad section (36) is arranged in the intermediate space (42), extends in the distal direction and exerts a supporting force on the distal head (18) of the first metatarsal bone (16) in a direction towards a longitudinal central axis (A1) of the foot. Medical shoe insole (32) according to Claim 5 , characterized in that the strip-like elevation (50) merges continuously into the thorn-like bulge (52). Medical shoe insole according to one of the Claims 4 until 6 , characterized in that the highest point (40) of the pad section (36) is located lower than a highest point (54) of the strip-like elevation (50). Medical shoe insert (32) according to one of the preceding claims, characterized in that a slot is formed along a longitudinal center axis (A5) and/or a transverse center axis (A6) of the pad section (36) and runs through the base body (34) and/or the pad section (36), through which a first loop runs for the purpose of fastening the medical shoe insert (32) to the foot (10), which can be guided dorsally around the foot (10), and a second loop which can be guided between the big toe (12) and the digitus pedis II (28) and dorsally around the big toe (12). Medical shoe insert (32) according to one of the preceding claims, characterized in that in or on the pad section (36) at least one magnet is arranged such that, when the pad section (36) is arranged in the intermediate space (42), it corresponds locally to an acupuncture point on the sole of the foot.

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