RU54770U1 - ELASTOSTUP - Google Patents

Abstract

The utility model relates to medicine, orthopedics, specifically to devices for the early conservative treatment of congenital clubfoot in children of the first year of life. In order to increase the effectiveness of treatment by creating conditions for the early simultaneous correction of all components of the deformity and normal development of the diseased limb in an elastogap, consisting of a slipper with a rigid flat sole - the base and the loincloth attached to it, the upper part of the slipper is made soft and the loincloth made of two elastic rods connected to each other from the side of their edges facing the back surface of the lower leg with a fastener consisting of a loop and a button, moreover, the loop is located on the edge of the outer surface of the rear edge of one of the elastic rods closer to the foot, and the button is located on the inner surface of the other of them at the level of the middle third of the lower leg, also, the distance between the fastener elements is 2-4 cm in height.

Description

The utility model relates to medicine, orthopedics, specifically to devices for the early conservative treatment of congenital clubfoot in children of the first year of life.

There are various devices for the treatment of congenital deformity of the feet, depending on the severity of the pathology and on the age of the patients, Fink-Ettingen corrective dressings (1). The use of known devices for the correction of congenital clubfoot has a number of disadvantages: first of all, they do not provide a sufficiently long, forced and safe effect on the affected limb. The Fink-Ettingen bandage (in its described versions of bandage, flannel stripes, adhesive-plaster species) does not sufficiently effectively correct all elements of clubfoot (especially in severe cases), restricts movement in joints and also contributes to the deterioration of trophic limbs (1, 5, 6, 7, 8). Volkov M.V. and Vilensky V.Ya. in their works they also emphasize the insufficiency of the obtained therapeutic effect.

Closest to the proposed device is a gypsum corrector (4). However, the gypsum corrector is inconvenient to use for caring for the baby, during the treatment process they cause the formation of pressure sores, restrict movements in the joints for a long time, thereby exacerbating trophic disorders, which are more or less present in this pathology. As a result of this, after treatment with a gypsum corrector, growth retardation and atrophic changes in the muscles of the foot, lower leg and thigh are often observed, especially noticeable with unilateral clubfoot. Also, the action of gypsum correctors is based on a phased (not simultaneous) correction of clubfoot elements: at the first stage, an attempt is made to eliminate the forefoot adduction and supination, and the equinus correction is left to the subsequent stages of treatment. Meanwhile, in the process of rapid growth of the child in 1-2 months of life, the foot skeleton is deformed due to the inability to simultaneously correct the relationship of the bones that form this pathology. The onset changes in bone structures in turn begin to impede the removal of the foot in the correct position with further attempts at conservative treatment. The specified factor is determining in the occurrence of relapses of the disease and subsequently leads to the need for surgical correction of deformity, as well as disability

patients due to unresolved functional and anatomical disorders of the foot and ankle joint.

A new technical task is to increase the effectiveness of treatment by creating conditions for early simultaneous correction of all components of the deformation and creating optimal conditions for the normal development of a diseased limb.

To solve this problem, in an elastic access, consisting of a slipper with a rigid flat sole - the base and a lap fastening connected to it, the upper part of the slipper is made soft, and the lap fastening is made of two elastic rods connected to each other from the side of their edges facing the back surface of the lower leg with the help of a fastener consisting of a buttonhole and button, moreover, the buttonhole is located on the edge of the outer surface of the rear edge of one of the elastic rods closer to the foot, and the button "is located on the inner surface STI another of them at the level of the middle third of the leg, also, the distance between the fastening elements height is 2-4 cm.

In Fig. 1, an elastapod is shown, consisting of a slipper 1 with a rigid flat sole - base 2 and a loincloth 3 connected to it, made in the form of two elastic rods 4, 5 interconnected by means of a fastener consisting of a loop 6 and a button 7, so that the loop 6 is located on the edge of the outer surface of the rear edge of one of the elastic rods closer to the foot, and the button 7 is located on the inner surface of the other of them at the level of the middle third of the leg, and the height of the distance between the fastener elements is 2-4 cm.

The device can be implemented as follows. The material for the manufacture of elasto-access is an elastic bandage of any production, and the sole-base can be made, for example, from a plywood plate of valgus shape corresponding to the size of the foot.

The device operates as follows. Treatment in elastostap begins after, through active correction of congenital deformity, the foot acquires an almost regular shape (after obtaining good and satisfactory results of treatment of congenital clubfoot with a modified Fink-Ettingen dressing) in children aged 0-2 weeks with a slight degree of clubfoot and 8- 12 weeks with severe deformity. The location of the device on the limbs is illustrated in Fig. 2. The first time, the use of elasto-access alternates with sessions of ongoing redress and bandaging with a modified Fink-Ettingen dressing until hypercorrection is achieved. Important conditions for foot correction are

perseverance, repeated repression of repressive manipulations and at the same time adherence to gradualness, without the application of significant force. Bandaging is used 2-3 times a week for 2-4 weeks, the dressing is left for 10-12 hours. The rest of the time, treatment is carried out using the proposed device - elasto-access until the functional and anatomical restoration of the limb. The proposed design is elastic, performing a corrective function, does not interfere with the free movements of the child. Therefore, it is recommended that you wear elastoboot until the moment when the child begins to stand up on his own and support his legs.

The location of the device on the extremities is illustrated in Fig. 2., where A is the degree of correction of congenital clubfoot achieved, B is the location of the device on the extremities of Slippers 1 put on the child’s foot, the loincloth 3 using rods 4 and 5 are fixed on the knee and fixed with a fastener, consisting from the located loop 6 on one of their elastic rods, and the buttons 7 located on the other of them, which allows the obtained result of eliminating the equinus to be fixed functionally in the early period.

Due to the traction of the elastic bandage (traction force of 100-200 g per cm *), a continuous effect is exerted on the foot (bending it to the rear), which does not interfere with the active movements of the child; - the elasto-fastener fastener along the back surface of the lower leg in the middle third has a feature that allows for easy gradual continuous corrective traction to correct supination due to the difference in the location of the fastener elements. The loop 6 on the edge of the outer surface of the rear edge of one of the elastic rods is closer to the foot, and the button 7 located on the inner surface of the other is 2-4 cm higher and closer to the level of the upper third of the tibia .; the arrow shows the direction of the traction force, which is provided by the difference between the fastening points of the fastener on the rear surface.

The results of treatment using the proposed device are shown in table No. 1. In total, a group of children with congenital clubfoot of varying severity was treated: 55 people taken for treatment from the first days of life (in the maternity ward) to 5 months. The earlier treatment of children with severe clubfoot was explained by the most obvious and frightening anomaly of limb development, which forced parents to decide more quickly on the need for treatment for the child.

Table No. 2 presents the results of the treatment of congenital clubfoot with the help of the proposed device - elastostap in children of the first year of life. At the first stage of correction in the age of children from 0 to 3-4 months, a modified

Fink-Ettingen dressing (as described above). The table shows that in the treatment of mild deformity, only excellent results (100%) were obtained taking into account the shape and function of the foot. In children with a pathology of 4-5 degrees of clubfoot (excessive flexion of the foot and significant protrusion of the tarsus on the back surface with the formation of a neo-joint between the calcaneus and the articular surface of the tibia with dislocation of the talus to the rear) satisfactory and good results were achieved. It was not possible to conduct further observation, as the patients were from another city. They were given recommendations for further treatment and to continue to use elastostap.

Among children with the second degree of clubfoot (27 people), the percentage of good and excellent results was 96%. With the third degree of deformation in 12 children, good and excellent results were obtained in 83% of cases.

After the treatment, prolonged monitoring of the further development of the child was carried out. For 3-5 years, the children received repeated courses of physiotherapy treatment, spa treatment, in some cases, wearing arch support. Most patients did not use orthopedic shoes. It was enough to use ordinary shoes with high backs, exciting the ankle joint. Thus, the limb that was not fixed with rigid orthopedic shoes continued to receive active physiological development, which significantly improved the functional state of the ankle joint and foot. The recovery of all children (with the high conscious help of the parents) was complete, additional types of correction were not carried out. The maximum observation period is 13 years.

An example of the treatment of mild congenital clubfoot.

Maxim P., was admitted to outpatient treatment at the age of 10 days with a diagnosis of left-side congenital clubfoot of the first degree (Figure 3).

The boy was identified supination, bringing the forefoot to 45 *, slight plantar flexion and a decrease in the heel region with elements of limb shortening. Bringing the foot to the correct position is difficult, but after redressing gymnastics is possible. The baby was treated with a modified Fink-Ettingen dressing for 1 month. The first 10 days, bandaging was applied twice a day.

Figure 4. Maxim P. 1 month after treatment, deformity of the foot is eliminated, limb length is restored, the function of the ankle joint is not impaired. Hyper correction is possible with passive bending.

Figure 5. Maxim P. at the stage of treatment in an elastogap to prevent relapse of clubfoot elements. On the diseased limb is a continuous elastic effect of the proposed device. Twice a day, a corrective bandage was applied after massage and gymnastics once by a doctor and a second time at home by a mother who learned the tactics of applying a bandage. Then, for 3 weeks, the bandage was bandaged once a day by a doctor. One month after the start of treatment, a good result was achieved (figure 4).

For further treatment, the proposed device was used. This allowed the diseased limb to develop under optimal physiological conditions with a gentle continuous and simultaneous effect on all the constituent elements of the clubfoot. Within 2-3 months, the wearing of elasto-access was regular, the bandage was practically not removed during the day. At the same time, the movements of the limbs of the child were not limited. Further, elastoblast was used during night and daytime sleep. At the same time, it was advisable to conduct repeated courses of massage, exercise therapy, and thermal procedures. Monitoring the development of the child lasted for 3 years. I did not use orthopedic shoes. There was no relapse of the disease.

An example of the treatment of severe congenital clubfoot.

Dasha G. was born with severe bilateral congenital clubfoot (Fig.6). The angle of adduction of the forefoot on both legs was 130-135 * with respect to the axis of the limb, there was a pronounced contracture of the deformed ankle and foot joints in the supination and plantar flexion to 160-170 * with respect to the lower leg, excretion of the distal lower limb in the correct position is sharply difficult. The girl’s treatment was started in the maternity ward - for 8 days the child was given massage, soft corrective gymnastics (5-7 minutes), followed by fixation of the deformed limbs in the position of the achieved correction with a modified Fink-Ettingen dressing. The procedure was carried out by a doctor with a frequency of 3-4 times a day. By the time the child was discharged from the maternity ward, the deformity on both sides decreased and was of 2 severity: the angle of adduction of the forefoot was 85-90 *, supination was decreased, and plantar flexion reached 130-140 * with respect to the lower leg. Increased range of motion in the ankle joints. 7. Dasha G., 3 months, at the stage of treatment

severe bilateral congenital clubfoot with elastoboots. The proposed device does not interfere with the active movements of the child and at the same time affects all elements of the clubfoot.

After discharge from the maternity ward, outpatient treatment with the Fink-Ettingen dressing continued for up to 3 months. The first month, bandaging was carried out 2-3 times a day by a doctor and at home by a mother trained in dressing. In the second and third month, against the background of physiotherapeutic procedures, modified dressings were applied 1-2 times a day. By the age of three months, a good correction was achieved and treatment with elastobes was started (Fig. 7). At first, regular use of elastobands alternated with sessions of ongoing redress and bandaging with Fink-Ettingen bandages until hypercorrection was achieved. Important conditions for stop correction were persistence, repeated repetition of redressing manipulations and simultaneous compliance with gradualness, without the application of significant force. Bandaging was used 2-3 times a week for another 4 weeks, the bandages remained on their legs for up to 10 hours. The rest of the day, the treatment was carried out in elastoboots and continued regularly until complete functional and anatomical restoration of the limbs. Corrective action of elastoblast did not interfere with the free movements of the child. Therefore, we recommended wearing elastoboots until the moment when the girl began to stand up on her own and exercise support on her legs. Then the parents were asked to use elastobut for day and night sleep of the child during the first year of life in order to prevent relapse and continue treatment. The girl continued to receive repeated courses of massage, exercise therapy, electrical stimulation and thermal procedures, wore arch support. Additional types of clubfoot correction were not used in this case. On Fig Dasha G. at the age of 13 years. No complaints. The shape and function of the feet and ankle joints are fully restored.

Thus, the proposed device is elastobust: 1) allows for the early simultaneous correction of all the components of the congenital clubfoot (supination, adduction and equinus) with a gradual soft continuous impact on the diseased limb; 2) allows you to create optimal physiological and functional conditions for the normal development of the foot and ankle joint, without interfering with their active movements, significantly accelerates the treatment of congenital clubfoot and allows to achieve better results: improve the shape and function of the foot, lower leg and ankle joint, by physiological

correction of muscle-tendon structures and the creation of equilibrium (balance) of muscle strength.

Thus, the use of the proposed device allows to achieve good results in the treatment of congenital clubfoot of varying severity with an early conservative approach, as early as possible to provide physiological conditions for the correct development of the distal limb, taking into account the improvement in the function of the ankle and foot joints, as well as to prevent the possibility of relapse in children of the first year of life

SOURCES:

1) Isakov Yu.F. Congenital clubfoot. // Children's surgery. Moscow. The medicine. 1983. S. 566-570

2) Mirazimov B.M., Ablakulov A.K. Clinic and treatment of congenital clubfoot. Tashkent. The medicine. 1988.120 s.

3) Lyabakh A.P. Clinical diagnosis of foot deformities. Kiev. ZAT Atlant YuEMSi. 2003.110 s.

4) Volkov S.E., Ter-Egiazarova G.M. Congenital clubfoot. // Orthopedics and traumatology of childhood. A guide for doctors. Moscow. Medicine, 1983. C.159-175. (prototype)

5) Vilensky V.Ya., Yukina G.P., Shumeyko V.I. Conservative treatment of congenital clubfoot with products made of polymer materials. // Guidelines. Moscow. Ministry of Health of the USSR. 1983. 23 p.

6) Vilensky V.Ya., Mikhailova L.K. Congenital clubfoot: errors and complications during treatment. // Doctor, 1993, No. 9. S.41-43.

7) Volkov S.E., Malakhov O.A., Zakharov E.S., Maksimov I.A. On the correction tactics of congenital clubfoot // Bulletin of Traumatology and Orthopedics. Priorova, 1998, No. 1. Moscow. The medicine. S.56-60.

8) Kazarezov M.V. Bauer I.V., Koroleva A.M. Deformations of the feet. // Traumatology, orthopedics and reconstructive surgery. Novosibirsk 2004. S. 213-216.

Claims (1)

Elastostup, consisting of a slipper with a rigid flat sole - the base and a hip fastening connected to it, characterized in that the upper part of the slipper is soft and the hip fastening is made of two elastic rods connected to each other from the side of their edges facing the back surface of the lower leg with a fastener consisting of a loop and a button, the loop being located on the edge of the outer surface of the rear edge of one of the elastic rods closer to the foot, and the button is located on the inner surface of the other x them on the middle third of the leg level, the distance between the adjustment fastener elements is 2-4 cm.