US2977692A - Shoes for paralytic patients - Google Patents

Description

April 4, 1961 A. BENESCH SHOES FOR PARALYTIC PATIENTS 5 Sheets-Sheet 1 Filed Dec. 16, 1958 INVENTOR flzr/cav BE/vase BY 476 ATTO R N EY April 4, 1961 A. BENESCH SHOES FOR PARALYTIC PATIENTS 5 Sheets-Sheet 2 Filed Dec. 16, 1958 INVENTOR FRED F'A/ ATTO R N EY April 4, 1961 A. BENESCH SHOES FOR PARALYTIC PATIENTS 5 Sheets-Sheet 3 Filed Dec. 16, 1958 INVENTOR A; FEED BEA/58Gb BY 44 6M ATTO R NEY April 1951 A. BENESCH 2,977,692

SHOES FOR PARALYTIC PATIENTS Filed D80. 16, 1958 5 Sheets-Sheet 4 INVENTOR #4 A'Ptl) \FENE'SCH wwwm ATTORNEY April 4, 1961 A. BENESCH SHOES FOR PARALYTIC PATIENTS 5 Sheets-$heet 5 Filed Dec. 16, 1958 INVENTOR ,00 flzFRED BENE'SCH ATTORNEY 0% rm W l a 0 I Z 4 7- q 2 m 4 7. 6 6 m w SHOES FOR PARALYTIC PATIENTS Alfred Benesch, 25 Nagle Ave., New York 40, NY.

Filed Dec. 16, 1958, Ser- No. 780,713 '5 Claims. (Cl. 36-85) This invention relates to shoes for paralytic patients.

In the treatment of patients who have suflered paralysis, particularly in cases of the youngv who have suffered cerebral palsy, the practitioner has to contend with the injury resulting in such cases where the patient tends to stand on his toes even when the foot is in the shoe. In such cases, the practitioner seeks to draw the heel of the patients foot down against the insole of the shoe in order to attain a relatively normal walking position for the foot of the patient. The practitioner, however, is unable to visualize the actual results ofthe adjustments. he is making when an ordinary shoe is used; he also is unable to measure whether he is applying pressure to the foot of. the patient in excess, of that necessary to attain the result he is'seeking, and thus actually may inflict actual injury.

It is an object of the invention to provide, for a patient of this type, a shoe which outwardly has the appearance of ordinary footwear, but which has a structure by which the practitioner is enabled positively to apply a controlled force to the foot of the patient and simultaneously to determine the progress and extent I of the adjustment being made by noting continuously the position of the heel of the foot itself in relation to the related parts of the shoe, and particularly in determining 'the'position of the heel of the foot with relation to the V insole of the shoe in seeking to attaina position of the foot with relation to the insole.

'itsdesired normal position upon :It' is an object ofthe invention to provide elements efiectiveifor drawing theheel of' such a ,patientjdown against the insoleofra shoe wherejtheelements are anchored directly'tothe insole in the' assembly of the shoe. Itisjan object of the invention toprovidemeans for rigidifyin'gi the shoe of a: paralytic patient with;,relation to;his fo'ot -;in establishing a definite relationship between .-the heel f the foot and the h'eelportion, of thegi'nsole "of the shoe; wherein such meanstoproduce-this effect is concealed was not to bes-eenat the outside Qf the shoe, but wherein themovernentand positionof the heel of a the foot-with relation to the; heel Of the insole may be 1 observed throughout the time the adjustment is being a made;

with a,-?-counterwhich is'molded from a translucent plastic sci-that; after such counter has beenassembled Other 7 :exernplii'ying the, inventio ever is liotintendedi'f to v be dreobjects of the: inventionrwill bejset forthlhere- ..;,inaiter, ;or; will be apparentgfronrthegdescriptipn'andf .the drawings, 1 in which are; -i llustrated embodiments Un sms arsn 2,977,692 Patented Apr. 4, 191

lar arrangement of parts, or any particular application of any such construction or arrangement of parts, or any specific method of operation or use, or any of the various details thereof, even where specifically shown "and described herein, as the samemay be modified in various particulars, or may be applied in many varied relations, without departing from the spirit and scope of the claimed invention, of which the exemplifying embodiments, herein shown and described, are intended only to be illustrative, and only for the purpose of complying with the requirements of the statutes for disclosure of an operative embodiment, but not to show all the ,various forms and modifications in which the invention might be embodied.

. On the drawings, in which the same reference characters refer to the same parts throughout, and in whic are disclosed such practical constructions,

Fig. 1 is a perspective view of a counter formed in accordance with the invention;

Fig. 2 is an exploded view of the upper,- and the lining for the upper, shown one above the other, and indicating the manner in which the lining is inserted within the upper;

Fig. 3 is a transverse cross-sectional view, substantially on the line33 of the parts shown in Fig. 2 but the part's'beingshown assembled;

Fig. 4 is a perspective view, showing the last, with the insole disposed'upon the last, as one of the stages of the assembly of the shoe of the invention;

Fig. 5 is an exploded view in perspective, showing the relationship of the counter to the assembled lining and upper, and the direction of the assembly of the counter with the upper and lining; i Fig. 6 is atransverse cross-sectional view, substantially on the line 6-6 of Fig. 5, showing the assembled re lationship of counter, lining and upper;

Fig. 7 is an exploded view in perspective, showing the disposition of the counter, upper, bracing means, lining, andthe spring bridge uponthe insole,and with the welt in place, all assembled upon the last, with the sole (to be applied to the shoe) shown positioned above the welt and insole to which it is to be secured; r

Fig. 8 is an exploded view, showing the shoe remove fromtthe last after sole and heel have been assembled with the shoe, and after the strap for a brace has. been Fig. 9 is a perspective view showing a manner of construction of-a bracing means to be assembled with the ,shge forgadusting the position of the heel of the foot with -relation to the shoe itself; g g

Fig. '10 is an exploded view illustrating a manner in which the bracing means may beassembled with the shoe;

Fig. 1'1 'is a longitudinal vertical.cross sectionalview of a shoe in accordance with the invention, showing the -bracing means and the attaching means for sustaining {a braceor similar device in position;

Fig. 12 ise transversecross-sectional view, substantialily on the lineg-12-12 of Fig. 11;

Fig. .133. is a transversecross-sectional view, substantially on the line 13- -13 of Fig. 11; 't l4 is an end perspective view at the heel: end of Ta shoe, showing a portion of the upperopened up so as to makevisible the adjustments of the foot as; seen through the translucent counter; and l 15 isa view similar to a portion of Fig. 11 to illus- ,trate a modification of the assembly of, the bracing means;

' In constructing ashoeitl toobtain the results desired I herein, .some usual procedures. employed in the .manufacture of the shoe may be employed to make theshbe.

,offthis invention. ;At ,least a portion of the shoe near heelis. opened upj'injthe manner described, .and yet them into position.

Now this assembly, so defined, is droppedrover last11 to which insole 12 has been tacked in position, and porthe shoe is made useful in the usual manner aside from its utility in the making of the adjustments here described. The usual last 11 may be utilized in making the shoe of this invention. The shoe to be constructed may be of any usual type, such as the welt type or other well known shoe construction. For purposes of illustration, the invention will be disclosed in connection with a shoe of the welt construction, but such specific disclosure is not intended to limit the application of the invention. In

. the illustrated method, an insole 12 is tacked to last 11.

The insole, in the usual manner, is shaped to the general contourof the last.

A portion 14 of leather, which may be substantially half the length of insole lZ, is positioned and worked directly upon the insole which is attached to the last itself, to produce bracing means 16. The leather or other material used in forming portion 14 may be skived or otherwise shaped to the contour of the last and the insole, and to thin it down so as to form a smooth junction with the insole at instep 18. To portion 14 are now aflixed a pair of flexible, preferably leather, straps 20. These straps (see Fig. 11) are intended to be brought to bear against the foot at position 22 in advance of the instep. They are prepared'of a suflicient width to distribute the pressure against the skin and tissue of the wearer so as not to be unbearable during the manipulations to be explained and the wearing of the shoe theresecured to portion 14. At ends of straps 20, suitable means may be provided for drawing ends 30 together. For instance, lace holes 32 may be provided for the reception of lacing 34.

An upper 36 may have been constructed off the last in the usual fashion. In this case, an upper of the blucher type of upper is utilized, and consists of a toe or tip portion 38, and the usual tongue 40 positioned between flaps 42 such as are provided for a blucher type shoe. All of this terminates in the heel part 44 of the upper. Flaps 42 are united at their rear ends by a seam 46. At their front or free ends 48, the flaps 42 may be provided with any suitablef astening means. In the structure illustrated, lacing holes 50 are provided to receive lacing 52. A lining 54. of the usual'lining material, cut to substantially the same shape as upper 36, tip portion 38 and flaps 42, may be provided, and be secured at selected anchor points to upper 36, leaving the lower edges 56 and 58 of upper and lining, respectively, free, although the remaining parts of upper and lining may be cemented together.

Lining 54(Figs. 3 and 13) is positioned withinupper 36. Portions of the lining and the upper at upper areas may be secured together, as, forinstance, by cementing, before proceeding with the further processing. A counter 60 maybe pushed between lining 54 and upper 36 at their lower ends (Figs. 5 and 6). j

Counter 60 (Figs. 1 and 5) maybe made by molding to the desired form from a suitable material, such as a translucent plastic. 7 Such a counter may comprise a continuous wall 62 including sidewalls 64 joined together by a curved rear wall 66. The bottom edges are bounded by flanges 68. When counter 60 is assembled between lining 54 and upper 36 by being pushed between them at their lower ends, the parts may be secured together in any preferred manner, as, for instance, by cementing 4 tion 14 with its straps 20 has been secured (Fig. 7). Lower edges 56 of upper 36, together with lower edges 58 of lining 54, are turned around flanges 68 and upon insole 12, and these turned edges and flanges 68 are secured to the insole by suitable means. The method of securing may be that generally used in the trade, as, for instance, tacking, the use of adhesive, or the like.

A welt 70 may now be positioned upon the portions of the turned and secured edges 56 and 58, the welt extending up to and terminating just at the boundary of heel portion 72 of insole 12 upon which portion 14- has been superimposed. The welt may be secured in position in the conventional manner; for instance, it may be adhered adhesively, or it may be stitched to the secured together edges of upper, lining, insole, and portion 14. A steel shank 74 may now be assembled to bridge from heel portion to instep 18.

A sole 76 is shown (Fig. 7) in position above the assembled portions of upper 36, lining 54, portion 14, counter 60, and insole 12. The assembled parts, without sole 76, but with last 11 still within shoe body 78 thus formed, may be taken to a suitable machine to stitch sole 76 to the welt 70, or otherwise to secure the sole in position. Heel 24 may be assembled upon sole 76 (Fig. 8). Then last 11 may be removed from the shoe thus constructed.

In Fig. 10, bracing means 16 is shown separated from the last. In one process of manufacture, bracing means 16, consisting of the parts already described, may be made up separately from the shoe assembly by doing the shaping of portion 14 and other work of joining straps 20 to portion 14 apart from the insole and upper. In such case, a construction such as shown in Fig. 15 may be produced, where insole 12 and its steel shank 74 will be the outermost parts to which the end edges of upper and lining and the flanges of the counter are secured. Bracing means 16, as shown, are pushed through the open end 80 of the upper (Fig. 10) against face 82 of the insole, and there secured in position by suitable means, as, for instance, adhesive or the like. Bracing means 16 now covers a substantial portion of face 82. Straps 20 extend up within the shoe body in either method of construction. A lining 84 (Figs. 11 and 12) may now be applied to top face 86 .of bracing means 16 and the rest of the uncovered portion of face 82. The lining may be secured in place as, for instance, by being adhesively applied. Where portion 14 (Fig. 11) is positioned below insole 12, lining 84 would cover the entire face 82 of the insole. Upper 36 atits rear section 88 (Figs. 2 and 14) is split apart. Portions of upper and lining are left unadhered to counter 60 at this position so that these portions may be moved aside, as flaps'90 and 92. Thus it is possible to inspect conditions within the interior of the shoe through the window provided by the translucent or transparent walls of counter 60. Suitable means, such as a strap 94 and a buckle 96, may be provided for holding flaps 90 and 92 closed normally when the shoe is in ordinary use. When buckle 96 and strap 94 are undone, flaps 90 and 92 may be moved aside, and thereupon the practitioner may observe all the operations which will ensue during manipulation of bracing means 16.

' A braceof a type sometimes worn by patients who wear shoes of this type may be assembled with heel 24.

The bottom strap 98' of a brace (not shown) of this type is shown extended through a passage 100 which may be cut* or otherwise formed to extend through heel 24.

' Strap 98 may be secured rigidly in position with relation to sole 76 and the shoe, by a rivet or similar securing means 102. Holes 104, 106 and 108 are provided, respectively, in, insole 12, portion 14 and sole 76. Through these holes which are alined, rivet 102 is extended positively to anchor strap 98 with relation to the several parts of the shoe. For this purpose, hole 104 in insole 12 may be countersunk at 110 so that head 112 of rivet 102 will'be flush with'face 82 of the insole. Lining 84, when .,.5 ,placed in-theshoe, then' will cover over beam-112 posi tioned in countersunk portion 110. p f

Lacings 34 and 52, provided, respectively, for straps .20 and flaps 42 (Fig. 12) function separately. Actual engagement of the foot is effected by straps 20. Flaps .42 will function as a cover to conceal the functioning parts of bracing means 16. V

Now when a patientputs shoe on his-foot, lacings '52 and 34 are loosened at flaps 42 and straps 20. The practitioner opens up straps 20, after releasing buckle 96 from strap 94, and sights through counter 60. Now he may tighten lacing 3,4 to cause straps to engage against the foot which usually will be standing upon the insole at location 114 on its toes. The heel of the foot, in the usual fashion, usually is, free of heel end 116 of insole l2 and. the lining thereover. Tightening upon lacing 52 at flaps 42 is not suflicient to force the foot downward. Any manipulations by the practitioner of the foot also will not cause the foot sufficiently to approach or come into contact or retain its position with relation to heel end 116 of the insole. The foot, because of the nature of the paralysis, tends to resist movement -of its heel down againstthe heel of the shoe,

The practitioner, looking through the window provided by counter 60, tightens lacing 34 at straps20. These :straps are diagonally disposed, as shown. The force ap- ,.plied to the foot causes it tobend about the toes as a fulcrum, and to compel the heel portion of the foot to move down against heel end-116. The doctor, watching as he applies. additional stress" to lacing 34 and as the :7 .heel of the foot is forced closer and closer to heel end 116, can govern this application of force by visualizing the results of this manipulation through the window provided by the counter. i

The doctor may determine that, in a progressive man- .-ner, he does not desire to apply all of this force .at one Thus, his inspection permits him to determine stage. the extent of the adjustment he desires, as he applies the necessary stress to lacing-34, and as heel of foot and heel of shoe approach each other.

After the adjustment desired by. the practitioner has been attainedfhe then may tie lacing 34, close up the shoe by tying lacing 52, and close the window at counter .fl r e n 9t a asi ebn k1e 6w th straps" in the proper manner. Where a brace is used, the brace may have been assembled with strap 98 either before or after such adjustment.

struction, and in specific .details thereof, hereinbefore set forth, without substantially departing from the inara e wholly inside the upper and'having extending ends extending diagonally upwardly and forwardly to be lapped over the instep of the wearer, said extending ends carrying means for tightening the anchored means progressively for drawing the'foot heel rearwardly towardand downwardly against the shoe heel while the degree of movement of the foot heel is being observed through the open portion and the counter, the forward extensions when closed by the closing means providing means for covering the extending ends and the tightening means.

2. In a shoe structure for use to facilitate orthopedic adjustments, the structure comprising a sole, a heel, an insole, and an upper secured to the sole, heel and insole,'the upper having an open portion at its rear portion associated with the heel, a counter associated with the insole, the heel and the upper at said open portion, the counter being translucent at said open portion and with the open portion providing a window for observing the position of the heel of the foot of the wearer with relation to the heel of the shoe, the upper having for- Ward extensions away from its rear portion, said forward extensions carrying means for closing the upper around the foot of the wearer, bracing members having an end of each member superposed on and secured to a face of the insole at a position approximately at the boundary between the heel'and sole of the shoe, the bracing members being wholly inside the upper and extending diagonally upwardly and forwardly from a position substantiallylimmediately at said boundary and providing free ends to be lapped over the instep of the wearer, said free ends carrying means for progressively tightening the bracing members to apply a downward and rearward force against the foot of the wearer for drawing the foot heel rearwardly toward and downwardly against the shoe heel while the degree of movement of the foot heel is being observed through the open portion and the connvention intended to bedefined herein, the specific de- 7 scription being merely of embodiments capable of illustrating certain principles of the invention. What is claimed as new and useful is:

1. In a shoe structure for use to facilitate orthopedic adjustments, the structure comprising a sole, a heel, and an upper havingthe sole and heel secured together therewith, the upper having an open portion at its rear portion associated with the heel, a counter associated with the heel and the upper at said open portion, the counter being translucent at'said open portion and with the open portion providing a window for observing the position of the heel of the foot of the wearer with relation to the heel of the shoe, the upper having forward extensions away from its rear portion, said forward extensions carrying means for closing. the upper around the foot of the wearer, and means anchored to the shoe structure at a position approximately at the boundary between the ter, the forward extensions when closed by the closing rneans' providing means for covering the extending ends and the tightening means,-and means carried by the upper at the open portion for releasably covering the counter. 3.- In a shoestructure for use to facilitate orthopedic adjustments, the structure comprising a sole, aheel, an insoleextending over the sole and the heel, and an upper secured to the sole, heel and insole, the upper having an open portion at its rear portion associated with the heel, a counter associated with the insole, the heel and the upper at said open portion, the counter being formed with a flange at its lower end and being translucent at said open portion, the counter with the open portion providing a window for observing the position of the heel of the foot of the wearer with relation to the heel of the shoe, the counter being mounted on the heel with the heel end of the insole extending within the counter and resting upon the flange, the upper being turned upon and being secured in superimposed relation to the-outer face of said flange and the bottom face of the insole, the upper having'forward extensions away from its rear portion, said forward extensions carrying means for closing the upper around the foot of the wearer, bracing members having an end of each member superposed on and secured to a face of the insole at a position approximately at the boundary between the heel and sole of the shoe, the bracing members being wholly inside the upper and extending diagonally upwardly and forwardly from a position substantially immediately at said boundary and providing free ends to be lapped over the instep of the wearer, said free ends carrying means for progressively tightening the bracing members to apply a downward and rearward force against the foot of the wearer for drawing the foot heel rearwardly toward and downwardly against the shoe heel while the degree of movement of the foot heel is being observed through the open portion and the counter, the forward extensions when closed by the closing means providing means for covering the extending ends and the tightening means, and means carried by the upper at the open portion for releasably covering the counter. a

4. In a shoe structure for use to facilitate orthopedic adjustments, the structure comprising a sole, a heel, an

insole extending over the sole and the heel, and an upper secured to the sole, heel and insole, the upper having an open portion at its rear portion associated with the heel, a counter associated with the insole, the heel and the upper at said open portion, the counter being formed with a flange at its lower end and being translucent at said open portion, the counter with the open portion providing a window for observing the position of the heel of the foot of the wearer with relation to the heel of the shoe, the counter being mounted on the heel with the heel end of the insole extending within the counter and resting upon the flange, the upper being turned upon and being secured in superimposed relation to the outer face of said flange and the bottom face of the insole, the upper having forward extensions away from its rear portion, said forward extensions carrying means for closing the upper around the foot of the wearer, bracing means having an end of each member superposed on and secured to a face of the insole at a position approximately at the boundary between the heel and sole of the shoe, the bracing members being wholly inside the upper and extending diagonally upwardly and forwardly from a position substantially immediately at said boundary and providing free ends to be lapped over the instep of the wearer, said free ends carrying means for progressively tightening the bracing members to apply a downward and rearward force against the foot of the wearer for drawing the foot heel rearwardly toward and downwardly against the shoe heel while the degree of movement of the foot heel is being observed through the open portion and the counter, the forward extensions when closed by the closing means providing means for covering the extending ends and the tightening means, flaps formed by the upper at the open portion, and means carried by the flaps for drawing the flaps releasably closed for covering the counter.

5. In a shoe structure for use to facilitate orthopedic adjustments, the structure comprising a sole, a heel, a primary insole extending over the sole and the heel, and an upper secured to the sole, heel and primary insole,

' games the upper having an open portion at its rear portion associated with the heel, a secondary insole associated with and disposed upon the primary insole at the heel and shank end of the primary insole, a counter associated with the insoles, the heel and the upper at said open portion, the counter being formed with a flange at its lower end and being translucent at said open portion, the counter with the open portion providing a window for observing the position of the heel of the foot of the wearer with relation to the heel of the shoe, the counter being mounted on the heel with the heel ends of the insoles extending within the counter and resting upon the flange, the upper being turned upon and being secured in superimposed relation to the outer face of said flange and the bottom faces of the insoles, the upper having forward extensions away from its rear portion, said forward extensions carrying means for closing the upper around the foot of the wearer, bracing members having an end of each member superposed on and secured to a face of the secondary insole at a position approximately at the boundary between the heel and sole of the shoe, the bracing members being wholly inside the upper and extending diagonally upwardly and forwardly from a position substantially immediately at said boundary and providing free ends to be lapped over the instep of the wearer, said free ends carrying means for progressively tightening the bracing members to apply a downward and rearward force against the foot of the wearer for drawing the foot heel rearwardly toward and downwardly against the shoe heel while the degree of movement of tht foot heel is being observed through the open portion and the counter, the forward extensions when closed by the closing means providing means for covering the extending ends and the tightening means, flaps formed by the upper at the open portion, and means carried by the flaps for drawing the flaps releasably closed for covering the counter.

References Cited in the file of this patent UNITED STATES PATENTS 1,726,057 Cardamone Aug. 27, 1929 FOREIGN PATENTS 674,588 Great Britain June 25, 1952

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