EP0378662A1

EP0378662A1 - Apparatus for continuous passive articular mobilization of the foot

Info

Publication number: EP0378662A1
Application number: EP89908201A
Authority: EP
Inventors: Jean-Claude Roger Pecheux
Original assignee: PECHEUX JEAN CLAUDE ROGER
Current assignee: PECHEUX JEAN CLAUDE ROGER
Priority date: 1988-07-08
Filing date: 1989-07-07
Publication date: 1990-07-25
Also published as: FR2648707A2; JPH03500261A; WO1990000383A1; US5170776A

Abstract

L'appareil est caractérisé en ce que le système articulé (I) est monté sur une colonne (104) par un pivot (103) d'articulation selon l'axe d'abduction-adduction (CC'); l'organe moteur (II) est associé à un mécanisme de transformation de mouvement (108) à déplacement angulaire, porteur de curseurs réglables (114 à 116). Les biellettes sont montées sur le système de semelle articulée et sur les curseurs. Application à la correction orthopédique du pied.The apparatus is characterized in that the articulated system (I) is mounted on a column (104) by a pivot (103) of articulation along the abduction-adduction axis (CC '); the motor member (II) is associated with a movement transformation mechanism (108) with angular displacement, carrying adjustable sliders (114 to 116). The links are mounted on the articulated sole system and on the sliders. Application to the orthopedic correction of the foot.

Description

CONTINUOUS PASSIVE JOINT MOUNTING APPARATUS

TECHNICAL AREA :

The invention relates to the technical field of joint mobilization for orthopedic correction of the foot.

The device makes it possible to mobilize the osteo-articular assembly that constitutes the foot in the three perpendicular planes of space (fig. 1). It authorizes:

1) flexion-extension of the ankle along the axis AA ',

2) The varus-valgus of the astragalo-calcaneal joint along the BB axis ",

3) abduction-adduction along the CC axis. This device is particularly intended for the continuous passive mobilization of the equino varus clubfoot in the newborn.

Equinus varus clubfoot is a deformation of the foot following an intrauterine malposition. According to the analysis of Professor Ombredanne, the deformation of the equino varus clubfoot takes place in the three perpendicular planes of space as illustrated for a left foot in fig. 2 to 7.

1) in the saggital plane (or vertical anteroposterior) the foot is deformed into EQUIN (fig. 2), that is to say that the entire foot swings in plantar flexion relative to the leg to form an angle obtuse with sinus open in front.

2) in the frontal plane, the foot is deformed into VARUS, that is to say that the sole of the foot looks towards the median axis of the body (fig. 3). 3) in the horizontal plane, the foot is deformed in

ADDUCTION (fig. 5), that is to say that its longitudinal axis (anteroposterior) goes towards the median axis of the body.

In total, like a boat, the equino varus clubfoot swings, rolls and turns. PRIOR TECHNIQUE:

We know the so-called mechanical therapy devices that allow the active or activo-passive mobilization of the foot in the three perpendicular axes of space (device called FRANCO).

This device does not fit into the concept of continuous passive joint mobilization.

The originality of the device according to the invention resides in its ability to drive continuous passive mobilization of the foot by: 1) isolated valgus-varus (axis BB 'fig. 1),

2) valgus-varus concomitant with abduction-adduction (axis BB 'and CC fig. 1),

3) dorsal flexion-isolated plantar flexion (axis AA * fig. 1). 4) dorsal flexion-plantar flexion concomitant with valgus-varus (axis AA * and BB 'fig. 1), 5) dorsal flexion-plantar flexion concomitant with valgus-varus and abduction-adduction (axes AA', BB ' and CC fig. 1) 6) isolated abduction-adduction (CC axis fig. 1).

In summary, the three axes of deformation can be mobilized in isolation or simultaneously.

The object of the invention is to provide such an apparatus which allows orthopedic correction of this condition to be carried out by combating deformation.

From a therapeutic point of view, the orthopedic correction of this condition consists in fighting against:

1) The supination of the forefoot and the hindfoot, which is the result of varus and adduction. 2) Equinism: The device makes it possible to correct the first deformation by mobilizing the foot in pronation (= valgus + abduction) and the second deformation by mobilizing the foot in dorsal flexion (axis AA * fig. 1).

The device makes it possible to correct one or the other deformation or both simultaneously. PRESENTATION OF THE INVENTION:

To achieve the above objectives. The device according to the invention is characterized in that it comprises on a foot base, on the one hand, an articulated sole system comprising a sole carried by articulated supports to give said sole three degrees of orientation adjustable on the orthogonal axes of flexion, abduction-adduction and varus-valgus, on the other hand, a rotary type drive member and, moreover, a transmission system with adjustable links connecting the drive member to the sole system articulated.

Various other characteristics appear from the description given below with reference to the appended drawings which show, by way of non-limiting examples, embodiments of the subject of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

Figs. 1 to 7 are schematic views highlighting some of the anatomical aspects of the articular assembly of the foot. Fig. 8 is a schematic perspective of a first embodiment of the device.

Fig. 9 is a perspective, partly broken away, on a larger scale, of one of the constituent elements of the device. Fig. 10 is a side view of the apparatus. Fig. 11 is a schematic top view corresponding to FIG. 1 and showing an operating phase.

Fig. 12 is a partial perspective, partly broken away of a variant.

Fig. 13 is a side view of the variant according to FIG. 12.

Fig. 14 is a plan view of the variant according to FIG. 12.

Fig. 15 is a perspective of another embodiment. Fig. 16 is a plan view corresponding to the Fig. 15.

Figs. 17 and 18 are schematic plan views showing two characteristic positions of the operation of the object according to FIG. 15. Fig. 19 is a partial perspective illustrating an alternative embodiment of some of the constituent elements of the object according to FIG. 15.

FIG. 20 is a side view showing a constructive detail according to FIG. 19. Fig. 21 is a partial perspective of another partial embodiment of the subject of the invention.

Fig. 22 is a partial side view showing a constructive detail according to FIG. 21.

ChronoLogique ent, it is important to start with the correction of the forefoot and the overfoot in pronation, before reducing Equinism, also the driving axis of the device will be that which corrects the supination.

The introduction of the fight against equinism, by the associated or isolated mobilization in dorsal flexion, is to be carried out only secondarily, after the correction of the first deformation.

The apparatus according to the invention is characterized in that it consists of an assembly comprising a sole 1 (fig. 8 and 9) orientable on an abduction-adduction axis CC and carried by a first orientable support 3 by an axis of dorsal flexion-plantar flexion AA 'on a second support 4 orientable by an axis of valgus-varus BB' on a base.

The device mainly consists of an articulated sole system I, a drive member II fixed on its base S and link arms or levers III.

The articulated sole system I comprises the sole itself 1 which is either a conventional sole of the Denis Bro ne splint type, or a plastic sole with a flexible coating of cellular foam absorbing the pressures of the foot, or a sole correcting the forefoot adductus, such as illustrated in fig. 9.

The foot is fixed on these various soles by means of compression bands on the market.

The sole 1 is fixed on the sole holder 2 on which it is orientable by means of two brackets 2a which can be locked in two perpendicular planes (dorsal flexion-plantar flexion and abduction-adduction).

The soleplate 2 is movable on the axis BB ′ by a pivot 13, is adjustable by 30 in abduction or in adduction and is blocked by a screw 32 (fig. 10) on a "U" caliper 3, movable around of axis AA '. The stirrup 3 drives the dorsal flexion-plantar flexion and is mounted on a "U" stirrup 4, movable around the axis CC which drives the valgus-varus.

The drive member II comprises a geared motor proper 5, a guide consisting of a rod 6 and a screw 7 mounted on bearings 8 and 9, a movable carriage 10, a system for reversing the direction of travel of the motor, consisting either of a tachometer generator 11, or of an electromechanical or opto-electric reversing device 12, or of a read potentiometer located on the axis BB '13.

The operation of the device is ensured by electronic control and by a console on which are displayed the usual functions known for passive joint mobilization devices (amplitude, speed, force, etc.). The link arms or Levers III comprise according to FIGS. 8, 10 and 11 a main lever 14 connecting the mobile carriage 10 to the U-shaped bracket 4. The lever drives the valgus and is positioned and articulated by means of a yoke 15, provided with a screw or an indexer 15a, on one or the other side of the stirrup 4 depending on whether one wants to mobilize the left or right foot. The lever 14 is fixed to the mobile carriage by means of the pivot 16. The movement can be disengaged by loosening the adjusting screw 17.

The levers III also include a lever 18 which causes the dorsal flexion-plantar flexion. This lever is connected: - on the one hand to the mobile carriage 10 by the pivot 19 provided an adjustment screw 20 (The movement can be disengaged by loosening this screw), - on the other hand, to the "U" -shaped bracket 3 by The pivot 21 which is positioned on the slide 22 and is blocked by The screw 23. The slide 22 is used to adjust the relative deflection of the dorsal flexion-plantar flexion, relative to the valgus-varus. Levers III include a third lever 24 which is positioned on the mobile carriage 10 and actuates an IV system for driving the sole in abduction-adduction.

The IV system comprises the pivot 40 (fig. 8, 10 and 11) driven in rotation by the lever 24 which is articulated, on the one hand, on one or the other arm of the pivot 40 depending on whether one mobilizes the right foot to the left (it is fixed by means of the yoke 42 provided with a screw or an indexer 42a) and, on the other hand, on the mobile carriage by means of the pivot 43 provided with a screw adjustment 43a (fig. 10). By loosening this screw. The movement is disengaged. The pivot 40 of the IV system is extended by a bevel gear 44, itself extended by a rotational drive device consisting of a hose 45, a slide 46 and a universal joint 47 secured to the axis. of the seed carrier.

The hose can be ^replaced by a rigid arm with two universal joints.

The device operates as follows. From the ZERO physiological position (fig. 1 and 6), the device can develop:

1) mobilization of the foot in valgus from 0 to 30 amplitude pivoting on the axis BB 'The stirrup 4 by Leverage 14 pulled by the mobile carriage. 2) mobilization of the foot in dorsal flexion from 0 to

40 by pivoting on the axis AA ′ The stirrup 3 by the lever 18 controlled by the carriage 10.

3) mobilization of the foot in abduction from 0 to 30 ° by rotating the sole 1 on the axis CC by the IV system. 4) concomitant mobilization of the foot in valgus and dorsal flexion by simultaneously pivoting the stirrup 4 on the axis BB 'by the lever 14 and the stirrup 3 on the axis AA' by the lever 18.

5) a concomitant mobilization of the foot in valgus and in abduction by simultaneously pivoting the stirrup 4 on the axis BB 'by the lever 14 and the sole 1 on the axis CC by the system IV.

6) a concomitant mobilization of the foot in valgus dorsal flexion-abduction by pivoting the three axes AA ', BB' and CC by means of their respective levers 14 and 18, as well as by the system IV.

The apparatus can also include a system V allowing abduction on the axis CC concomitantly with the valgus on the axis BB '. This system V comprises (fig. 12 to 14) a U-shaped bracket 26 fixed on the base 27 carrying the axis CC; The branches 28 and 29 of the stirrup 26 are connected to the soleplate 2 by a double right and left circuit of elastic ropes 31 mounted on return pulleys 31a.

The tightening bolt 32 makes it possible to unlock the soleplate 2 which can then pivot on its axis CC.

The elastic ropes 31 are mounted on the cursor 33. As the valgus develops by rotation of the stirrup 4 on its axis BB ', the soleplate 2 pivots around its axis CC.

By adjusting the position of the cursor 33 on the rod 34, a maximum of 30 abduction can be obtained for a valgus travel of 30.

The screw 32 then abuts at the end of the groove 35, as shown in FIG. 13.

BEST WAY OF CARRYING OUT THE INVENTION: According to another example of embodiment illustrated in FIGS. 15 and 16, the pivot 13 or pin is carried by a suspension piece 100 advantageously made in the form of a square, the branch 101 of which carries the pin 13. The branch 102 of the square 100 is suspended by a pivot pivot 103 at the upper end of a column 104 ^el? efore from the base 1. the

_ articulation pivot 103 is coaxial with the axis CC and is preferably formed by a rotating shaft passing through the upper part of the column 104. The branch 102 is fixed on the constituent shaft of the pivot 103 in any case suitable to be immobilized angularly on the latter, while being able to be easily separated from it. The sole 1 is adapted on the sole holder 2, so that, in the state of rest of the device. The articulation pivot 103 or the axis CC coincides with the center of the physiological articulation of the foot. The motor assembly II is constituted by an otoréducteur group 105, with two directions of rotation, preferably of the electric type, the output shaft of which is provided with a pinion driving a belt 106 surrounding a pulley or wheel 107 of gear reduction carried by the base S, preferably by means of an axis of rotation DD 'perpendicular to said base and parallel to the axis BB'. The wheel 107 supports a movement transformation mechanism 108 comprising a support 109 immobilized on the wheel or The pulley 107, so that it can be driven by the latter with an alternating angular displacement on the axis of rotation of the pulley. The support 109 carries three threaded rods

110, 111 and 112 able to be driven each in rotation on its axis by a button 113 of manual actuation or not. The screws 110, 111 and 112 extend parallel to each other in a general direction parallel to the axis AA * and are produced in the manner of micrometric screws.

The threaded rods 110, 111 and 112 cooperate respectively with a cursor 114, 115 and 116 in the form of a threaded ring capable of being thus displaced along the corresponding threaded rod by the rotation imparted to the latter by the control button 113.

The transmission system III consists of rigid rods 120, 121 and 122 which are mounted by hinge pins 123, 124 and 125 on the corresponding sliders 114, 115 and 116. The rods 120, 121 and 122 are, by elsewhere, mounted by their opposite end part respectively on the soleplate 2 or the base stirrup 3, on the intermediate stirrup 4 and on the articulation pivot 103. According to a preferred constructive form, the link 121 is linked to a crank 126 fixed on an axis 127 carried by the column 104 and provided with a pinion 128 cooperating with a complementary pinion 129 adapted on the end part of the shaft constituting the articulation pivot 103 opposite the sole 1. The pinions 128 and 129 constitute, in the present case, a angle reference.

The construction of the device as described above makes it possible to have a particularly compact and resistant articulated sole system I, since it is carried by a suspension part coupled to the shaft passing through the articulation pivot 103 The sole 2 is therefore devoid of connection with the axis CC and its adaptation to the sole holder 2 can thus be changed very quickly each time it is necessary to adapt the apparatus to the morphological conformation of the subject to be mobilized. The suspension of the articulated sole system I makes it possible to produce a compact but robust articulated assembly by adopting, for the construction of the pivot 13 and of the pivot 103, mechanical means well known for their sensitivity, their precision, their concentricity such as bearings with needles or rollers.

The use of a movement transformation mechanism 108 with angular displacement makes it possible to use micrometric screws 110, 111, 112 offering a great possibility of fine adjustment of each movement transmitted by the rods 120, 121 and 122 along the axes AA ′, CC * and BB 'respectively.

Indeed, fig. 17 shows a state in which, by rotation of the screws 110 to 112, the sliders 114 to 116 have been aligned with the axis DD * of partial angular rotation of the pulley 107. In such a state adapted to the mobilization of a foot straight as shown, any angular displacement of this pulley, for example in the direction of arrow f .., by means of the motor 105, does not produce any movement of the articulated sole system I. The points of application of different rods centered on the axis DD 'are, in fact, not modified by the rotation, whatever the angular amplitude of the latter. Such operation is, in particular, made possible by means of the connecting pins 123 to 125 between the links and the sliders.

On the contrary, when the sliders have been brought to maximum displacement in the direction corresponding to the active adjustment stroke possible from the neutral point in alignment with the axis DD ¹ , as illustrated in FIG. 18, a rotation in the direction of the arrow f. Of the wheel or pulley 107 results in a simultaneous actuation of the rods 120, 121 and 122 each respectively controlling the movement in dorsal flexion of the sole 1 by means of the base stirrup 3, The movement in abduction by rotation of the suspension part 100 on the axis CC 'via the angular gear 128, 129 and The movement in valgus by the rotation drive of L 'intermediate stirrup 4 on the BB axis'.

A rotation drive of pulley 107 in the opposite direction to that of arrow f. produces simultaneous plantar flexion, adduction and varus movements.

By the means used described above, it therefore becomes possible to individually adjust the amplitude of each mobilization movement to be imposed on the foot, by acting for example manually on the button 113 of the corresponding micrometric screw. Such an adjustment can be made easily and precisely, due to the accessibility to the mechanism 108 and the fine adjustment precision which can be brought to the respective position of the sliders 114 to 116 moved precisely between the two positions above. It should be noted that it appears advantageous to have the screw 110 have a thread extending over the entire useful length, while threading over only half the length of the screws 111, 112 may be provided. Thus, as is apparent from the description and the drawings, the same device can then be used for a left or right foot by simple displacement of the cursor 114 on one or the other of the useful ranges of the screw 110 on either side of the axis DD 'and inversion of the direction of rotation of the motor 105, so that the movements described above of valgus and Right foot abduction becomes varus movements and left foot adduction.

Another advantage of the above structure lies in the simplicity of the transmission of movement ensured by means of the set of rods controlled by the transformation mechanism 108. The above means therefore make it possible to adapt easily the mobilization device for the treatment to be carried out and, also, for the patient's morphology.

The particular construction of the device offers the additional possibility of allowing passive mobilization of the forefoot with a view to correcting the deformation of étatarsus-adductus.

To this end, as illustrated in FIG. 19, the articulated sole assembly I comprises a sole 1 which is constituted by a rear part 130 immobilized by any appropriate means on the base stirrup 3. The rear part 130 carries a front part 131 by means of a articulation axis 132 which is offset in the direction of the external lateral edge, so as to be, in all cases, arranged coaxially with the pivot 103 centered on the axis CC. As illustrated in fig. 20, the rear part 130 has a postero-internal rim 133, while the front part 131 is provided with an antero-internal rim 134 and an external median edge 135.

The flanges 133, 134 and 135 make it possible to keep a foot in place in a static immobilization position, but also possibly dynamic tending to mobilize the front part of the foot. Indeed, as illustrated in FIG. 19, the front part 131 can be angularly blocked by means of a bar 136 adapted in an adjustable manner on the column 104 or on a telescopic extension 137 of the latter, so as to engage a complementary stop 138 carried by the front part 131. In this way, after adjusting the transformation mechanism 108 to neutralize the commands in plantar-dorsal flexion and varus-valgus by means of the rods 120 and 122, an angular rotation of the pulley or wheel 107 rotates the suspension piece 102 on the CC axis. The suspension part 102 drives the rear part 130, while the front part 131 remains immobilized by means of the bar 136. In this way, as illustrated in FIG. 20, it becomes possible to mobilize angularly and alternately, for example on the range α, the posterior part 130 of the sole 1 and to mobilize the foot in metatarsus-adductus.

An alternative embodiment is illustrated in FIGS. 21 and 22 showing a sole 1 produced as said previously to include a rear part 130 and a front part 131 provided with the same internal and external edges as those described with reference to FIG. 20.

In the example illustrated, the front part 131 is adapted to be immobilized angularly on the shaft passing through the articulation pivot 103, while the rear part 130 can be immobilized angularly by means of a bar 139- engaging column 104. In this exemplary embodiment, the mobilization of the forefoot in metatarsus adductus is then ensured by subjecting the anterior portion 131 to an angular displacement relative to the posterior portion 130 immobilized on which the anterior portion is also articulated by through Axis 132.

INDUSTRIAL APPLICATION: The invention finds a preferred application in the manufacture of rehabilitation devices or continuous passive mobilization of the clubfoot.

Claims

1 - Apparatus for passive articular mobilization of the foot, characterized in that it comprises on a base (S), on the one hand, an articulated sole system (I) comprising a sole (1) carried by articulated supports (3 , 4) to give said sole three degrees of adjustable orientation on the orthogonal axes of flexion (AA '), abduction-adduction (CC) and varus-valgus (BB ¹ ), on the other hand, an organ motor (II) of the rotary type and, moreover, a transmission system (III) with adjustable links connecting the motor member to the articulated sole system.

2 - Apparatus according to claim 1, characterized in that the motor member (II) actuates a carriage (10) in reciprocating movement and in that the transmission system (III) comprises two levers (14) and (18) connecting The trolley to the sole system (I) and a drive shaft connecting the sole pivot (13) to a rotary actuation system (IV).

3 - Device according to claim 2, characterized in that the levers (18) and (14) are disengageable mounted on the carriage.

4 - Apparatus according to claims 2 or 3, characterized in that the lever (14) connecting the carriage (10) to the second support (4) is adaptable on one side or the other of the axis (BB ') . 5 - Apparatus according to claims 2 to 4, characterized in that the levers are adjustable in length.

6 - Apparatus according to claim 2, characterized in that the transmission shaft is a flexible cable or a cardan rod (45) connected to the pivot ⁽ 13) and to a torque angular gear (44) actuates in rotation at from the carriage by a lever (24) adjustable in length and disengageable.

7 - Apparatus according to claim 1, characterized in that it comprises an actuation system (V) comprising a support vl

(26) immobilizes on the base and connects by a double system of elastic cables (31) to the sole (1). 8 - Apparatus according to claim 1, characterized in that:

the articulated system (I) is mounted on a column (104) by a pivot (103) of articulation along the abduction-adduction axis (CC),

- The driving member (II) is associated with a movement transformation mechanism (108) with angular displacement, carrying adjustable sliders (114 to 116), - the links are mounted on the articulated sole system and on the sliders.

9 - Apparatus according to claim 8, characterized in that the articulated sole system (I) comprises:

a suspension part (100) on the column (104) by the articulation pivot (103),

- an intermediate stirrup (4) mounted on the part (100) by a pivot (13) of articulation along the axis of varus-valgus (BB ¹ ),

- a base bracket (3) mounted on the intermediate bracket by an articulation along the bending axis (AA "),

- And a sole (1) removably attached to the base bracket so that its part corresponding to the center of the complex articulation of the foot is centered on the axis of abduction-adduction (CC).

10 - Apparatus according to claim 8 or 9, characterized in that the articulated sole system comprises a sole (1) constituted by a rear part (130) immobilized on the base bracket (3), a front part (131) articulated on the rear part by an axis (132) coinciding with the pivot and a blocking bar (136) mounted adjustable in the column to be able to engage and immobilize the front part.

11 - Apparatus according to claim 8, characterized in that the articulated sole system comprises a front part ⁽ 131) mounted integral with the articulation pivot (103) so that its part corresponding to the center of the articulation of the foot is centered on the pivot, a rear part (130) articulated on the front part by an axis ⁽ 132) and a blocking bar (139) capable of being interposed between the rear part and the column.

12 - Apparatus according to claim 10, characterized in that the axis (132) of articulation of the anterior and posterior parts of the sole is offset towards the external middle part.

13 - Apparatus according to claim 10, characterized in that the sole has an anterior part provided with an anterior-internal rim (134) and an external median rim (135) and a posterior part provided with a postero-internal rim internal (133). 14 - Apparatus according to claim 8 or 9, characterized in that the articulation pivot (103) consists of a shaft carrying the articulated sole system (I) and crossing the column beyond which it is controlled in rotation by a link. 15 - Apparatus according to claim 14, characterized in that the shaft and the link are linked by a couple of pinion gear angle (128, 129).

16 - Apparatus according to claim 8, characterized in that the links (120, 121, 122) are articulated respectively on the base stirrup (3 ⁾ or on the sole (1), on the intermediate stirrup (4) and on a crank (126) for controlling the bevel gear.

17 - Apparatus according to claim 8, characterized in that the transmission mechanism (108) consists of a rotating support (109) on which are mounted three threaded rods (110, 111, 112) each provided with a button (113 ) control in rotation and each cooperating with a slider (114, 115, 116) threaded on which a link is articulated.