EP1744643B1 - Orthoris having a particular relief - Google Patents

Description

The present invention relates to a new plantar orthosis or orthopedic insole.

This sole can be made in removable form or plantar orthosis or sockliner, or not be removable and constitute a glued sockliner, or even the upper part of the first sole of the shoe.

It is usual, in the practice of orthopedics, to create plantar orthoses according to the needs, at least such as the orthopedist determines them, for the person intended to wear the orthesis or orthoses. The result is an artisanal production practically to the unit, and resulting in a high cost.
Already known in the state of the art, orthoses to satisfy a number of requests for orthopedic insoles for a number of pathologies encountered.
In this respect, please refer to the documents EP-A-1,358,812 , DE-U-18 87 407 , GB 761 148 and US-A-4,841,648 . But these orthoses do not allow to treat a large number of pathologies.

The present invention proposes to remedy these disadvantages.

It has been discovered, thanks to the invention, that in the real world, it is possible to produce a single orthosis or orthopedic insole profile making it possible to treat the vast majority of individual cases, and this independently of their individual anatomical or pathological particularities. . Surprisingly, thanks to the invention, it is possible, industrially, to manufacture identical soles (in their right and left shapes and obviously taking into account the different foot sizes) making it possible to satisfy the demands for orthopedic insoles in more than one embodiment. 80% or more than 90% and up to 95% of pathologies encountered. Only the small remaining quantity of pathologies will then require different soles which will have to be individually adapted to these infrequent pathologies.

The invention relates to a plantar orthosis comprising, from front to rear, on a substantially flat area (17), so-called sub-capital zones, namely an area (11) for the first metatarsal and a zone (12) for the fourth and fifth metatarsals, at the rear of these zones, separated from one another, a retro-capital bar zone or retro-capital support (13) said zones having substantially the outlines represented on the figure 1 , and reliefs substantially as appearing on the figure 2 .

Preferably, the plantar orthosis may optionally further comprise, in the rear, an internal hemicoupole zone (14) and an external hemicoupole zone (15), the plantar orthosis ending in a talar ring ( 16) said zones having the outlines represented on the figure 1 , and reliefs of these areas substantially as appearing on the cuts of the figure 2 .

• les zones sous capitaux (11) et (12) ont une hauteur comprise entre 0,5 mm et 10 mm et sont plates ou légèrement inclinées vers l'avant ;
• la zone de barre rétro-capitale (13) présente un renflement médian en arrière des différentes têtes métatarsiennes (avec une forme plane ou galbée en section transversale et inclinée vers l'arrière en section longitudinale), la hauteur maximale de ladite zone étant comprise entre 2 à 10 mm, de préférence de 4 à 5 mm ;
• ou bien la zone de barre rétro-capitale est remplacée par une zone d'appui rétro-capital située en arrière des deuxième, troisième et quatrième têtes métatarsiennes, la hauteur maximale de ladite zone étant comprise entre 2 et 10 mm;
• la zone d'hémicoupole interne (14) est généralement convexe dans un plan longitudinal et épouse la voûte plantaire interne du pied, et dans un plan transversal elle est convexe ou concave ou en oreille de voûte ; cette zone est généralement concave dans le sens de sa longueur et sa section transversale est régulièrement concave, converse ou en oreille de voûte, la plus grande hauteur étant située entre 2 et 25 mm, ladite zone s'étendant longitudinalement du 1/3 postérieur environ du calcanéum vers le col du premier métatarsien et transversalement jusqu'aux 2/3 environ de la largeur du pied ;
• la zone d'hémicoupole externe est convexe dans le plan longitudinal en s'étendant environ depuis le tiers postérieur du calcanéum vers l'arrière de la tête du cinquième métatarsien, en soutenant la voûte plantaire externe, et en s'étendant transversalement jusqu'à environ la moitié de la largeur du pied, la section transversale étant concave, inclinée plane ou convexe ;
• la zone d'anneau talonnier (16) présente une forme semi-annulaire concave, les sections longitudinales des deux branches étant de hauteur constante ou légèrement inclinées vers l'avant, les section en coupe étant légèrement convexes, inclinées planes ou concaves.

In a plantar orthosis according to the invention, the combination of all these zones results in the almost universal character of the plantar orthosis, said zones respectively presenting the following characteristics, starting from a horizontal geometric reference plane:

• the sub-capital zones (11) and (12) have a height of between 0.5 mm and 10 mm and are flat or slightly inclined towards the front;
• the retro-capital bar zone (13) has a median bulge behind the different metatarsal heads (with a flat or curved shape in cross-section and inclined backwards in longitudinal section), the maximum height of said zone being between 2 to 10 mm, preferably 4 to 5 mm;
• or the retro-capital bar zone is replaced by a retro-capital support zone located behind the second, third and fourth metatarsal heads, the maximum height of said zone being between 2 and 10 mm;
• the inner hemicoupole zone (14) is generally convex in a longitudinal plane and follows the internal arch of the foot, and in a transverse plane is convex or concave or arched; this zone is generally concave in the direction of its length and its cross-section is regularly concave, converse or arch-ear, the greatest height being between 2 and 25 mm, said zone extending longitudinally of the rear 1/3 approximately from the calcaneus to the neck of the first metatarsal and transversally to about 2/3 of the width of the foot;
• the outer hemicoupole zone is convex in the longitudinal plane extending approximately from the posterior third of the calcaneus towards the back of the head of the fifth metatarsal, supporting the external arch, and extending transversely to approximately half the width of the foot, the cross section being concave, inclined flat or convex;
• the heel ring zone (16) has a concave semi-annular shape, the longitudinal sections of the two branches being of height constant or slightly inclined forwardly, the sectional sections being slightly convex, inclined plane or concave.

• la figure 1 représente une vue de dessus d'une orthèse plantaire ou selon l'invention montrant toutes les zones de l'orthèse ;
• la figure 2 représente une vue de dessus de cette orthèse dans une forme de réalisation concrète, dans laquelle l'orthèse est formée par un montage d'une pluralité de pièces dont certaines sont superposées pour réaliser les zones de l'orthèse selon la figure 1, cette figure 2 représentant également une pluralité de sections selon les lignes 1-1 à 7-7, lesdites sections étant verticales par rapport à la semelle posée dans un plan horizontal ;
• la figure 3 représente des sections longitudinales des parties sous-capitales ;
• la figure 4 représente une vue de dessus de l'anneau talonnier et des sections longitudinales et transversales, à différents niveaux ;
• la figure 5 représente une vue en section longitudinale et trois sections transversales selon trois variantes de l'hémicoupole interne ;
• la figure 6 représente des sections longitudinale et transversale de la zone d'appui rétro-capitale médian ;
• la figure 7 représente des sections longitudinales et transversales selon différentes variantes de la pièce permettant de former la barre rétro-capitale ;
• la figure 8 représente des sections longitudinales et des variantes de section transversale de l'hémicoupole externe.

Other advantages and characteristics of the invention will appear on reading the following description, given by way of non-limiting example and with reference to the appended drawing in which:

• the figure 1 represents a top view of a plantar orthosis or according to the invention showing all the zones of the orthosis;
• the figure 2 represents a top view of this orthosis in a concrete embodiment, wherein the orthosis is formed by mounting a plurality of parts, some of which are superimposed to achieve the areas of the orthosis according to the figure 1 , this figure 2 also representing a plurality of sections along the lines 1-1 to 7-7, said sections being vertical to the soleplate in a horizontal plane;
• the figure 3 represents longitudinal sections of the sub-capitals;
• the figure 4 represents a top view of the heel ring and longitudinal and transverse sections, at different levels;
• the figure 5 represents a view in longitudinal section and three cross sections according to three variants of the internal hemicoupole;
• the figure 6 represents longitudinal and transverse sections of the median retro-capital support zone;
• the figure 7 represents longitudinal and transverse sections according to different variants of the part making it possible to form the retro-capital bar;
• the figure 8 represents longitudinal sections and transverse section variants of the outer hemicoupole.

The orthotic orthosis represented on the figure 1 has, at its lower level, a base 10 cut, for example, in a thick sheet of a flat material and forming a flat first sole. On this base are arranged, in relief, a certain number of zones, namely a zone 11 under capital of the first metatarsal, an area 12 for sub-capitals of fourth and fifth metatarsals, a retro-capital bar or retro-capital support 13, an internal hemicoupole 14, an external hemicoupole 15 and a heel ring 16.

The layout shown on the figure 1 defines, according to the invention, the contour lines of the different zones, it being understood that these zones may vary, in their width or in their length. Preferably, the length and / or width of the zones may vary within ± 10%, and preferably ± 7%, with respect to the dimensions as they appear in the figure, the dimensions being proportional to the sizes of the orthoses.

The presence of zones 11 to 16 reveals an additional zone which remains flat, namely an anterior zone 17 for the phalanges, and possibly an inner flat zone 18 internal to the heel ring and also delimited by the hemicoupoles, but which could also be be slightly concave.

The different zones 11 to 16 are connected to the flat areas 17 and 18, as well as to each other for the adjacent areas, by smooth connecting lines, avoiding any abrupt transition that would form a sensitive edge for the foot.

The different areas can be realized in different ways. Thus, a first embodiment makes it possible to manufacture the orthosis according to the figure 1 from a flat sheet, suitably cut and deformed and stiffened so as to present the different zones 11 to 18 in one piece.

Another embodiment consists in producing the orthosis by molding.

Another embodiment may consist in providing zones 11 to 16 cut along the lines represented on the figure 1 these areas are then juxtaposed and fixed, for example by gluing or stitching, on the sheet or soleplate which will reveal the plane areas (17) and (18).

Another embodiment, an example of which is shown on the figure 2 consists in producing parts that will be partially superposed and assembled, preferably by gluing.

So, we see on the figure 2 , that the orthosis comprises a first part A, the anterior ends of which respectively form the zones 11 and 12. piece B forms, in its central part, the retrocapital bar. It can be completed, on its surface, by a piece C which comes to thicken it in its center.

Another piece D forms the outer hemicoupole 15, and extends forwardly and towards the inner side. It overflows the outer side of the orthosis (10).

A piece E forms the heel ring 16 and has a U-shape which makes it extend under the outer and inner hemicoupoles.

A part F forms the internal hemicollole which is partially superimposed on the internal metatarsal part of the piece A, on the central part of the piece D, and on one of the branches of the piece E. This hemicoupole 14 overflows the periphery of the the sole 10 on the inner side, as is usual.

The contours of these pieces are as follows.

Exhibit A:

• previous limits , (21, 22) : they correspond on a plantar footprint to the digital vacuum a few millimeters in front of the anterior border of the forefoot, so as to predict the advance of the plantar and metatarsals during the digitigrade phase of the step. From the strictly anatomical point of view, this limit lies directly above the proximal diaphyses of the toes. From a geometrical point of view, the anterior limit is on the cutting line of the flanges ¾ (1/6, 3/10). Each element will occupy 1/6 of this width;
• posterior limit : if the sub-capital elements are executed alone, the posterior limit 23 is located at the articulation of Lisfranc; if the sub-capital elements are associated in monoblock with the retro-capital element, the limit corresponds to the limit of the metatarsal passes;
• lateral limits 24, 25, 26, 27: they correspond to the transverse divisions of the forefoot in 1/6 of its width.

The reliefs 11 and 12 have a height preferably between 0.5 mm and 10 mm. These areas may be flat or slightly inclined forward.

Referring to the figure 3 , we see three possible longitudinal section variants for the sub- and anterocapital elements of the first, fourth and fifth metatarsals defined by part A, the maximum thickness being substantially located at the neck of the metatarsals, the inclined or plane surfaces between the cervix and the 1/6 limit being discovered to form zones 11 or 12 while the posterior parts located between the Lisfranc joint neck will be covered by part B.

Exhibit B:

• BRC : c'est un élément situé juste en arrière des têtes métatarsiennes qui constituent pour l'ensemble la palette métatarsienne. Il présente généralement un renflement médian (juste en arrière des deuxième et troisième têtes métatarsiennes), sa limite inférieure étant indifférente ;
• longitudinalement, c'est un élément qui présente une hauteur de flèche maximale juste en arrière des têtes métatarsiennes et qui se transforme régulièrement en plan incliné en allant vers sa limite inférieure ;
• ARC idem à l'élément précédent, sauf que l'élément est situé en arrière des deuxième, troisième et quatrième têtes métatarsiennes.

This piece is intended to form the retro-capital bar zone (BRC) or, alternatively, the retro-capital support zone (ARC).

• BRC: it is an element located just behind the metatarsal heads which constitute for the whole the metatarsal pallet. It generally presents a median bulge (just behind the second and third metatarsal heads), its lower limit being indifferent;
• longitudinally, it is an element that has a maximum deflection height just behind the metatarsal heads and is regularly transformed into an inclined plane towards its lower limit;
• ARC ditto the previous element, except that the element is located behind the second, third, and fourth metatarsal heads.

• limite antérieure 31 : elle correspond à la ligne des cols métatarsiens;
• limite postérieure 32 : elle correspond à l'interligne articulaire de l'articulation de Lisfranc ;
• limite latérale interne 33 : elle correspond au débord d'adaptation avec la chaussure convexe en dedans, le débord variant de 2 à 4 mm;
• limite latérale externe 34, convexe en dehors, le débord variant de 2 à 4 mm.

The limits are, for BRC:

• anterior limit 31 : it corresponds to the line of metatarsal passes;
• posterior limit 32 : it corresponds to the joint space between the Lisfranc joint;
• internal lateral limit 33 : it corresponds to the adaptation overhang with the shoe convex inside, the overhang varying from 2 to 4 mm;
• lateral lateral limit 34 , convex outside, the overhang varying from 2 to 4 mm.

• limite antérieure : elle suit la limite des cols des deuxième, troisième et quatrième métatarsiens ;
• limite postérieure : point situé à l'intersection de l'interligne de Lisfranc ou bien à l'intersection de l'axe géométrique du pied, ou bien encore à l'intersection de l'axe de l'arrière-pied ;
• limites latérales : légèrement convexe, la largeur est égale au 3/6 correspondant aux deuxième, troisième et quatrième métatarsiens. En interne, au 2/6 transversale, en externe au 2/6 longitudinale, 5/6 transversale, 2/5 longitudinale.

The limits are, for the CRA:

• previous limit : it follows the limit of the passes of the second, third and fourth metatarsals;
• posterior limit : point situated at the intersection of Lisfranc's line spacing, or at the intersection of the geometric axis of the foot, or at the intersection of the axis of the hindfoot;
• lateral limits : slightly convex, the width is equal to 3/6 corresponding to the second, third and fourth metatarsals. Internally, at 2/6 transverse, externally at 2/6 longitudinal, 5/6 transverse, 2/5 longitudinal.

The thicknesses are preferably between 1 and 10 mm.

Referring to the figure 7 a longitudinal sectional view is shown in the central part of the retro-capital bar, inclined towards the rear. In cross section, it can be flat, or curved with a gutter, as shown in section 4-4, figure 2 , or even flat with a median bulge without lateral gutter, or well curved with a gutter and lateral fins.

The height in the thickest part is 2 to 5 mm at least up to 8 or 9 mm at most.

When realized in the form of retro-capital support, we see, on the figure 6 it has a central longitudinal section similar to that of the retro-capital bar, but extends only under the central metatarsals, namely the second, third and fourth metatarsals, and then has convex cross-sections with the maximum heights under the second, third or fourth metatarsal. The height may vary from 2 to 5 mm at least and 8 or 9 mm at most.

Internal hemicupolus (F) :

It is an element that marries the internal arch of the foot or inner arch. In a longitudinal plane, it is generally convex. In a plane transversely it is either totally convex, or totally concave, or arch ear, that is to say concave in its upper part, convex in its lower part. It can extend posterior 1/3 of the calcaneus up to the neck of the first metatarsal. Transversally, it can extend up to 2/3 of the width of the foot.

• limite antérieure 41 : col du premier métatarsien ;
• limite postérieure 42 : ½ de la longueur du calcanéum ou 1/3 de la longueur du calcanéum ;
• limite latérale interne 43 : débord d'adaptation : limite droite ou légèrement convexe en dedans ;
• limite latérale externe 44 : ligne convexe vers le dehors, largeur maximale à l'aplomb du scaphoïde. ½ de la largeur de la semelle première.

The limits are:

• anterior limit 41 : neck of the first metatarsal;
• posterior limit 42 : ½ of the length of the calcaneus or 1/3 of the length of the calcaneus;
• internal lateral limit 43 : adaptation overhang: right limit or slightly convex inside;
• external lateral limit 44 : line convex outwards, maximum width above the scaphoid. ½ the width of the first sole.

Referring to the figure 5 on the one hand, we see the longitudinal section and, on the other hand, three cross-sectional variants for the relief of this internal hemicoupole. For the relief for the longitudinal section, the maximum height may be at the medial border perpendicular to the scaphoid or at the base of the scapho-cunean joint, or at the level of the internal Lisfranc articulation (cunéo -métatarsienne).

In the transverse direction, the section, taken at its maximum height, may be regularly convex, or arch ear, or even regularly concave.

The height varies from 2 to 25 mm.

External haemicupole (D) :

It is an element that marries the external arch or outer arch of the foot (see constitution of the outer arch of the foot after Kapandji). In a longitudinal plane, it is generally convex, but can be flat, even concave.

In a transverse plane, it is either totally convex, or totally concave, or arched, that is to say concave in its upper part, convex in its lower part. It may extend behind the posterior third of the calcaneus to the front of the back of the fifth metatarsal head; transversely it can extend up to 2/3 of foot width.

• limite antérieure 51 : col du cinquième métatarsien ;
• limite postérieure 52 : 1/3 antérieur de la longueur du calcanéum ou ½ de la largeur du calcanéum ;
• limite latérale interne : ½ de la largeur de la semelle première à l'aplomb de l'apophyse styloïde du cinquième métatarsien ;
• limite latérale externe : débord d'adaptation légèrement convexe vers l'extérieur.

The limits are:

• anterior limit 51 : neck of the fifth metatarsal;
• Posterior limit 52 : 1/3 anterior of calcaneal length or ½ of calcaneal width;
• internal lateral limit : ½ of the width of the first insole directly above the styloid process of the fifth metatarsal;
• external lateral limit : slightly convex overhang towards the outside.

Referring to the figure 8 we see a longitudinal section and three variants of transverse sections of this external hemicoupole. The maximum height is substantially in line with the cupoid or the styloid process.

The transverse relief may be concave or inclined flat, or convex.

The height is between 2 and 25 mm.

Ring heel (E) :

It is an element that marries and accentuates the footprint of the heel (calcaneus). It follows the anatomical contours of the posterior support of the calcaneus on the ground. It has a relief and a thickness that prefigure the support of the heel to the ground. The relief given by this element is essentially concave.

• limite antéro-interne 61 : elle se situe en regard de l'articulation scapho-cunéenne ;
• limite antéro-externe 62 : bord externe de la semelle première en regard de l'articulation de Lisfranc externe ;
• limite intérieure 63 : dans sa partie interne, la limite est plus ou moins convexe. Dans sa partie antérieure, la largeur de cette portion est égale au 1/3 interne de la largeur de la semelle première, puis concave dans la partie postérieure. La largeur de la portion concave est égale au 1/5 interne de la largeur de la semelle première dans sa portion externe. En avant, elle convexe en dedans, sa largeur est égale au quart externe de la semelle première, puis concave dans sa portion postérieure et la largeur correspond au 1/5 externe ;
• limites latérales 64, 65 : ce sont des limites qui correspondent au débord d'adaptation avec la chaussure. Ces limites sont convexes, le débord maximum de 3 à 5 mm environ se situant à la ½ de la longueur de l'élément.

The limits are:

• antero-internal limit 61 : it is located opposite the scapho-cunean joint;
• antero-external limit 62 : outer edge of the first sole opposite the external Lisfranc joint;
• inner limit 63 : in its internal part, the limit is more or less convex. In its anterior part, the width of this portion is equal to the internal 1/3 of the width of the first sole, and then concave in the posterior part. The width of the concave portion is equal to the internal 1/5 of the width of the outsole first in its outer portion. In front, it convexes inwards, its width is equal to the outer quarter of the first sole, then concave in its posterior portion, and the width corresponds to the outer 1/5;
• lateral limits 64, 65 : these are limits that correspond to the adaptation edge with the shoe. These limits are convex, the maximum overhang of 3 to 5 mm approximately being ½ of the length of the element.

Referring to the figure 4 we see the reliefs in the longitudinal direction, either of substantially constant height, or slightly inclined forwards, in the diagram on the left. The reliefs in cross-section 1-1, 2-2 or 3-3 may be in particular slightly convex or flat inclined in the front part corresponding to section 1-1, or flat inclined or slightly concave for sections 2-2 and 3-3. The height can vary from 2 mm to 25 mm.

The orthoses according to the invention can be made in different ways.

In general, it is preferred that the plantar orthosis overhang an empty volume or containing a light or porous material, the orthosis itself ensuring the resistance to deformation due to weight and effort.

For example, an orthosis according to the figure 1 may be made in one piece by injection molding or, preferably, by deformation, in a press fitted with suitable complementary matrices, to provide a rigid orthosis, although provided with a certain elasticity, and which rests on the base or sole properly said shoe, essentially by its periphery, the volume under the reliefs of the orthosis being, for example, empty.

As has been said, in another embodiment, the orthosis can be manufactured by separate production of its various components, which are then assembled and fixed on the flat base 10, for example by gluing.

Alternatively, as seen on the figure 2 the different constituents can be obtained by partial stackings of constituents which extend one under the other.

Finally, orthotics can be manufactured with the set of a shoe sole and do not constitute a sockliner which is integrated later in it. This can be obtained, for example, by molding in a suitable material. The materials used in general will have a shore hardness of between 0 and 200.

In summary, the orthosis according to the invention may constitute a sockliner or form the upper part, or be part of a first midsole, or be part of the outer sole, depending on the different types of shoes , the orthosis according to the invention can be reported, or conversely be in one piece with the insole, or the first mounting sole or the outer sole, the orthosis may be removable or not relative to a shoe.

Claims (11)

1. Plantar orthosis having, on a substantially flat area (17), a retrocapital bar area (13), so-called subcapital areas in relief, namely a subcapital area (11) for the first metatarsal and a subcapital area (12) for the fourth and fifth metatarsals, said subcapital areas being separate from each other and being arranged in front of the retrocapital bar area (13), the retrocapital bar area (13) being located just behind the metatarsal heads and having a median bulge just behind the second and third metatarsal heads and, longitudinally, a maximum camber height just behind the metatarsal heads, which merges smoothly into an inclined plane.
2. Plantar orthosis according to Claim 1, having, towards the rear of the retrocapital bar area (13), an internal half-dome area (14) and an external half-dome area (15), the orthosis terminating in a heel ring (16).
3. Plantar orthosis according to one of Claims 1 and 2, characterized in that:

   - the subcapital areas (11) and (12) have a height of between 0.5 mm and 10 mm and are flat or gently inclined towards the front; in that

   - the internal half-dome area (14) is generally convex in a longitudinal plane and matches the internal plantar arch of the foot, and it is convex or concave or S-shaped in a transverse plane, this internal half-dome area (14) being generally concave in the direction of its length, and its transverse section being uniformly concave, convex or S-shaped, the maximum height being situated at between 2 and 25 mm, said area extending longitudinally from the posterior 1/3 of the calcaneus to the rear of the neck of the first metatarsal and transversely as far as 2/3 of the width of the foot; in that

   - the external half-dome area (15) is convex in the longitudinal plane, extending from about the posterior third of the calcaneus to the rear of the head of the fifth metatarsal, supporting the external plantar arch, and extending transversely as far as about half the width of the foot, the transverse section being concave, inclined, plane or convex; and in that

   - the heel ring area (16) has a concave semi-annular shape, the longitudinal sections of the two branches being of constant height or being gently inclined towards the front, the cross sections being slightly convex, inclined, plane or concave.
4. Plantar orthosis according to Claim 3, characterized in that the maximum camber height of said retrocapital bar area (13) is between 2 and 10 mm.
5. Plantar orthosis according to any one of Claims 1 to 4, having, below its inner face, a space that is empty or filled with porous material.
6. Plantar orthosis according to one of Claims 1 to 4, having, below its inner face, a solid material.
7. Plantar orthosis according to any one of Claims 1 to 6, characterized in that it is removable with respect to a shoe.
8. Plantar orthosis according Claims 1 to 6, characterized in that it is not removable with respect to a shoe.
9. Plantar orthosis according to one of Claims 1 to 4, characterized in that it forms the upper part of a complete shoe sole.
10. Plantar orthosis according to one of Claims 1 to 8, characterized in that it forms part of a fitted insole of a shoe.
11. Plantar orthosis according to one of Claims 1 to 6 or 8, characterized in that it forms part of an outer sole of a shoe.

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