WO1997049359A1

WO1997049359A1 - An orthopedic bandage

Info

Publication number: WO1997049359A1
Application number: PCT/DK1997/000276
Authority: WO
Inventors: Søren SKJOLDBORG
Original assignee: Mobicare Aps.
Priority date: 1996-06-21
Filing date: 1997-06-23
Publication date: 1997-12-31
Also published as: EP0909150A1; AU3254097A; JP2001510355A; CA2258784A1

Abstract

An orthopedic bandage (1) for the treatment of trauma to the Achilles tendon comprising a support for the lower leg, a walking support comprising a sole (4) and a support device (5) configured for securing the sole relative to the lower leg portion in such a manner that the patient's foot is elevated above the walking surface, a foot support (16), a hinge (19) that secures the foot support relative to the walking support which is pivotal about an axis that coincides with the axis of the ankle joint, a means for limiting the pivoting movement of the foot support relative to the walking support to a predetermined range, and a releasable locking means (21) which may be activated to prevent pivoting of the foot support. Use of this bandage allows the patient to choose between a fixed position for his foot in order for him to be able to walk without straining his Achilles tendon, and a movable foot position for rehabilitation as needed.

Description

AN ORTHOPEDIC BANDAGE

The present invention relates to an orthopaedic bandage, e.g. for use as a part of the treatment of trauma to the Achilles tendon.

In the treatment of severe trauma to the Achilles tendon, such as ruptures, a usual prescribed treatment comprises rigid immobilisation of the ankle joint for a period of from six to eight weeks in a position where the foot in¬ clines slightly forward whereby the pull on the Achilles tendon is reduced. Prior to the immobilisation surgery may be performed to suture the Achilles tendon; however some treating consultants recommend treatment without surgical intervention.

In an article from "Clinical Orthopaedics and Related Re^¬ search" No. 308, pp 155-165, titled "A New Treatment of Ruptured Achilles Tendons" the author Rene Cetti, Lars Onsberg Henπksen and Kurt Skovgaard Jacobsen describe a so-called mobile plaster encasement comprising a plaster bandage on the lower leg with a stirrup portion below the foot to carry the full weight, with a bottom portion to support the heel to a point centrally of the arch and with a top portion to support the top side of the median foot.

The foot support portion is rigidly integrated with the remaining part of the bandage but configured to allow the patient to freely move his toes and to permit a certain plantar flexion, i.e. downward bending of the fore part of the foot whereas the dorsal flexion, i.e. the oppo^¬ sitely oriented tipping of the ankle joint, is prevented beyond a position of 20° of plantar flexion. This is a position m which the Achilles tendon is somewhat short^¬ ened relative to the normal flat standing position on a planar support. According to this article a substantially improved course of treatment is obtained m that the foot is allowed a certain freedom of movement whereby the pa¬ tient may stimulate blood circulation and exercise some rehabilitation of the foot prior to removal of the plas¬ ter.

US patent No. 5,176,623 teaches an orthopaedic supporting bandage comprising a support for the lower leg intended for being tightly secured around the lower leg of the pa¬ tient, a foot support intended for supporting around the foot, and a pivot joint arranqed to allow the foot sup¬ port to pivot relative to the lower leg support about an axis which is presumably to correspond to a certain de- gree to the axis of pivoting of the ankle joint. The pat¬ ent teaches a means for locking the pivot joint in a num¬ ber of different angular settings whereby the patient is allowed to use the support in accordance with his needs, and has the option of rehabilitating the movability of his ankle joint following release of the locking fitting. The locking means comprises two screws which are screwed into grooves where crests allow selection between differ¬ ent angular positions at 10° intervals. In case of this known device it is critical that the locking means is correctly engaged when the patient attempts to stand up on this leg, because any attempt at walking on the device will influence the foot support to tip relative to the lower leg support. All turning forces that occur during walking are transmitted to the locking mechanism which is consequently under load during walking. Moreover use of this prior art device while taking steps during walking will produce a rolling motion on the foot portion; at the end of which rolling motion a toe set-off is produced, which means that the Achilles tendon is activated. This is unacceptable in connection with the treatment of trauma to the Achilles tendon. Therefore this device is unsuitable for the treatment of ailments, such as trauma to the Achilles tendon, where toe set-offs are not to oc¬ cur. Release of the foot support relative to the lower leg support also presupposes the use of tools and there- fore practice has proved this device unsuitable for reha¬ bilitation purposes in its mounted state. Accordingly, the device is used exclusively for rigid treatment.

According to the invention an orthopaedic bandage as fea- tured in claim 1 is provided.

Usually, the use of this bandage is such that the locking means is set to its fixated position when the patient is to walk, in its release position when the patient desires to rehabilitate his foot joint. Usually, rehabilitation is performed with the leg in its unloaded state, e.g. while sitting. When the patient walks, his weight is transferred partly to the lower leg support, partly to the foot support.

Hereby a very convenient bandage is obtained which is suitable for treatment of trauma to the Achilles tendon where the patient has adequate mobility and yet, follow^¬ ing controlled release of the locking means, he is able to rehabilitate his Achilles tendon and his foot joint as he pleases while, simultaneously, the pivoting movement in the foot joint is restrictured so as to eliminate the danger that the Achilles tendon is stretched too far. It is considered to be most convenient if the pivoting move- ment m the dorsal direction is restricted to 20° of plantar flexion. A suitable pivoting range for the reha^¬ bilitation may be from 20° to 40° of plantar flexion. The requirements to the strength m the locking device are less than the those to the prior art. Besides, the lock- ing is not so critical for the walking since, m all cir- cumstances, the pivoting movement is limited to an range where the Achilles tendon is not stretched too far.

According to one embodiment the foot support itself is so arranged that it only supports below the heel and onwards to centrally below the arch and across the median foot whereby the patient is allowed to freely move his toes and whereby a certain plantar flexion of the fore part of the foot is permitted, whereas the option of performing dorsal flexion of the foot relative to the foot support is narrowly restricted. In this embodiment the patient has a adequate opportunity of rehabilitating his toes and foot within a relatively narrow range of movements which is adapted to fully ensure that his Achilles tendon is not stretched too far. This embodiment allows the patient to choose between to movement ranges, a narrow one with the foot support locked and a wider one with the foot support released for pivoting within the predetermined range. However, it may be desirable that the foot support extends in the entire length of the foot in order to hereby obtain full support of the foot from below.

According to convenient embodiments the locking means is provided with means for securing the holder in each of the two positions, viz. release position and fixation po¬ sition, since the holder is arranged in such a manner that, under the influence of gravity, it will have a ten¬ dency to move towards the fixation position. This embodi¬ ment provides a stable functioning of the holder and at the same time adequate security that the locking engage¬ ment is not unintentionally released, e.g. as a conse^¬ quence of thrust-like impacts which may occur during walking.

The means for securing the holder may conveniently com¬ prise a spring-biased, displaceable element with a tip or a rounded portion which may engage with two respective indentations whereby easy operation and perceptible indi¬ cation of the correct positioning of the holder are ob¬ tained.

According to a convenient embodiment of the invention, the orthopaedic bandage is so configured that the means for restricting the pivoting of the foot support are themselves pivotally embedded whereby the pivoting range may be shifted to different angular ranges. This may be brought about e.g. by the guide pm being provided on a separately pivotal element and thus excentrically rela¬ tive to the rotational axis of the separately pivotal element. Hereby the bandage may be adjusted to the vari- ous requirements of treatment as to the securing of the foot relative to the lower leg.

Further characteristics and advantages of the invention will appear from the following description of embodiments thereof given with reference to the drawings, wherein:

Figure 1 is a vertical side view of an orthopaedic bandage where the foot support is fixated in a position in which it inclines 20° forwards,

Figure 2 illustrates the same as Figure 1, but wherein the lock is released and the foot support in¬ clines 35° forwards,

Figure 3 is a sectional view seen from the back and along the line A-A m Figure 1,

Figure 4 illustrates the walking support, seen from the back, Figure 5 illustrates the foot-shell seen from the side, from the back and from above, respec^¬ tively,

Figure 6 illustrates the ankle-shell seen from the side, from the back and from above, respec¬ tively,

Figure 7 illustrates the locking panel seen from the side, from the back and in a planar section view from above, respectively,

Figure 8 is an enlarged-scale view of a detail of the bandage for illustration of the locking means in the fixation position,

Figure 9 illustrates a detail corresponding to Figure 8 but having the locking means in the release position and with the foot support tipped into the 35° position,

Figure 10 is a vertical side view of an orthopaedic bandage in which the foot support is fixated in a position on which it inclines 20° for- wards,

Figure 11 is a vertical side view of an orthopaedic bandage where the foot support is fixated m a position in which it inclines 0° forwards,

Figure 12 is a vertical side view of an orthopaedic bandage wherein the foot support is in a po¬ sition an which it inclines 20° forwards and is not fixated, Figure 13 is a vertical side view of an orthopaedic bandage wherein the foot support is in a po¬ sition in which it inclines 40° forwards and is not fixated,

Figure 14 is a back view of the bandage shown in Fig¬ ures 10 through 13,

Figure 15 is a side view, a top view and a front view of the foot element m the embodiment shown in Figures 10 through 13,

Figure 16 is a side view, an end view and a top view of a lateral board for mounting on the foot ele- ment shown in Figure 15,

Figure 17 shows an element for angular setting mounted in connection with the lateral board of the foot element, one from the front and from the side,

Figure 18 illustrates an ankle element seen from the side, from the back and from above,

Figure 19 is a sectional view of the element for angu¬ lar setting in a position corresponding to the one shown in Figure 10,

Figure 20 is a side view of the position of the element for angular setting, corresponding to Figure

10,

Tigure 21 is a sectional view of the element for angu¬ lar setting in a position corresponding to the one shown in Figure 11, Figure 22 is a side view of the position of the element for angular setting corresponding to Figure 11,

Figure 23 is a sectional view of the element for angu¬ lar setting in a position corresponding to the one shown in Figure 12,

Figure 24 is a side view of the position of the element for angular setting corresponding to Figure

12,

Figure 25 is a sectional view of the element for angu^¬ lar setting in a position corresponding to the one shown in Figure 13, and

Figure 26 is a side view of the position of the element for angular setting corresponding to Figure 13.

All views of the Tigures are schematic and not necessar^¬ ily to scale, and they show only details that aie essen¬ tial to the understanding of the invention whereas other details have been omitted for the sake of clarity. In all figures identical reference numerals are used to desig^¬ nate identical or corresponding elements.

Reference is first made to Figures 1, 2, and 3 that show assembly views of the bandage in a position like the one it occupies when worn around the lower leg and foot. The bandage, which is, as a whole, designated by the refer¬ ence numeral 1, is supported by the walking support 2 which has the approximate shape of a U-brace with a transversal element 3 at the bottom and two upright ele- ments 5 so configured and adapted that the lower leg may be positioned between said upright elements. At the top and to the front, the upright elements 5 are provided with a shaped, forwardly arched shinbone-shell that may be made of plastics and configured to provide a comfortable and steady bracing relative to the front of the patient's lower leg. In level with the shinbone-shell 6, the backs of the upright elements are provided with an adjustable girth 7 made of a flexible material and which is configured to be opened and closed and its length ad- justed to conveniently support around the back of the pa¬ tient's lower leg. Slightly below the upper girth 7 a corresponding lower girth 12 is provided for further sup^¬ porting the back of the patient's lower leg.

Slightly further down the upright elements, the front is provided with a forwardly arched ankle-shell 13 which is a shaped component configured to provide steady and com^¬ fortable support against the front of the patient's lower leg immediately above the ankle. Further down the foot- shell 16 is seen which is pivotally suspended relative to the upright elements 5 by the pivoting pin 19. Opposite the ankle-shell 13, the fixation panel 21 is seen. The fixation panel is shown in Figure 1 in its lowermost po^¬ sition and in which position it secures the foot-shell in a position with 20° of plantar flexion, i.e. the foot has an 20° forward inclination relative to the position it will occupy when the subject stands on a planar support.

Figure 2 illustrates a fixation panel 21 in its uppermost position in which it releases the pivoting of the foot- shell about the guide pin 20. In Figure 2, the foot-shell occupies a position of 35° of plantar flexion.

It will appear from Figure 3 how the sides of the foot- shell are innermost positioned so as to be able to sup¬ port on the sides of the foot, the ankle-shell is outside the foot-shell, and the walking support has the outermost position at a small distance from the ankle-shell.

Figure 4 depicts the walking support 2 itself, which con- sists of a rectangular profile, e.g. of aluminium bent to be substantially U-shaped with the transversal element 3 at the bottom and two upright elements 5. On its under¬ side, the transversal element is provided with a sole 4 which may be of rubber or some other suitable walking ma- terial . The sole is not shown in Figure 4, but it will appear from Figure 1. The upright elements extend sub¬ stantially parallel at the bottom and further upwards it is has a slightly outward angulation in order to provide adequate adaptation to the lower leg. On each of the up- right elements an upper locking groove 10 is provided and a lower locking groove 11 having a purpose which will be described below. Besides, the upright elements are pro¬ vided with mounting holes for securing the remaining de¬ tails of the finished bandage.

Reference is now made to F'igure 5 for a description of the foot-shell 16, in Figure 5a shown from the side, in Figure 5b from the back and in F'igure 5c from above. The foot-shell is made of e.g. a plastics material and is so arranged that the foot may be inserted between the sides above the arch portion 17 and below the inclined top ele¬ ment 18. The foot may be advanced until the arch portion 17 supports the heel and the rear half of the foot from below to a point centrally on the arch. The top element 18 abuts on the top side of the foot, but it is so suita¬ bly short that it does not prevent upwardly bending of the toes. To each side of the foot-shell, holes are ar¬ ranged for a pivoting pin and a guide pm, which will be subject to more detailed description below. The foot- shell may be made of a form-stable material, such as ABS plastics (acrylomtril-butadiene-styrene plastics) . Reference is now made to Figure 6 for a description of the ankle-shell 13, in Figure 6a shown from the side, in Figure 6b shown from the back and m Figure 6c shown from above. The ankle-shell comprises a plastics object bent to such a shape that it fits around the front of the an¬ kle just above the ankle joint. To each side of the an¬ kle-shell a circular hole 14 is provided intended for passage of a pivoting pm, and a sector hole 15 intended for a guide pm to be described later. The ankle-shell may be made of a material corresponding to the material used for the foot-shell.

Reference is now made to Figure 7 which shows the fixa- tion panel 21 m Figure 7a in a side view, in Figure 7b in a rear view, and in Figure 7c m a planar sectional view, respectively. The fixation panel comprises a block of material m which a dovetail notch or the like is pro^¬ vided m the form of guides 22 as will appear most clearly from the sectional view in Figure 7c. The guide 22 is dimensioned to allow the fixation panel to be shifted downwards over an upright element 5 of the walk¬ ing support and such that the fixation panel 21 is se^¬ cured by the walking support. In the fixation panel 21 a hole is also arranged in an inward orientation towards the edge of an upright element 5 when arranged m the guide 22. The narrowed entry portion of the dovetail notch forms the holding groove 23 where the distance be¬ tween the edges correspond to the width of the guide pin 20, as will be explained m further detail below. The fixation panel is made of a form-stable material, such as aluminium.

Reference is now made to Figures 8 and 9 that illustrate a section of the bandage for further illustrating the co¬ operation between walking support, foot-shell, ankle- shell, and fixation panel. Figure 8 illustrates these de¬ tails in a position where the fixation panel forms a locking engagement relative to the foot-shell, whereas Figure 9 shows a situation in which the engagement of the fixation panel is loosened. Figure 8a shows the detail in a lateral view and Figure 8b the same in a sectional view from the back. In the same manner Figure 9a illustrates the detail in a lateral view and Figure 9b in a sectional view seen from the back.

These figures will show how the pivoting pm 19 comprises a pm tightly secured to the upright element 5 of the walking support and with a collar and bushing, respec¬ tively, for securing foot-shell and ankle-shell in close contact with each other and at a small distance from the walking support. Moreover, the guide pm 20 is illus¬ trated, which is somewhat shorter than the pivoting pin 19 and comprises a pm securely attached to the foot- shell and conveyed through the sector hole 15 in the an- kle-shell. The guide pm protrudes outside the ankle- shell, but not so far as to touch the upright element 5 of the walking support. Figure 8 also illustrates the fixation panel 21 with a locking unit 24 comprising a spring-biased locking ball which is, m the view shown in Figure 8, in engagement with the lower locking notch 11 on the walking support. In this position the holding groove 23 engages with the guide pm 20 from both sides and thereby completely prevents pivoting of the foot- shell relative to the walking support.

In Figure 9 the fixation panel 21 is shifted upwards com¬ pared to the position in Figure 8, and so far that the spring-biased ball element in the locking unit 24 is in engagement with the upper locking notch 10 on the walking support whereby the panel is secured in this position. Hereby the guide 20 goes clear of the holding grooves 23 of the fixation panel. In this situation it is possible for the foot-shell to pivot about the pivoting pm 19 to the extent allowed by the engagement between guide pm 20 and the sector hole 15.

The sector hole 15 is an arched groove with a centre of curvature at the centre of the pivoting pm of a width corresponding to the guide pm and having an angular ex¬ tent adapted to give room for pivoting of the foot-shell about the pivoting pm 19 from 20° to 35° of plantar flexion. In the preferred embodiment the foot-shell occu^¬ pies a position of 20° of plantar flexion m the locked position. It would be obvious to the person skilled in the art to configure the embodiment for other pivoting directions and ranges.

Figures 10 through 13 illustrate a further embodiment of the bandage accordmg to the invention in which elements are provided that are intended for adjustment of the range for the pivoting interval to different angular ranges, and wherein it is also possible to fixate the foot portion m a horizontal position. Thus, this embodi¬ ment makes it possible to perform a pivoting movement in the angular range of 0-20° of plantar flexion and in an- other setting to perform a pivoting movement within the range of 20-40° of plantar flexion. It should be noted that in this embodiment the foot support extends m the full length of the foot in order to hereby support the entire foot. This is desirable in connection with a vari- ety of treatments.

The means 8 for adjusting the angular range of the pivot¬ ing intervals will appear in part from Figure 14 which is a rear view of the bandage accordmg to the invention. Figure 15 illustrates an embodiment of a foot element which has, as opposed to the foot-shell shown in Figure 5, an adjustable instep element or top part 18 which is, in the embodiment shown, fixated in the correct position by means of a top part girth 25 of a burr-locking band (Velcro®) . This measure allows for improved individual fitting to the foot of the actual patient. This measure may also be implemented by the bandage shown in Figures 1-9.

Figure 16 describes a lateral board for mounting in con¬ nection with the foot clement. The connection to the foot element is established in the lowermost edge area of the lateral board. In the lateral board, two recesses 27,28 are provided where the one 27 serves to receive a shaft about which the foot element is to be pivoted, and the other 28 serves to receive an element 8 for angular set¬ ting, as will be described in the following.

Figure 17 describes an element 8 for angular setting and comprising an engagement portion and a shaft portion 9 for mounting in the recess 28 in the lateral board. A guide pin is provided excentrically relative to the part mounted through the recess 28 in the lateral board. This guide pin is moved, as was the case with the embodiment shown in Figures 1-9, in a sector hole 15 in an element which is fixated relative to the walking support, where the sector hole 15 outwardly delimits the movements of the guide pin 20.

Figure 18 describes an ankle element 13 which has, like shown in Figure 6, a sector hole 15 for receiving a guide pin 20 and for delimiting the range of pivoting thereof.

Figures 19-26 are views, some being sectional and some side views where the elements not immediately visible are also shown, in which the element for angular setting of different positions generates various limitations to the pivoting movement. Release positions are also shown (Figures 23-26) and locking positions (Figures 19-22) for the locking means, respectively. In the locking position, the locking means slides down over the guide pin 20 and secures this so as to prevent angular rotation.

Although specific embodiments of the invention have been described above, the present description is only to be considered as exemplary ol a few of the alternative ways m which to realise the invention, but not as a limita¬ tion of the scope of the invention which is determined exclusively by the appended patent claims. In this con- text it is possible to configure a bandage according to the invention by allowing the guide pin be securely at¬ tached relative to the lower leg support and at the same time allow the element comprising the sector hole to be pivotal along with the foot element. Hereby the locking means may accordingly be configured for engaging with the element comprising the sector hole, e.g. by means of a pin which is caused to engage with a cut-out in this ele^¬ ment intended therefor.

R e f e r e n c e n u m e r a l s

1. Bandage

2. Walking support

3. Transversal element

4. Sole

5. Upright element

6. Shm-shell

7. Girth, upper

8. Element for angular setting

9. Shaft portion

10. Locking notch, upper

11. Locking notch, lower

12. Girth, lower

13. Ankle-shell

14. Circular hole in ankle-shell

15. Sector hole in ankle-shell

16. Foot-shell

17. Arch portion

18. Top portion

19. Pivoting pm

20. Guide pm

21. Fixation panel

22. Guides

23. Holding grooves

24. Locking unit

25. Top portion girth

26. Lateral board

27. Recess

28. Recess

Claims

C l a i m s

1. An orthopaedic bandage comprising a support for the lower leg intended for being securely attached around the lower leg of the patient, a walking support comprising a sole and a sup¬ port device intended for securing the sole relative to the portion supporting the lower leg in such a position and in such a manner that the lower leg of the patient is supported m a position with his foot elevated so much that the patient may walk without his foot being thrust against the walking surface, a foot support intended for supporting around the foot, a hinge that secures the foot support relative to the walking support which is pivotal about an axis which corresponds to the axis of the ankle joint, a means for delimiting the pivoting of the foot support relative to the walking support to a predeter- mined range, and a releasable locking means which may be acti^¬ vated to prevent pivoting of the foot support.

2. An orthopaedic bandage accordmg to claim 1, c h a r a c t e r i z e d in that the means for de¬ limiting the pivoting of the foot support is itself piv¬ otally embedded whereby the pivoting range may be shifted to different angular ranges.

3. An orthopaedic bandage accordmg to claim 1, c h a r a c t e r i z e d in that the portion sup¬ porting the lower leg comprises a U-shaped brace consist¬ ing of a transversal element and two upright elements so configured that foot and lower leg may conveniently be arranged between the upright elements, 49359 PC17DK97/00276

the transversal elements being provided with a sole on its underside, and the upright elements being provided with means for securely attaching the lower leg.

4. An orthopaedic bandage according to any one of the preceding claims, c h a r a c t e r i z e d m that the means for securing the lower leg comprises shaped elements for supporting the front of the lower leg and adjustable straps for tightening around the back of the lower leg.

5. An orthopaedic bandage accordmg to any one of the preceding claims, c h a r a c t e r i z e d in that it comprises a foot support for supporting the foot below the heel, below the rearmost portion of the median foot, and above the median foot in such a manner that the patient is able to freely move his toes and has the op¬ tion of exercising a certain plantar flexion, whereas the option of dorsal flexion of the foot relative to the foot support is narrowly restricted.

6. An orthopaedic bandage accordmg to claim 5, c h a r a c t e r i z e d m that the foot support comprises a separately adjustable mstep element.

7. An orthopaedic bandage accordmg to any one of the preceding claims, c h a r a c t e r i z e d in that the foot support comprises a shaped board for en- closing the foot, an eye to each side for hinged suspen¬ sion of the foot support, and an outwardly oriented guide pm on each side arranged at a radial distance from the axis of the hinge, whereas the walking support comprises a hinge pin for engagement with the eye and a sector-shaped recess ar¬ ranged for co-operatmg with the guide pm so as to allow the foot support to perform a well-defined, limited piv¬ oting movement.

8. An orthopaedic bandage according to claim 5, c h a r a c t e r i z e d m that the foot support and the locking means are so arranged that the guide pin is used for fixation of the pivoting movement of the foot support.

9. An orthopaedic bandage according to any one of claims 2-6, c h a r a c t e r i z e d in that the guide pm is provided on a separately pivotal element and hereby excentrically relative to the axis of rotation of the separately pivotal element.

10. An orthopaedic bandaqo accordmg to any one of the preceding claims, c h a i a c t e r i / e d in that the locking means comprises a holder arranged for shifting between two positions for release and fixation, respectively, of the pivoting movement, by use of means for securing the holder m each of the two positions, and wherein the holder is so configured that the influence of gravity causes the holder to travel towards its fixation position.

11. An orthopaedic bandage according to claim 7, c h a r a c t e r i z e d in that the means for se¬ curing the holder comprises a spring-biased tip that may engage with two respective indentations.

12. An orthopaedic bandage accordmg to any one of the preceding claims, c h a r a c t e r i z e d in that the locking means comprises a claw-like element ar¬ ranged for vertical displacement on an upright element and with a groove which may prevent a pm from moving forwards and backwards.

13. An orthopaedic bandage according to any one of the preceding claims, c h a r a c t e r i z e d in that the locking means comprises a claw-like element on each of the upright elements that engages with the up¬ right element on the outside.