EP2835072B1 - Orthopaedic shoe for preventing excess pressure loads - Google Patents

Description

The invention relates to an orthopedic shoe for the prevention of excessive pressure loads on pressure-sensitive soles according to the preamble of claim 1. Such orthopedic shoes can be used in particular, but not exclusively, for the treatment of diabetics. In general, the shoes according to the invention are suitable for the treatment of pressure-sensitive soles. Especially in diabetics, however, the avoidance of excessive pressure on the feet of great therapeutic importance.

On average, every fifth in the age group between 20 and 70 years is in need of treatment for venous disease or has pathological vein changes that can cause discomfort and require treatment. This usually comes from an often considerable connective tissue weakness, which leads to the relaxation of the venous walls and thus to a lack of closing venous valves. This results in a reduction of venous return from both legs into the body.

In Germany alone there are about 5 million diabetics who have such a "diabetic foot" in more or less pronounced form. As a result, this means that open wounds can develop on the sole of the forefoot that infect many times and then often lead to a foot amputation. The causes of the diabetic foot are that due to the diabetic metabolic condition in the arterial vascular system constrictions and under certain circumstances comes to the closure of larger arteries and smaller arterial capillaries. As a result, the tissue, in particular the skin, is no longer adequately supplied with oxygen and is partially destroyed, as a result of which open skin areas develop. Due to the minor function, in particular the arterial capillaries, the skin nerves are no longer sufficiently nourished and there is a diabetic polyneuropathy. This means that the affected person in the skin area, which is no longer sufficiently nourished, clearly loses the sensibility and thus the sensation of pain, so that anatomically predefined pressure points are no longer registered and the skin thus basically undergoes pain-free damage. Since those affected in the congested skin zones have no sensation of pain, the damage to the skin is often not noticed or at least many times too late.

From the DE 10 2010 022 329 A1 is a generic shoe with rigid sole and convex rounded sole areas known, as it can be worn in particular by diabetics. To fix the foot in the shoe, the fixation of the verse area is of utmost importance in the case of generic shoes, since the foot essentially does not roll off during walking due to the flexural rigidity of the sole. Instead, the shoe rolls on the rounded sole areas, wherein the rear part of the sole must be pulled up when going forward opposite the roll-off point under the ball of the foot. In this raising the rear part of the sole act considerably forces between the fixing of the shoe on the one hand and the foot, on the other hand, to prevent the heel from slipping in the shoe. Because such a slagging of the heel in the shoe would cause unwanted relative movements of the foot relative to the inside of the sole, which can lead to injuries and wounds.

To fix the heel in the shoe beats the DE 10 2010 022 329 A1 a Y-shaped insert before, whose lower end is fixed to the sole and whose two upper branches, the heel on the one hand and the spine on the other hand span. It has been found that this Y-type fixative is not very suitable for the backlash-free fixation of the foot in the shoe. In particular, in the area of the heel, when clamping the fixing means, sufficient clamping pressure can not be applied, so that the heel in the shoe easily starts to slack. If the holding pressure in the area of the back of the foot is increased too much to compensate for this insufficient pressure in the area of the heel, the wearing comfort is reduced and unwanted blood congestion can also occur.

Based on this prior art, it is therefore an object of the present invention to propose a novel orthopedic shoe, which can be adapted in the heel to different foot shapes, thereby reducing excessive pressure loads on pressure-sensitive feet or completely avoided.

This object is achieved by an orthopedic shoe according to the teaching of claim 1.

Advantageous embodiments of the invention are the subject of the dependent claims.

The shoe according to the invention is based on the idea that the fixation means a heel pull, which runs from the left Fußrist on the back of the heel bone to the right Fußrist, and a Fußrückenzug, which runs over the instep and has a pulling member comprises. According to the teaching of the invention, it is provided that the Fußrückenzug is attached load-transmitting with a left and a right connecting element on the left and right portion of the heel pull, wherein the connecting elements in each case a distance to the two ends of the heel strap arranged laterally and to the Have heel bone spanning mid-heel. By means of such a fixing agent, it is possible to optimally fix the heel of the foot to the sole of the shoe according to the invention. Namely, the tension member of the Fußrückenzugs stretched in the size adjustment, the clamping forces are introduced to the connecting elements load-transmitting in the two sections of the heel pull. Since the two ends of the heel pull are fastened to the shoe, the tension forces introduced into the heel pull on the connecting elements cause a pulling force on the middle of the heel pull spanning the heel bone. As a result, the heel strap forms a form-fitting fit around the heel of the foot and fixes the heel in the shoe through a tight fit. The applied by the heel pull on the heel clamping force can be adjusted by varying the applied tension of the tension member by the user. Due to the adaptable in its tension between the heel ring on the one hand and the heel of the user on the other hand, an optimal fit is set, which prevents slipping out of the heel relative to the sole. When moving forward, so the heel remains fixed during the rolling of the rigid sole essentially free of play in the shoe and unwanted relative movements between the sole of the foot and the shoe insole are minimized or completely excluded.

With regard to the optimum adaptation of the fit of the shoe in the heel, the arrangement of the two connecting elements, where the tensile forces are introduced into the heel, relative to the heel bone spanning center of the heel pull on the one hand and the two sides of the shoe fixed ends of Heel pulls on the other hand from great importance. Because depending on the arrangement of the two fasteners on the heel pull, the mechanical leverage and draft conditions change. To be particularly advantageous, it has been found that the connecting elements are arranged in the direction of the longitudinal axis of the shoe in each case between the heel bone spanning the center of the heel pull on the one hand and the two ends of the heel pull fastened laterally on the shoe. This means in other words that when looking at the shoe in the lateral profile, the connecting elements between the back of the heel on the one hand and the two attachment points of the heel pull on the other hand is arranged. The heel pull may extend in a straight line or slightly arcuate manner between the two attachment points on the one hand and the middle of the heel pull spanning the heel bone on the other hand. Due to the arrangement of the connecting elements between the middle of the heel pull on the one hand and the ends of the heel pull on the other hand it is achieved that the heel pull when tensioning the tension member pulls the two connecting elements of the two lateral portions of the heel pull from its straight or slightly curved shape in the direction of the back of the foot and due to the pulling and lifting conditions at relatively low adjusting forces on the tension member high fastening forces can be applied to the heel. This means a high ease of use for the user, since he has to apply only relatively small forces on the tension member of the Fußrückenzugs for tensioning the heel pull.

As already described, the two lateral portions of the heel pull are contracted during tensioning of the traction element of the Fußrückenzugs upwards in the direction of the back of the foot and thereby tensioned the middle of the heel pull in the direction of the toes towards the front. This adjustment movement of the heel pull causes in the region of the attachment points at the two ends of the heel pull a slight rotation of the heel pull relative to the attachment point. This slight rotation can be compensated for by a deformation of the heel pull in the region of the attachment points with sufficiently elastic material of the heel pull. However, then the user must be applied an additional clamping force for elastic deformation of the heel pull in the region of the two attachment points. To avoid this additional clamping force, it is therefore particularly advantageous if the two ends of the heel pull are each secured in pivot bearings on the sole. For this purpose, the two ends of the heel pull can be riveted to the sole, for example with a fastening rivet. The pivot bearing allows a substantially force-free rotation of the ends of the heel pull around the attachment point, at the same time the necessary clamping forces can be introduced via the pivot bearing in the sole.

The shaft of the shoe according to the invention is intended to fix the foot on the sole of the shoe. The shaft of the shoe encompasses the top of the foot at least partially. For example, the shaft may consist of different bands, whereby an open shoe, such as a sandal would be formed. Alternatively or additionally, the shaft may comprise a shell of a conformable upper. The outer material can be synthetic materials, for example Gore-Tex textile material, or leather. The upper then at least partially covers the foot and increases the wearing comfort. In the shoe according to the invention, it is provided that the heel pull runs on the outside of the shell.

If the shoe according to the invention is equipped with a shell made of a supple upper, it is advantageous if the heel pull does not coincide with the shell in the left and right sections between the middle of the heel pull spanning the heel bone and the two ends of the heel pull laterally attached to the shoe is connected, but runs freely on the supple upper. Due to the fact that the heel pull on the one hand and the shell on the other hand are not connected to each other, in particular not sewn together, the heel pull when tensioning the tension member on Foot heel move freely over the upper of the shell are offset, so that the upper material is not deformed despite the adjustment of the heel pull and wrinkling is avoided.

Furthermore, it is particularly advantageous if also the heel bone spanning center of the heel pull is not connected to the shell of cuddly upper material. As a result, the heel piece is then directly connected only at the two ends to the shoe, in particular to the sole of the shoe. All other parts of the heel pull can be moved freely over the supple upper of the shell and thereby realize an optimal fit between the heel pull on the one hand and the heel on the other hand. In order to fix the height of the middle of the heel pull in the region of the heel relative to the shell, an upwardly projecting tab can be provided on the shell. The heel pull then passes over the attachment area of the upwardly projecting tab to prevent the heel pull from slipping too far down.

In order to easily transfer the necessary forces in the heel stroke of the shoe according to the invention, the heel pull should be made of a mechanically sufficient rigid material, for example of a plastic strip of suitable thickness. However, such a heel pull of a material of higher rigidity has the disadvantage that the heel pull in the point of articulation of the two connecting elements of its deformation during tensioning the heel pull opposes a considerable resistance, since the rigid material must be at least slightly elastically deformed in the point of articulation of the connecting elements. To avoid these undesirable counterforces, which are necessary for the deformation of the heel pull in the region of the articulation points of the two connecting elements, it is particularly advantageous if the heel pull has a material weakening, in particular a wedge-shaped incision, in the region of the articulation points of the two connecting elements. Due to this material weakening, the stiffness of the heel pull transverse to its longitudinal axis in the region of Linkage points of the two connecting elements can be reduced, so that the resistance of the heel pull is reduced against deformation when tightening the heel pull.

The structure of the sole of the orthopedic shoe is basically arbitrary, as far as the sole has a sufficient flexural rigidity and the movement of the foot during walking thereby does not exceed a tolerable level. In order to ensure a high level of comfort at the same time in addition to the necessary rigidity, it is particularly advantageous if the sole comprises an outsole and an insole made of different materials. The outsole can then be made of an elastically damping material to achieve the desired walking comfort. The insole is made of a rigid material. The flexural rigidity of the insole can then be chosen so high regardless of the material of the outsole that the sole has the total required for use on an orthopedic shoe bending stiffness.

For many users, the use of the orthopedic shoe is only necessary on one foot, since the second foot is not altered pathologically. However, the necessary production costs are thereby considerably increased, since the users only need one shoe at a time, but the manufacturer must provide shoes for both the left and the right feet in different shoe sizes. In order to reduce the necessary variety of variants and the associated production costs, it is therefore particularly advantageous if the foot-facing inside of the sole and the shaft are formed axially symmetrical with respect to the shoe longitudinal axis. This axial symmetry of the inside of the shoe ensures that the shoe can optionally be worn on the left or right foot. To supply the various users, it is then only necessary to offer the shoe in different shoe sizes, the Shoe can then be worn either on the left or right foot.

Which type of tension member of the shoe according to the invention is fixed to the foot of the user, is basically arbitrary. Preferably, the tension member may be formed in the manner of a Zuggurts. This tension belt is fixed with one end, namely the fixed end, on one side of the Fußrückenzugs. On the opposite side of the Fußrückenzugs then a Umlenkschlaufe is attached, in which the Zuggurt can be deflected starting from its fixed end, thereby spanning the instep with variable length. At the free end of the Zuggurts then a Velcro or loop tape is provided, which is placed after setting the necessary tension length of Zuggurts on a provided in the fixed end Velcro or loop tape and thereby fixed.

If the shoe according to the invention is formed axially symmetrical and can be worn either on the left or right foot, then it is particularly advantageous if the fixed end and the deflection loop of Zuggurts are releasably secured respectively with coupling members. By mutual loosening of the coupling members at the fixed end and the deflection loop, the arrangement of the fixed end on the right or left side of the shoe can be changed. As a result, it is thereby possible despite the axisymmetric design of the shoe by switching the two coupling members to ensure that the free end of the Zuggurts runs from the inside to the outside. This means, in other words, that by adapting the coupling members of the tether an adjustment can be made so that the shoe can be worn on a left or on a right foot.

In order to fix the Velcro of the tension member in the largest possible range, it is particularly advantageous if the Velcro or Velcro strip of Velcro at the fixed end of Zuggurts covers the outside of the fixed end associated coupling member.

The shoe according to the invention may preferably be combined with an orthopedic shoe insole. Preferably, the shoe inner sole has in the space between the top and bottom of the shoe insole, in the area under the forefoot, a pressure peaks distributing cushion, the deformable cushion cover is filled with deformable and relatively movable packing. Such a cushion with a deformable cushion cover and with deformable and relatively movable fillers contained therein makes it possible for the shape of the pillow to adapt itself again and again to the changing shape of the sole of the foot in the area of the forefoot joint. Because the shape of the pad is determined by the arrangement of the movable packing in the cushion cover. Now changes the shape of the sole of the foot or the position of the sole of the foot on the shoe sole, so the shape of the pad can be easily adapted to this change by rearrangement of the movable packing. The rearrangement of the packing continues in each case until it has come to a largely complete pressure equalization. In other words, this means that the filling bodies are rearranged in the cushion cover until the shape of the cushion optimally fits the shape of the sole of the foot and, as a result, all pressure peaks between the sole of the foot and the shoe sole have been largely eliminated or completely eliminated. During the subsequent wearing of the shoe insole is ensured by the deformability of the packing or by the deformability of the cushion cover for optimum damping. The rearrangement of the filling in the cushion cover also causes to some extent a kind of massage movement of the shoe insole on the skin of the sole of the foot, through which the blood circulation is stimulated. This, in turn, has a positive effect on the prevention of open spots on the skin of the sole of diabetics.

In order to enable an optimal adaptation of the shape of the pad filled with the movable packing to the shape of the sole of the foot, it is necessary to that there are no air cushions in the cushion cover. Because such air cushions shift within the cushion cover depending on the pressure load and thereby change again and again the pressure state and cause unwanted pressure peaks. According to a preferred embodiment of the shoe insole according to the invention, it is therefore provided that the cushion cover has at least one vent opening through which the air present in the cushion can escape to the outside when pressurized. As a result, it is ensured by the vent that a complete pressure equalization between the inside of the cushion cover and the ambient atmosphere takes place. The formation of unwanted air cushion within the cushion cover is thereby avoided.

In order to fix the shape of the filled with the pad cushion at least temporarily, an evacuation device can be provided on the cushion cover. By means of the evacuation device, the air present in the cushion cover can be evacuated to the extent that a negative pressure forms in the cushion cover. By this negative pressure, the deformable cushion cover is pulled against the deformable packing and thereby fixed the relative position between the individual packing. By venting the evacuation device, the negative pressure can then be released again from the cushion cover and a new shape of the pad can be adjusted by rearrangement of the filler in the cushion cover.

The adaptation of the shape of the shoe insole by rearrangement of the movable packing located in the cushion cover is based on the rearrangement of the packing under load. In the process, fillers in the area with high pressures are transferred to areas with lower pressures until all areas of the sole of the foot have a substantially similar pressure load. Due to the anatomical deformation of the sole of the foot and the respectively associated pressure load, it may be during the rearrangement of the packing to very long rearrangement paths that can not be traversed within a relative time. In particular, when the entire sole of the foot is to be stored in the shoe with a single cushion cover and the movable packing located therein, it can lead to very long Umlagerungswegen that can not expect a transformation of the pillow within reasonable periods. In order to avoid such an inadmissibly long Umlagerungswege the filler and to be able to make a region-specific adjustment of the cushion geometry to the different areas of the sole, it is particularly advantageous if the cushion is divided into at least two cushion segments. The shape of the individual pillow segments and in particular the degree of filling of the individual pillow segments can then be adapted to the different requirements in the different areas of the sole of the foot.

How many cushion segments are present and in which areas of the sole of the foot are arranged, is basically arbitrary. According to an advantageous embodiment, it is provided that a cushion segment is arranged according to the invention in the forefoot joint area of the foot and / or in the toe area of the foot and / or in the metatarsal and tarsal area of the foot and / or in the heel area of the foot. In particular, a variant embodiment with a total of four cushion segments in the toe area and in the forefoot joint area and in the metatarsal and frontal root area and in the heel area is particularly advantageous.

During the walking movement of a user of the orthopedic shoe insole, there is a rolling movement of the shoe insole in the shoe. This rolling movement of the shoe insole can lead to unwanted rearrangement effects of the filler in the cushion cover. In order to minimize these unwanted rearrangements, it is particularly advantageous if a clearance groove is provided between adjacent cushion segments. This clearance groove allows a relative movement when rolling the shoe insole while walking the adjacent cushion segments and thereby minimizes the rearrangement effect on the movable packing in the individual pillow segments.

With a view to minimizing as far as possible the unwanted rearrangement effect due to the rolling movement of the shoe inner sole, it is particularly advantageous if the clearance groove between adjacent cushion segments runs along an arc along its longitudinal axis. The arc of the arcuate slot should be concave around the verses of the shoe sole and thus point with its central region in the direction of the forefoot.

As far as the shoe insole has a plurality of cushion segments, it may be desirable to let the filler variable between the individual pillow segments, for example, to vary the degree of filling of the individual pillow segments can. This makes it possible in particular to adapt the properties of the shoe inner sole to the requirements of different users. In order to realize this type of adaptation of the shoe insole according to the invention, it is provided according to a preferred embodiment that the cushion segments are at least partially communicating, wherein air and / or filler can pass through at least one transition opening between two communicating cushion segments. By rearrangement of the filler through the transition openings through the degree of filling of the individual cushion segments can be varied and changed. In addition, air can be conveyed through the transition openings between the individual cushion segments, so that in particular not every single cushion segment must have a vent opening and / or an evacuation device.

In order to avoid the rearrangement of packing between the communicating cushion segments during use of the shoe inner sole, it is particularly advantageous if the cross section of the transition opening is chosen to be suitable relative to the cross section of the packing becomes. The cross section of the transition opening should be at least so large relative to the cross section of the filler that the filler can pass in the unloaded state through the transition opening between the communicating cushion segments. At the same time, the cross section of the transition opening should be so small relative to the cross section of the packing that the packing in the loaded state of the shoe sole can not be transferred through the transition opening.

In order to ensure, in particular in the area of the spacer grooves, a transition that is as free of pressure peaks as possible and wearing comfort, it is particularly advantageous if an additional elastic pressure distribution layer, in particular made of foam, is arranged on the foot facing side of the shoe inner sole. Since this additional pressure distribution layer only has to absorb small pressure peaks, it can be made correspondingly thin and is not subject to the otherwise occurring signs of wear with the associated undesired embossing of the shoe sole.

An embodiment of the invention is shown schematically in the drawings and is explained below by way of example.

Fig. 1

einen erfindungsgemäßen Schuh in seitlicher Ansicht von links;

Fig. 2

den Schuh gemäß Fig. 1 in seitlicher Ansicht von rechts;

Fig. 3

den Schuh gemäß Fig. 1 in seitlicher Ansicht von hinten;

Fig. 4

das hintere Fixiermittel zur Fixierung des Fußes im Schuh gemäß Fig. 1 mit daran befestigtem Zugorgan in perspektivischer Ansicht;

Fig. 5

die hinteren Fixiermittel gemäß Fig. 4 nach der Montage des Zugorgans in perspektivischer Ansicht;

Fig. 6

das Fixiermittel gemäß Fig. 4 in seitlicher Ansicht;

Fig. 7

das Fixiermittel gemäß Fig. 6 nach der Montage des Zugorgans;

Fig. 8

die Oberseite einer Schuhinnensohle in perspektivischer Ansicht von oben;

Fig. 9

die Unterseite der Schuhinnensohle gemäß Fig. 8 in perspektivischer Ansicht von oben;

Fig. 10

einen Längsschnitt durch die Schuhinnensohle gemäß Fig. 9 in perspektivischer Ansicht von oben;

Fig. 11

die Unterseite der Schuhinnensohle gemäß Fig. 9 in Ansicht von oben;

Fig. 12

die Schuhinnensohle gemäß Fig. 11 im Querschnitt entlang der Schnittlinie A-A.

Show it:

Fig. 1

a shoe according to the invention in lateral view from the left;

Fig. 2

according to the shoe Fig. 1 in lateral view from the right;

Fig. 3

according to the shoe Fig. 1 in lateral view from behind;

Fig. 4

the rear fixing means for fixing the foot in the shoe according to Fig. 1 with attached tension member in perspective view;

Fig. 5

the rear fixative according to Fig. 4 after assembly of the tension member in a perspective view;

Fig. 6

the fixing agent according to Fig. 4 in lateral view;

Fig. 7

the fixing agent according to Fig. 6 after installation of the tension member;

Fig. 8

the top of a shoe insole in a perspective view from above;

Fig. 9

the underside of the shoe insole according to Fig. 8 in a perspective view from above;

Fig. 10

a longitudinal section through the shoe inner sole according to Fig. 9 in a perspective view from above;

Fig. 11

the underside of the shoe insole according to Fig. 9 in top view;

Fig. 12

the shoe insole according to Fig. 11 in cross section along the section line AA.

Fig. 1 shows an orthopedic shoe 01 to avoid excessive pressure loads on pressure-sensitive soles according to the teaching of the invention, as provided in particular for diabetics. The shoe 01 consists in its basic structure of a rigid outsole 02 and a shaft 03. The outsole has in the area of the toes and in the heel each have a convexly rounded sole region 04 and 05. The rounded sole areas 04 and 05 make it possible to unroll the shoe with its bottom sole while walking, so that the user despite the flexural rigidity of the outsole 02 an approximately normal motion picture is possible. The shank 03 provided for fixing the foot to the outsole 02 comprises a front fixing means 06 and a rear fixing means 07. Furthermore, the shank 03 comprises a shell 08 made of a cuddly upper material, for example leather or a textile material.

At the front fixing 06 and the rear fixing 07 each traction elements 09 and 10 are provided to allow the user to resize the shoe 01 to his individual needs. With the traction element 09, the front part of the shoe 01 is fixed in the area of the forefoot, whereas with the traction element 10 a size adjustment in the area of the metatarsus and the heel is made possible. The two tension members 09 and 10 are each formed as Zuggurte, each having a Velcro closure on its inner side and thus allow a size adjustment of the tension member 09 and 10 respectively.

The rear fixing means 07 consists in its basic structure of a heel pull 11 and an attached Fußrückenzug 12. The Fußrückenzug 12 can be stretched by the tension member 10 in variable length over the back of the user's foot. The tension member 10 forms an integral part of the Fußrückenzugs 12. The heel pull 11 extends from its first end 13 which is secured with a mounting rivet on the sole 02 (mounting rivet 14 and end 13 in Fig. 1 and Fig. 2 In the middle of the heel pull 11, the heel bone is deflected spanning and then runs back over the right Fußrist towards the second end 16, which in turn rotatably connected to a rivet 17 at the Sole 02 is attached (see Fig. 2 ). The Fußrückenzug 12 with the tension member 10 is fastened by means of connecting elements 18 and 19 load-transmitting on the left and right portions of the heel piece 11. The connecting elements 18 and 19 in this case have a distance to the ends 13 and 16 of the heel pull 11 and a distance to the center 20 of the heel pull, which spans the heel bone in the region of the cap 15 on. The left portion 11a of the heel pull 11 and the right portion 11b of the heel pull 11 each extend in an arc from the fastening points in the region of the ends 13 and 16 to the middle 20 of the heel pull 11. Now, if the Fußrückenzug 12 stretched by changing the length of the tension member 10 on the instep of the user, then the corresponding Tensile forces introduced via the connecting elements 18 and 19 in the heel pull 11. Since the heel pull 11 is only connected at its ends 13 and 16 to the shoe 01, namely to the sole 02, the center 20 of the heel pull 11 is displaced forward when tensile forces are applied and ensures optimum positive locking of the cap 15 over the latter Heel bone of the user. The portions 11a and 11b and the middle 20 of the heel pull 11 are not connected to the upper of the shell 08, whereby a relative movement between the upper of the shell 08 and the heel pull 11 is made possible.

The connecting elements 18 and 19 are, as in Fig. 1 and Fig. 2 seen, in each case in the direction of the longitudinal axis of the shoe between the center 20 of the heel pull 11 on the one hand and the two laterally arranged on the shoe ends 13 and 16 of the heel pull 11 on the other hand. This arrangement of the connecting elements 18 and 19 in the direction of the longitudinal axis between the center 20 on the one hand and the ends 13 and 16 on the other hand leads to an optimal introduction of force applied by the Fußrückenzug 12 tensile forces in the heel pull 11. Due to the leverage already causes a relatively low tensile load in the Fußrückenzug 12 a high tensile load in the heel pull 11, so that even when applying relatively low forces on the tension member 10 is already a very firm fixation of the foot in the shoe 01 can be effected by the heel pull 11. This high force efficiency is further enhanced by the fact that the ends 13 and 16 are rotatably supported by means of the rivets 14 and 17 and the heel pull 11 is otherwise not connected to the upper of the shell 08. In order to further improve the force effectiveness of the rear fixing means 07, the heel pull 11 in the region of the two connecting elements 18 and 19 each have a material weakening 21, which is designed in the manner of a wedge-shaped incision. As a result of this material weakening, the two sections 11a and 11b of the heel pull 11 are weakened with regard to their flexural rigidity with the left and right articulation point of the heel pull 12, so that the heel pull 11 is subjected to the tensile load of the heel pull Fußrückenzugs 12 here just buckle easier. A deformation of the heel pull 11, apart from these two areas with the targeted material weakening, is substantially avoided in this way. Fig. 3 shows the shoe 01 in view from behind. It can be seen how the heel pull 11 with its middle 20 spans the shoe 01 in the region of the heel bone. To fix the height of the heel pull 11 in the region of its center 20, a tab 22 is provided on the cap 15, the free end of which projects upwards. The seam between the cap 15 and the tab 22 prevents inadvertently far slipping down the heel 11th

4 and FIG. 5 show the rear fixing means 07 prior to attachment to the sole 02. It can be seen the ends 13 and 16 with the fastening holes provided therein for the passage of the fastening rivets 14 and 17. Further, one recognizes the heel pull sections 11a and 11b with the intermediate middle 20. The Fußrückenzug 12 consists of two deflection loops 23, 24 and the tension member 10. The deflection loops 23 and 24 are formed integrally with the connecting elements 18 and 19 on the heel pull 11. The tension member 10 can be releasably fixed to the deflection loop 23 or 24 by means of a coupling member 25, which engages behind the deflection loop 23 or 24 in its recess with two wings in a form-fitting manner. After insertion of the coupling member 25 in the recess of the Umlenkschlaufe 23 or 24, the coupling member 25 must be rotated to about 90 degrees.

The coupling member 25 is attached to the fixed end 26 of the tension member 10. To use the tension member 10 this is threaded after the fixation of the coupling member 25 on the first deflection loop 23 with the free end 27 through the second deflection loop 24 and guided back to the fixed end 26. On the tension member 10 is on both sides a hook and loop fastener provided with a loop tape and a functionally complementary chopping band, so that the clamping length of the tension member 10 through Aufeinanderliegen the Hackenbands can be fixed to the loop tape.

In Fig. 6 and Fig. 7 the free end 27 on the opposite side of Fußrückenzugs 12 can be seen. It can be seen that the free end 27 of the tension member 10, the coupling member 25 completely covers and thereby comes to rest over the entire surface on the underlying functionally complementary Hacken- or loop tape at the fixed end 26. Due to the fact that the Velcro strip completely covers the coupling element 25, a greater variation in the length adjustment of the pulling element 10 is made possible.

By the coupling member 25, it is possible to attach the tension member 10 with its fixed end 26 selectively on the first Umlenkschlaufe 23 or second Umlenkschlaufe 23. Since the shoe 01 is otherwise formed absolutely axially symmetric with respect to its longitudinal axis and thereby optionally functionally identical worn on the right or left foot, a selective appearance of the shoe 01 is made possible by the optional attachment of the fixed end 26 to the first Umlenkschlaufe 23 or the second Umlenkschlaufe 23 , In the Fig. 1 and Fig. 2 variants shown are provided, for example, to be worn on a right foot. By repositioning the coupling member 25 to the respective other deflection loop 23 or 24, the shoe 01 can be changed over as it is intended to be worn on the left foot.

Fig. 8 shows an orthopedic shoe inner sole 101, which can be arranged in the shoe 01 on the sole 02. Fig. 8 The shoe insole 101 with its upper side 102 is a perspective view from above. The shoe insole 101 can be detachably arranged in the shoe 01 according to the invention of the corresponding shoe size and serves to improve the pressure distribution on pressure-sensitive soles, in particular of diabetics. The properties of the shoe inner sole 101 in the shoe 01 are particularly advantageous, since a uniform as possible Pressure distribution on the foot under the aspect of very firm fixation of the foot in the shoe 01 is very desirable.

Fig. 9 shows the shoe insole from its bottom 103 forth in a perspective view from above. It can be seen that between the upper side 102 and the lower side 103 there is a pressure-tip-spreading cushion 104 with four cushion segments 105, 106, 107 and 108.

The structure of the pad 104 with the pad segments 105 to 108 is shown in the longitudinal section according to Fig. 10 seen. The deformable cushion cover 109 made of PU film encloses a multiplicity of deformable and relatively movable packings 110. These fillers 110 can be relocated relative to one another in order thereby to be able to adapt the shape and contour of the pillow 104 again and again. How out Fig. 9 can be seen, between the individual cushion segments 105, 106, 107 and 108 respectively transitions 111 to form transition openings 112 between the respective adjacent cushion segments present. Through the transition openings 112, the filling body 110 can pass between the adjacent cushion segments 105, 106, 107 and 108, in order thereby to be able to vary in particular the degree of filling of the individual cushion segments 105 to 108. In addition, the air in the individual cushion segments 105 to 108 can flow through the transition openings 112 and then escape through vent openings 120 which are mounted in the wall of the cushion cover 109 in the region of the transitions 111 in the outside atmosphere.

Fig. 11 shows the shoe insole 101 with its bottom 103 in a frontal view from above. It can be seen three clearance grooves 113, 114 and 115, which separate the four cushion segments 105 to 108 from each other and allow a relative movement of the adjacent cushion segments 105 to 108.

The spacer grooves 113 to 115 each extend in an arcuate concave around the heel of the shoe inner sole 101. The transitions 111 between the The arrangement of the ventilation openings 120 on the side of the transitions 111 facing the underside 103 ensures that the ventilation openings 120 are not closed even when the shoe inner sole is loaded, since the transitions 111 against the bottom 103 are recessed in the spacer grooves 113 to 115 are arranged.

Fig. 12 shows the shoe inner sole 101 in cross section along the section line AA. It can be seen the transition opening 112 between the cushion segments 106 and 105, through which the filler 110 can pass between the adjacent cushion segments. The cross section of the transition opening 112 relative to the cross section of the filler body 110 indicated only schematically is just chosen so that a transition of the packing 110 in the unloaded state is possible and is excluded at the same time in the loaded state of the shoe sole 101.

The cushion segments 105 to 108 of the shoe inner sole 101 are formed by two layers 116 and 117 of PU film. The layer 116 has a substantially flat blank. On the other hand, the layer 117 is shaped in three dimensions, for example by deep-drawing the PU film and forms four chambers 118 corresponding in shape to the cushion segments 105. In the manufacture of the shoe insole 101, first the three-dimensionally deformed layer 117 is filled with the packing 110 and then the layer is filled 116 with the layer 117 welded together in the contact areas. By welding the two layers 116 and 117, the chambers 118 are closed with the packing 110 therein. In order to ensure as pressure-free as possible pressure distribution for the user in the area of the spacer grooves 113 to 115, a pressure-distribution layer 119 consisting of foam is finally attached to the upper side of the layer 116.

Claims (15)

1. An orthopaedic shoe (01) for preventing excess pressure loads on pressure-sensitive foot soles, in particular those of diabetics, the shoe (01) having a rigid sole (02) which substantially precludes bending of the forward joint of the foot during walking, and the sole (02), in the area of the toes and/or in the area of the heel, having a convexly rounded sole portion (04, 05) which allows the rigid sole (02) to roll, and the shoe (01) having a shaft (03), and fixation means (06, 07) being provided on the shaft (03), by means of which the foot can be fixed in the shoe (01), and the fixation means (06, 07) having a heel strap (11) which extends from the left instep across the back of the heel bone to the right instep, and the fixation means (06, 07) comprising a dorsal strap (12), which extends across the dorsum of the foot and has a pulling means (10) which can be tensioned across the dorsum for size adjustment,
   characterised in that
   the dorsal strap (12) is attached in a load-transmitting manner with a left and a right connecting element (18, 19) to the left and right portion (11a, 11b) of the heel strap (11), the connecting elements (18, 19) each having a distance to the two ends (13, 16) of the heel strap (11) attached laterally to the shoe (01) and a distance to the centre (20) of the heel strap (11) spanning across the heel bone.
2. The orthopaedic shoe according to claim 1,
   characterised in that
   in the direction of the longitudinal axis of the shoe (01), the connecting elements (18, 19) are arranged between the centre (20) of the heel strap (11) spanning across the heel bone on the one hand and the two ends (13, 16) of the heel strap (11) attached laterally to the shoe on the other hand.
3. The orthopaedic shoe according to claim 1 or 2,
   characterised in that
   the two ends (13, 16) of the heel strap (11) are attached to the shoe (01) in respective pivot bearings, in particular riveted thereto with a respective fixing rivet (14, 17).
4. The orthopaedic shoe according to any of the claims 1 to 3,
   characterised in that
   the shaft (03) has a shell (08) made of a supple upper material, said shell covering the foot at least in sections, the heel strap (11) extending at least in sections along the outer side of the shell (08).
5. The orthopaedic shoe according to claim 4,
   characterised in that
   the heel strap (11) is not connected to the shell (08) in the left and right portion (11a, 11b) between the centre (20) of the heel strap (11) spanning across the heel bone on the one hand and the two ends (13, 16) of the heel strap (11) arranged laterally on the shoe on the other hand.
6. The orthopaedic shoe according to claim 4 or 5,
   characterised in that
   the centre (20) of the heel strap (11) spanning across the heel bone is not connected to the shell (08) made of a supple upper material and is in particular fixed in its height by a flap (22) protruding upward from the shell (08).
7. The orthopaedic shoe according to any of the claims 1 to 6,
   characterised in that
   the heel strap (11) is produced from a rigid material, the heel strap (11), in the area of the connecting elements (18, 19), having a material weakening (21), in particular a wedge-shaped indentation, by means of which the stiffness of the heel strap (11) is decreased transversally to its longitudinal axis.
8. The orthopaedic shoe according to any of the claims 1 to 7,
   characterised in that
   the sole (02) comprises an outer sole and an inner sole, the outer sole being produced from an elastically damping material, and the inner sole being produced from a more rigid material than the outer sole.
9. The orthopaedic shoe according to any of the claims 1 to 8,
   characterised in that
   the inner side of the sole (02) facing the foot and the inner side of the shaft (03) facing the foot are formed to be axially symmetric with respect to the longitudinal axis of the shoe, and the shoe can be worn optionally on the left or on the right foot.
10. The orthopaedic shoe according to any of the claims 1 to 9,
    characterised in that
    the pulling means (10) for tightening the dorsal strap (12) is formed in the manner of a tension strap, the tension strap being fixed with a fixing end (26) to the dorsal strap (12) and being deflected in a deflection loop (24) attached to the dorsal strap (12), and the effective tightening length of the tension strap between the fixing end (26) and the deflection loop (24) being adjustable by means of a hook and loop fastener.
11. The orthopaedic shoe according to claim 10,
    characterised in that
    two deflection loops (23, 24) are provided on the dorsal strap (12), the fixing end (26) of the tension strap (10) being attachable with a coupling means (25) optionally to the right or left deflection loop (23, 24) of the dorsal strap (12).
12. The orthopaedic shoe according to any of the claims 1 to 11,
    characterised in that
    the hook tape or loop tape of the hook and loop fastener on the fixing end (26) of the tension strap (10) covers the outer side of the coupling means (25) associated with the fixing end (26).
13. The orthopaedic shoe according to any of the claims 1 to 12,
    characterised in that
    on the inner side of the sole (02) facing the foot, an orthopaedic inner shoe sole (101) is arranged, at least one space being formed between the top side (102) and the bottom side (103) of the inner shoe sole (101), a pad (104) distributing pressure peaks at least in partial areas being arranged in said space, whose deformable pad casing (109) is filled with deformable filling bodies (110) which are mobile relative to one another.
14. The orthopaedic shoe according to claim 13,
    characterised in that
    the pad casing (109) has at least one deaeration opening (120), through which air present in the pad (104) can escape to the outside when pressure is applied.
15. The orthopaedic shoe according to claim 13 or 14,
    characterised in that
    the pad (104) is divided into individual pad segments (105, 106, 107, 108), wherein in particular one pad segment (105) is arranged in the toe area of the foot, and/or one pad segment (106) is arranged in the area of the forefoot joint of the foot and/or one pad segment (107) is arranged in the area of the metatarsus and tarsus of the foot and/or one pad segment (108) is arranged in the heel area of the foot, and wherein between at least two adjacent pad segments (105, 106, 107, 108), a spacing groove (113, 114, 115) is provided which allows a relative motion of the adjacent pad segments (105, 106, 107, 108), and wherein the pad segments (105, 106, 107, 108) are formed to be at least partially communicative, air and/or filling bodies being able to pass through passage openings (112) between two communicating pad segments (105, 106, 107, 108).

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