FR2923681A1 - ORTHESE PLANTAIRE - Google Patents

Abstract

The invention relates to a plantar orthosis consisting of a unitary assembly (10) having, in elevation, an internal correction reference element (14) and an external correction reference element (15) intended to be in contact with the inner medial foot respectively. and external of the wearer of said orthosis.According to the invention, the plantar orthosis (10) further comprises an anterior corrective element (20) which is shaped to act on the five metatarsal heads of the wearer, positioning each metatarsal head respective at an angle of inclination with respect to the ground corresponding to the metatarsal angle thereof in an anatomical physiological reference position.

Description

The present invention relates to the field of plantar gold-theses. BACKGROUND OF THE INVENTION For a long time, plantar orthotics have been made to measure in a somewhat empirical way, from materials such as foams or cork covered with leather, without precise control of density and hardness. selected materials, and without extensive research profile shapes optimized for the desired therapeutic action. For some fifteen years, specialists have been working on different geometries of plantar orthotics, and have sometimes been particularly interested in therapeutic action on certain metatarsal heads of the wearer of the orthosis. US-A-5,611,153 discloses an orthosis presenting a posterior corrective element, and the anterior portion terminates either behind or in front of the metatarsal heads of the wearer of the orthosis.

It is stated in this document that the anterior portion should preferably not terminate directly above the metatarsal line, to avoid some discomfort for the wearer of the orthosis. Various planetary orthoses have also been proposed whose geometry is chosen to exert corrective action at some of the metatarsal heads. Document FR-A-2 766 673 thus describes a unitary plantar orthosis which comprises a bearing shim associated with the first metatarsal head. EP-A-0 820 706 describes a plantar orthosis constituted by a unitary assembly having, in elevation, internal and external correction elements, as well as an anterior correction element with a convex central portion only. associated with the second, third, and fourth metatarsal heads, and exerting its action behind these heads (it is said that it is a retro-capital element), in order to unload said heads by limiting the support. The technological background is also illustrated by the documents WO-A-01 89 337, FR-A-2 803 495, US-A-4,759,136, and WO-A-96 12 420.

We can also refer to document FR-A-2,844,995 of the present applicants, which describes a plantar or-thesis consisting of a unitary assembly having, in elevation, an element, anterior corrector and a posterior corrective element, the corrector element prior art having a lateral profile cut having the effect of limiting the therapeutic action of said orthosis to some of the metatarsal heads on the inner or outer side of the wearer's foot, said lateral cut-out completing a final cut located in front of the metatarsal heads concerned. Thus, the general teaching of the state of the art is generally directed to plantar orthotics which, at most, are interested in a therapeutic action exerted on only some of the metatarsal heads, in front of or behind those this, depending on the malfunction noted for the person concerned. OBJECT OF THE INVENTION The object of the invention is to design a plantar orthosis arranged to exert a therapeutic action at the level of all the metatarsal heads, while being as universal as possible and capable of exerting a correction of the dynamic rotation. foot for a very large population of carriers. GENERAL DEFINITION OF THE INVENTION The aforesaid technical problem is solved according to the invention by means of a plantar orthosis constituted by a unitary assembly having, in elevation, an internal correction reference element and an external correction reference element intended to be used. in contact with the medial-foot respectively internal and external of the wearer of said orthosis, the orthosis further comprising an anterior corrective element which is shaped to act at the level of the five metatarsal heads of the wearer, positioning each meta-tarsal head respective at an angle of inclination to the ground corresponding to the metatarsal angle thereof in an anatomical physiological reference position. The prior corrector element is therefore sub-capital type, insofar as it recharges the metatarsal heads, positioning said heads as they should be. The therapeutic action exerted by such anterior corrective element is therefore radically different from that exerted by the retro-capital elements of the state of the art, which aim on the contrary to unload the metatarsal heads by limiting their support to the ground. Thus, thanks to the respect of the metatarsal angle in the anatomical physiological position in the front part of the foot, it is possible to perform a correction of the dynamic rotation, both external and internal rotation, regardless of the metatarsal angles with respect to the ground essentially universal. The so-called reference anatomical physiological position mentioned above will be determined according to the population concerned, while respecting structural criteria (which take into account the skeletal structure of the wearer of the orthosis) and dynamic (which induces a movement as perfect as possible by settling on a geometry of least constraints). Preferably, the anterior corrective element extends, in a transverse direction of the orthosis, over almost the entire width of said orthosis, and, in a longitudinal direction of the orthosis, over a predetermined distance sufficient to provide the desired support of the wearer's five metatarsal heads.

In particular, the anterior corrective element has, in the transverse direction of the orthosis, a substantially domed shape, and, in the longitudinal direction of the orthosis, a substantially flat shape. The convex shape of the anterior corrective element may be defined by a transverse profile of convex shape whose height decreases progressively in the increasing order of the metatarsal heads, or alternatively by a transverse profile whose height is constant for the first metatarsal heads, especially the first three heads, then gradually decreases for the last metatarsal heads. More specifically, the transverse profile of the convex shape of the prior corrector element obeys five heights respectively corresponding to the desired angles of inclination of the metatarsal heads relative to the ground, regardless of the size of the wearer's foot. In particular, the five heights of the transverse profile are between 8 to 10 mm for the height associated with the support of the first metatarsal head, and 1 to 2 mm for the height associated with the support of the last metatarsal head.

In a particularly advantageous embodiment, the prior corrective element is arranged at the lower face of the orthosis. More preferably, the longitudinal profile of the flat shape of the anterior corrective element connects smoothly with the rectilinear profile of the underside of the orthosis. Advantageously, the prior corrective element is arranged at the lower face of the orthosis. However, it may alternatively provide an arrangement at the upper face of the orthosis, but the realization of said orthosis will be a little more complicated. The corrective element can be integrated unitarily with the remaining part of the orthosis, or alternatively be attached to said remaining portion of the orthosis, and fixed thereto. It may then be provided that the remaining part of the orthosis additionally has, in raised position, a posterior corrective element having a zone of reduced thickness adjacent to the reference element of internal or external correction. According to a particular embodiment, the anterior corrective element is part of a lower part of orthosis, which is fixed face-to-face against an upper part of orthosis, which includes the reference elements of internal correction and ex-dull . In particular, the lower part of the orthosis of which the front corrector element is part additionally has, on its lower face, a posterior corrector element having a zone of reduced thickness adjacent to the plumb of the reference element. internal or external correction of the orthosis upper part. Advantageously finally, the orthosis is made from a material having a density of between 50 and 450 kg / m 3, with a preference for a density of between 100 and 250 kg / m 3, and a Shore hardness of between 10 and 95. , with a preference for a hardness of between 15 and 60. Other features and advantages of the invention will appear more clearly in the light of the following description and the accompanying drawings, which illustrate particular embodiments of the invention. invention. BRIEF DESCRIPTION OF THE DRAWINGS Reference will be made to the figures of the accompanying drawings in which: FIG. 1 is a top view of a plantar thesis according to the invention, the geometry of which is specified by the cross sections of FIGS. 4, and the longitudinal sections of Figures 5 and 6 which are sections along VV and VI - VI of Figure 1; FIG. 7 illustrates a variant of plantar orthosis according to the invention, the geometry of which is also specified by the cross sections of FIGS. 8, 9 and 10, and by the longitudinal sections of FIGS. 11 and 12 which are sections according to the invention. XI - XI and XII - XII of Figure 7; FIG. 13 is an anatomical view of the foot showing the metatarsal angles with respect to the ground for the five metatarsal heads, in order to better understand the organization of the supports made at each of the five metatarsal heads by means of the anterior corrective element which is a feature of the plantar orthosis of the invention; FIG. 14 illustrates, by way of examples, two transverse profiles of the prior corrector element according to the invention, with the five heights respectively associated with the support of the five corresponding metatarsal heads; FIGS. 15 and 16 are respectively external and internal sagittal views of a planar-floor orthosis according to the invention, which is produced not in a unitary and monoblock manner as was the case in the previous embodiments, but in two orthesis parts superimposed and fixed to each other face to face, each of Figures 15 and 16- thus being an exploded view showing the two complementary orthosis parts.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT OF THE INVENTION In FIG. 1, which is a plan view illustrating a plantar orthosis according to the invention, the foot bones P are represented with its five metatarsal heads referenced 1, 2, 3, 4, 5, this to better visualize the positioning of the foot of the wearer of the orthosis with respect to said orthosis. The plantar orthosis, denoted 10, according to the invention has a peripheral contour 11 constituting the extreme perimeter of the orthosis, it being understood that said orthosis may have anterior and / or posterior parts of essentially negligible thickness, when no referential correction is sought. The plantar orthosis 10 has an anterior portion 12 and a posterior portion 13. In this case, the anterior portion 12 is of reduced thickness for its border zone, while the posterior portion 13 has a posterior corrective element 16 in this case. elevation, with an area of reduced thickness 17. This posterior corrective element 16 is here positioned on the external side, which favors a posterior pronating action. As suggested by the dashed line, however, the posterior corrective element 16 is by no means obligatory in the context of the invention, which is in no way limited to such an arrangement.

The orthosis 10 further has, in elevation, an internal correction reference element 14 and an external correction reference element 15, which are intended to be in contact with the medial-foot respectively internal and external of the wearer of said orthosis. The sections of FIGS. 3 and 4 make it possible to better understand the geometry of this orthosis, which geometry is in accordance with document FR-A-2 844 995 mentioned by the applicants. According to an essential characteristic of the invention, the plantar orthosis 10 further comprises an anterior corrective element 20, which is shaped to act on the five metatarsal heads of the wearer, by positioning each respective metatarsal head at an angle of inclination. relative to the ground corresponding to the metatarsal angle of the latter in an anatomical physiological reference position. This respect of the metatarsal angle of each of the heads with respect to the ground in an anatomical physiological position differs radically from the previous attempts at the beginning of the description, which aimed at correcting a particular defect by the support of some of the heads only. metatarsal. On the contrary, in the present case, the controlled organization of the support of the five metatarsal heads of the foot makes it possible to obtain a correction of the dynamic rotation, both external and internal, regardless of the angle of each of the metatarsals. to the ground, which leads to an almost universal orthosis, ideally adapted to movement thanks to the respect of structural criteria taking into account the skeletal structure of the wearer, and of dynamic criteria which induce a movement as perfect as possible set on a geometry of least constraints. The anatomical physiological position of reference may naturally depend on the population, but within the same population, the plantar orthosis may globally agree almost universally. As can be seen in FIG. 1, the front corrector element 20 extends, in a transverse direction of the orthosis, over almost the entire width of the orthosis, and in a longitudinal direction of the orthosis, over a predetermined distance sufficient to provide the desired support of the five metatarsal heads of the wearer. In this case, the inner and outer edges of the front corrective element 20 and the front and back edges respectively of the front corrector have been noted 21 and 22 respectively. Of course, the rear and front edges 23, 24 are located on either side of the five metatarsal heads, in order to optimally exercise the desired specific therapeutic action. It is interesting to note at this level that the approach of the invention is the opposite of the teaching of the document US-A-5 611 153 supra, by arranging a support at the level of the five metatarsal heads, this support being perfectly controlled through a particular transverse profile of prior corrective element 20 which will be described in more detail below. As can be seen in the cross-section of FIG. 2, the anterior corrective element 20 has a substantially domed shape in the transverse direction of the orthosis. On the other hand, as can be seen in the longitudinal sections of FIGS. 5 and 6, the front corrector element 20 has, in the longitudinal direction of the orthosis, a substantially flat shape. The transverse profile of the prior corrector element 20 is noted 25, while the longitudinal pro-thread of said prior corrector element is denoted 26.

In the transverse direction, it can be seen in FIG. 2 that the curved shape of the prior corrective element 20 is defined by a transverse profile 25 of convex shape whose height decreases progressively in the increasing order of the metatarsal heads.

Thus, we find the largest thickness at the level of the first metatarsal head 1, and these thicknesses gradually decrease to the thickness associated with the support of the fifth metatarsal head 5. The longitudinal profile 26 of the The flat shape of the anterior corrector element 20 connects smoothly with the rectilinear profile of the inferior face of the orthosis, and in FIGS. 5 and 6 are seen gently sloping connections 23 and 24 respectively. back and forward of the anterior cor rector element 20. FIGS. 7 to 12, similar to FIGS. 1 to 6 which have just been described, illustrate a variant of a plantar orthosis according to the invention which differs from the previous one by a different profile of the previous corrective element and the posterior corrective element. The posterior portion 13 has in this case a rearward corrective element 18, arranged on the inner side, with a zone of reduced thickness 19 which is adjacent to the external correction reference element 15. Such a corrector element 18 thus promotes a posterior supine action. As previously indicated for the posterior corrective element 16 of the variant of FIGS. 1 to 6, the posterior corrective element 18 is optional in the context of the invention, as suggested by the dashed line. The corresponding section of FIG. 10 is then exactly symmetrical with that of FIG. 4 above. With regard to the prior corrective element 20, it is always arranged in the same area of the orthosis with respect to the five metatarsal heads, but its curved shape is defined by a transverse profile, denoted 25 ', whose height is constant for the first metatarsal heads, then gradually decreases for the last metatarsal heads. In the present case, there is provided a transverse profile 25 'comprising a part 25.1 of constant height, that is to say corresponding to a horizontal flat, for the first three metatarsal heads 1, 2, 3 and then a decreasing height defined by a ramp 25.2 for the last two metatarsal heads 4 and 5. In this case, the connection of the rectilinear profile 25.1 and inclined profile 25.2 areas is at a barely perceptible edge 25.3. With regard to the longitudinal direction, the front corrector element 20 has a profile 26 of flat shape similar to that of the orthosis previously described with reference to FIGS. 1 to 6. The corrective action exerted by the corrector element 20 The anatomical view of FIG. 13 illustrates the foot bones P with the five metatarsal heads 1 to 5, and al, a2, a3, a4, and a5, the corresponding metatarsal angles to the ground.

According to the invention, the plantar orthosis 10 organizes a dedicated support at each of the metatarsal heads 1 to 5 by a height h, respectively corresponding to the desired angle of inclination ai of each of the metatarsal heads with respect to the ground.

Thus, the heights h1, h2, h3, h4, h5, will each be chosen so that the angles of inclination with respect to the ground al, a2, a3, a4, as, respectively correspond to the metatarsal angle each of the respective heads in an anatomical physiological position this reference.

In FIG. 14, there is illustrated in a) a transverse profile 25 of the prior corrector element 20, corresponding to that of the section of FIG. 2. Thus, the heights h1, h2, h3, h4, h5, associated in support of the five metatarsal heads 1 to 5. Thus, for such a transverse profile 15 of convex shape, there is a height which decreases progressively in the increasing order of the metatarsal heads: we then have the relation h1> h2> h3> h4> hs.

In b), there is a transverse profile 25 'corresponding to that of the section of FIG. 8, with here heights h1, h2, h3 which are equal for the first three metatarsal heads, and decreasing heights h4, h5 for the last two meta-tarsal heads 4, 5. We thus have the relation hl = h2 = h3> h4> h5. In practice, the transverse profile of the prior corrective element will be accurately chosen so as to be optimized with regard to the population concerned and compliance with the aforementioned structural and dynamic criteria. By way of example, it will be possible for the five heights hi of the transverse profile 25 or 25 'to be between 8 and 10 mm for the height h1 associated with the support of the first metatarsal head, and 1 to 2 mm for the height. h5 associated with the support of the fifth metatarsal head. This will correspond to metatarsal angles of anatomical physiological position ranging between 18 ° to 20 ° for the first metatarsal head, and 40 to 5 ° for the fifth metatarsal head. The prior corrective element 20 may be arranged at the upper face or the lower face of the orthosis. In this case, an arrangement has been preferred at the lower face of the orthosis 10, which allows easier realization in two superimposed parts as will be described hereinafter with reference to FIGS. 15 and 16. Anterior corrective element 20 may be integrally integrated with the remaining part of the orthosis 10, as has been illustrated here, or alternatively may be attached to the remaining part of the orthosis, and fixed for example by gluing on it. this.

The plantar orthosis 10 according to the invention may be made according to a unitary unitary single unit, or alternatively according to a unitary assembly consisting of two portions assembled to one another.

FIGS. 15 and 16 illustrate precisely this second possibility, with an upper portion of orthosis 10.1 and a lower portion of orthosis 10.2, each having a flat face, respectively P1 and P2, facing each other, these two planes being brought against each other for the final fixing of the two portions for the realization of a unitary orthosis, the face-to-face fixation being performed by gluing or by any other. equivalent way.

As can be seen in FIGS. 15 and 16, the front corrective element 20 is part of the lower part of orthosis 10.2 intended to be fixed face-to-face against the upper part of orthosis 10.1, which includes the reference elements. It will be noted that the rear corrective element 16 here also provided is part of the lower part of orthosis 10.2, with its zone of reduced thickness adjacent to the plumb of the referent element. internal correction device 14 of the upper part of orthosis 10.1. The external sagittal view of FIG. 15 and the internal sagittal view of FIG. 16 thus make it possible, by this exploded view, to clearly understand the arrangement of the two orthosis portions which are then attached to one another. another, face-to-face, at the level of contact planes P1 and P2. Such a two-part embodiment is particularly advantageous insofar as it makes it possible to produce an orthosis portion 10.1 with its internal and external correction reference elements 14 in a completely standardized way, for example by using a perfectly adapted thermoforming technique. to an industrial manufacture. The lower part of orthotic 10.2 then comes the essentially corrective part, with its corrective elements anterior 20 and posterior 16 (or 18 if we take the variant of Figures 7 to 12). This then makes it possible to refine with very great precision the longitudinal and transverse profiles of the corrective elements anterior and posterior. As for materials. As components, materials such as ethylvinylacetates or EVA, crosslinked polyethylene foams, expanded copolymers, and polyisoprenic resins can be used. Preferably, a material having a density of between 50 and 450 kg / m 3 and a Shore hardness of between 10 and 95 will be used. Even more preferably, the material constituting the planar orthosis 10 will have a density of between 100 and 100. and 250 kg / m3, and a Shore hardness of between 15 and 60. It was thus possible to achieve a planar orthosis of generally universal design, with a targeted correction on a positioning of each of the five metatarsal heads at an angle of slope relative to the metatarsal angle thereof in a reference anatomical physiological position, the five angles of inclination of the metatarsals with respect to the ground then corresponding to a position inducing almost perfect movement during the displacement of the person thanks to a geometry of least constraints.

The invention is not limited to the embodiments that have just been described, but on the contrary covers any variant using, with equivalent means, the essential characteristics mentioned above.

Claims (16)

1. Plantar orthosis consisting of a unitary assembly (10) having, in elevation, an internal correction reference element (14) and an external correction reference element (15) intended to be in contact with the internal and external midfoot respectively. carrier of said orthosis, characterized in that it further comprises an anté-laughing corrective element (20) which is shaped to act at the level of the five metatarsal heads of the wearer, by positioning each respective metatarsal head at an angle of inclination by relation to the soil, which corresponds to the metatarsal angle of the latter in an anatomical phy-Biological position of reference. 2. Plantar orthosis according to claim 1, characterized in that the corrective element (20) extends, in a transverse direction of the orthosis, over almost the entire width of said orthosis, and in a longitudinal direction of the orthosis, over a predetermined distance sufficient to provide the desired support of the five metatarsal heads of the wearer. 3. Plantar orthosis according to claim 2, characterized in that the anterior corrective element (20) has, in the transverse direction of the orthosis, a substantially domed shape, and, in the longitudinal direction of the orthosis, an essentially flat shape. 4. Plantar orthosis according to claim 3, characterized in that the convex shape of the anterior cor-rector element (20) is defined by a transverse profile (25) of convex shape whose height decreases progressively in ascending order of the heads. meta-tarsal. 5. Plantar orthosis according to claim 3, characterized in that the convex shape of the anterior cor- rector element (20) is defined by a transverse profile (25 ') whose height is constant for the first metatarsal heads, then decreases progressively for the last metatarsal heads. Plantar orthosis according to claim 4 or claim 5, characterized in that the transverse profile (25, 25 ') of the convex shape of the front corrector element (20) obeys five heights (hi) respectively corresponding to the angles. desired inclination (ai) metatarsal heads relative to the ground, and this regardless of the size of the wearer's foot. 7. Plantar orthosis according to claim 6, characterized in that the five heights (hi) of the transverse profile (25, 25 ') are between 8 and 10 mm for the height h1 associated with the support of the first meta-head. tarsal, and 1 to 2 mm for the height h5 associated with the support of the last metatarsal head. 8. Plantar orthosis according to one of claims 3 to 7, characterized in that the longitudinal profile (26) of the flat shape of the front corrector element (20) connects with the rectilinear pro-wire in a gentle slope. from the underside of the orthosis. 9. Plantar orthosis according to one of claims 1 to 8, characterized in that the front corrective element (20) is arranged at the underside of the orthosis. 10. Plantar orthosis according to one of claims 1 to 9, characterized in that the correc-tor prior element (20) is integrally integrated with the remaining part of the orthosis. Plantar orthosis according to one of claims 1 to 9, characterized in that the front corrective element (20) is attached to and attached to the remaining part of the orthosis. Plantar orthosis according to claim 10 or claim 11, characterized in that the remaining part of the orthosis additionally has a rearward corrective element (16; 18) having an area of reduced thickness ( 17; 19) adjacent to the internal correction reference element (14) or ex-dull element (15). Plantar orthosis according to one of Claims 1 to 9, characterized in that the front corrective element (20) is part of a lower part of orthosis (10.2), which is fixed face-to-face against. an orthosis upper part (10.1), which includes the internal (14) and external (15) correction elements. 14. Plantar orthosis according to claim 13, characterized in that the lower part of the orthosis (10.2) of which the front corrector element (20) is part has, on its lower face, a corrective element (16). 18) having an area of reduced thickness (17; 19) adjacent to the plenum of the internal (14) or ex-dull reference (15) reference element of the orthosis upper part (10.1). Plantar orthosis according to one of claims 1 to 14, characterized in that said orthosis (10) is made from a material having a density of between 50 and 450 kg / m 3 and a Shore hardness of between between 10 and 95. 16. Plantar orthosis according to claim 15, characterized in that the material constituting the said orthosis (10) has a density of between 100 and 250 kg / m3, and a Shore hardness between 15 and 60.