Abstract:
An orthopedic guide to aid in donning an ankle foot orthosis (AFO) is disclosed comprising an L-shaped channel and a rocker to allow the L-shaped channel to smoothly rotate generally about the L-shape joint when tilted. The horizontal portion of the L is weighted to urge the device to an upright position when at rest. A shoe and an AFO are placed in the L-shaped channel and a patient foot uses the vertical portion of the L to guide the patient foot into the shoe. In use the device tilts to create a natural rotation movement for the foot insertion, and places the foot and guides it in a more comfortable tilted position. A shoe tongue retainer clip is also disclosed to allow further ease in donning the shoe and AFO by enlarging the shoe opening and keeping the tongue out of the way.

Description:
FIELD OF THE INVENTION 
     The invention relates in general to orthopedic guides, and more particularly to an apparatus for aiding a person in donning an ankle foot orthosis. 
     BACKGROUND OF THE INVENTION 
     An Ankle Foot Orthosis (hereinafter an AFO) is a medical device that assists patients who have lost at least partial control over the angle in which they can maintain their foot respective to their leg. Often, as a result of a stroke or some other medical conditions, those patients&#39; foot can not be raised to avoid obstacles. This may be dangerous, since the patient can trip. The AFO thus holds the foot at a predetermined angle, usually around 90 degrees, to the leg. Common AFO&#39;s hold the patient&#39;s calf and foot, and inserted into a regular shoe. The shoe is then worn over the AFO and thus the AFO is invisible. However donning such an AFO is a hard task for many patients due to the reduced motor control, difficulty in bending down, reduced coordination and other physical limitations stemming from their condition. 
     The AFO generally has a foot portion and a calf portion, at about 90 degrees to each other. The foot portion is inserted into the shoe, and the patient puts his/her leg into the shoe in the usual manner. A band or other securing means is used to secure the calf portion to the patient&#39;s calf. Thus the patient&#39;s foot gains rigidity to avoid dropping the foot at an angle greater than 90 degrees. 
     The problem of donning an AFO is known, and several inventions have been made to assist patients in donning them. In U.S. Pat. No. 4,683,876, Changras teaches an orthopedic guide having a backing slab and two parallel sidewalls secured parallel thereto to define a channel in which an AFO is placed within a shoe. The shoe is then placed in the channel, so that the AFO calf portion rests against the backing slab. The patient grabs a handle attached to the device and slides his foot along the AFO using it to guide his/her foot into the shoe. 
     The &#39;876 patent suffers from several disadvantages. It forces the patient to hold onto the orthopedic guide while performing the task of sliding the foot down the guide. The device is placed vertically, so it requires the patients&#39; leg to follow such a vertical movement. This is often inconvenient and difficult, especially while attempting to hold the device steady. The Changras device is also unstable since the backing plate and extensions to the side walls are placed high on the device causing it to have a high center of gravity and making it prone to falling over on its back or side. The device also requires the use of a strap in order to stabilize the shoe in place. For a patient with motor control problem, this is often a difficult task to achieve. 
     U.S. Pat. No. 3,012,702 to Van Der Vliet describes a shoehorn having a flat base to hold the shoe in place. A flexible portion positioned above the rear portion of the shoe is adapted to engage the heel of a foot being inserted into the shoe. This device again does not solve the problem of easily locating the device with the shoe at a comfortable angle for placing the patient&#39;s foot into the shoe, and the flexible portion is likely to interfere with an AFO inserted into the shoe. Additionally, while using a shoehorn, the AFO will tend to turn and fail to maintain alignment with the shoe. Votino et al. in U.S. Pat. No. 5,972,573 disclose another shoehorn directed specifically to the physically handicapped. This device as well is likely to interfere with a shoe having an AFO attached thereto, and is large and bulky in comparison to the current invention. 
     Different gripper devices are contemplated in the likes of U.S. Pat. Nos. 5,974,701 to Busch and 5,687,889 to Liden. Those devices fall short of the desired results as they require precise manipulation of a gripper arm or hook, placed at the end of a long stick, all by a patient often suffering severe motor dysfunction. 
     There is therefore a clear and unsolved need for a stable, simple to operate device to assist a patient in donning an AFO, without requiring uncomfortable or hard to maintain body positions. The current invention aims to provide such a device. 
     SUMMARY OF THE INVENTION 
     In this application, the word cylindrical is not limited to a circular cylinder or shape, but should be construed as the surface traced by a straight line moving parallel to a fixed straight line and intersecting a fixed planar curve. Unless otherwise indicated, the direction extending along the foot portion away from the joint is commonly referred to as forward and the direction extending along the calf portion away from the joint is referred to as up. Correspondingly, back and down directions are construed as opposite to said forward and up directions respectively. Unless otherwise indicated, the word ‘device’ relates to one or more implementations of the current invention. 
     It is an object of the present invention to solve the problem and shortcoming described above and to provide an AFO donning device constructed of an L-shaped channel where the vertical leg of the L shaped channel forms a channel-like calf portion, and the horizontal leg of the L shaped channel forms a channel-like-foot portion. The connecting point of the foot portion and the calf portion is referred to as a joint in this application. Surfaces and volumes generally formed within the volume bound by the smaller of the two angles defined by the foot portion and the calf portion are referred to as being inside, and conversely surfaces and volumes defined by the larger of the two angles are referred to as being outside, the L-shape. 
     A rocker is provided on the outer or rear side of the L-shaped channel, at least near the joint. The rocker extends rearwardly from the back side of the joint area, and has a convexly arcuate rail  25 , acting as a ground engaging surface. The rail is contoured to act as a cam to allow substantially smooth rotation of the L-shaped channel into an inclined position when tilted. 
     The foot portion of the L-shaped channel is weighted, preferably at its forward portion away from the joint. The weighting may be done by properly distributing the mass of the device, using different materials, adding a weight along the foot portion, preferably at a point distal to the joint, or by other known methods. The weight distribution should be sufficient so that when the device is positioned on the rail, the weight of the foot portion will bias and urge the device to an upright rest position in which the calf portion is in a substantially vertical orientation, and the foot portion is in a substantially horizontal orientation. Optionally, in resting position, the device should lean slightly backward to compensate for the weight of a shoe and an AFO placed is the L-shaped channel, or provide a more comfortable angle for positioning a patient&#39;s leg. 
     Preferably, an extended rail extends upwardly in continuation to the aforesaid rail, or integrated therewith. In the preferred implementation, the extended rail is formed as an integral extension of the rocker, and extends upward and backward of the joint area to form a rocker extension. By adapting the extended rail cylindrical shape to increase the distance of the joint from the ground as the device is tilted, an eccentric cam is created. The eccentric cam further increases the moment of the added weight of the foot portion and thus further biases the propensity of the device to return to an upright rest position. 
     Optionally, the rocker may depend forwardly and downwardly from the joint area towards the distal end  15  of the foot portion to form a resting rail  30 . Such a resting rail is helpful for example if an increased height or a specific rocking motion is desired. 
     To further enhance the invention, a shoe tongue retainer is disclosed. The shoe tongue retainer generally comprises a short C-shaped clip  202 , where one end of the clip is bent or formed to roughly conform to the shoe toe, and the other end is formed as a hook to engage and maintain the tongue of a shoe at a forwardly folded position. This tongue retainer is used to increase the shoe opening during foot insertion, and may be easily removed when not needed, as described below. 
    
    
     SHORT DESCRIPTION OF THE DRAWINGS 
     FIG. 1 depicts a schematic isometric view of one preferred implementation of the device, showing a shoe and an AFO in place for foot insertion. 
     FIG. 2 depicts a preferred implementation of the invention. 
     FIG. 3 depicts a rear isometric view of an implementation of the invention. 
     FIG. 4 depicts a preferred implementation of a shoe tongue retainer. 
     FIG. 5 depicts a deployed shoe tongue retainer. 
     FIG. 6 depicts a preferred implementation of the invention showing a preferred use method thereof. 
     FIG. 7 depicts another preferred implementation of the invention showing an integral rocker. 
     FIG. 8 depicts yet another embodiment of the invention showing a shoe shaped leg portion. 
    
    
     DETAILED DESCRIPTION 
     Referring now to FIGS. 1 and 2, an L-shaped channel  50  having a calf portion  80  and a foot portion  90  is visible. Calf portion  80  and foot portion  90  are joined at a joint  75 . Preferably, the joint  75  has a rounded profile to better accommodate the heel of a shoe  150 . The foot portion  90  is constructed of a slab  70  with sufficient width to receive a human shoe  150 . Two parallel vertical sidewalls  65  attached to opposite sides of the slab  70  define the channel at the foot portion  90  and serve to prevent the shoe  150  from sliding off the foot portion  90 . Alternatively, the foot portion  90  may comprise a shoe-shaped support  95 , in which case the sidewalls  65  are not parallel but rather generally conforming to the shape of a shoe  150 . Optionally, partially or fully constructing the foot portion  90  of flexible yielding material, springs embedded in the foot portion  90 , molding at least a part of the foot portion  90  to conform to a shoe  150  shape (e.g. as shown in FIG.  8 ), utilizing a plurality of pegs to hold the shoe  150  in place, or other means, may be employed to hold the shoe  150  in place. Such implementation should also be construed as a channel for the purpose of the present invention, since they conform to the primary purpose of the channel, which is to maintain the shoe  150  in the desired, position while donning the AFO  100  and the shoe  150 . All the above mentioned implementations and their equivalents, may be summed up as having the foot portion  90  comprise a molded shoe  150  support to conformally and yieldingly receive a shoe  150 . 
     Preferably, the calf portion  80  is provided with a concave arcuate forward surface such as a semi-circle or elliptical cross section, to better fit the contours of an AFO  100  upper part, and thus serve to better stabilize an AFO  100  nestled therein. The calf portion  80  is also constructed wide enough to offer support for an AFO  100 . 
     In the preferred implementation, a weight  55  is attached to the forward part  15  of the foot portion  90 . The weight  55  causes a gravitational force to act on the device and thus urge the device to a rest position with the foot portion  90  being substantially parallel to the floor, and the calf portion  80  vertical. Achieving weight distribution to cause such bias may be carried out by adding a weight  55  to the foot portion as described, using different construction materials, making the foot portion  90  thicker, and other methods clear to a person skilled in the art. 
     A rocker  10  is attached to, or preferably integral to, the back side  60  of the calf portion  80 , and extends at least to the back of the joint  75  area. The rocker  10  gives a rounded profile to the lower outer side of the joint  75  and forms a rail  25  to act as a ground interface surface. The rounded rail  25  serves as a cam to allow smooth rotation of the device to an inclined position. Preferably, the rocker  10  is molded into the back of the L channel  50  and more preferably, it comprises two roll bar sections  12  and  13 , with similar profiles disposed substantially parallel to each other at laterally opposing sides of the L-shaped channel  50 . This arrangement allows for a lighter, more stable device and less expensive construction. 
     The rocker  10  in the preferred implementation extends upward and backward from the joint  75  area, to form an upper extended rail  20  portion with extended ground interfacing surface. The extended rail  20  profile is also arcuate in form, but extends further rearwardly so as to increase the moment effects of the weight concentration  55  in the forward part of the foot portion  90 . This construction increases the propensity of the device to maintain upright position at rest. Preferably, a protrusion  22  is located the upper part of the extended rail  20  to act as a roll stop to further reduce the risk of rolling over when the device is tilted. The roll stop is sufficiently large to stop the device from toppling over and lying on the ground on its calf portion  80  under normal operating conditions. 
     Optionally, the rocker  10  may also be extended along and below the foot portion  90  to any convenient length, to form a resting rail  30 . If extended along the foot portion  90 , the resting rail  30  preferably extends for a sufficient distance to allow the foot portion  90  to lie parallel to ground at rest. More preferably, the resting rail  30  is substantially flat, or includes one or more downward protrusions to support the device at rest into a desired position. Yet another desired feature is having the lower surface of the resting rail  30  comprise a high friction surface, commonly known as non-slip surface. Special needs may require a tall resting rail  30 , and such resting rail  30  is thus contemplated herein and considered a part of one preferred implementation. It is however a desired feature of the preferred implementation to reduce the total height of the foot portion  90  above ground. Therefore, the resting rail  30  may be eliminated without detracting from the invention. 
     The preferred implementation calls for the rocker  10  to be integrally molded into the back side  60  of the L-shaped channel  50 . A molded plastic, single piece unit is believed to be the most cost effective and allowing for the easy integration of the contour and weight distribution desired. 
     Due to difficulty in tying shoelaces, patients frequently use elastic shoelaces, Velcro fasteners or other elastic method for fastening the shoe  150 , without shoelaces. The fastening arrangements and the shoe construction allow the tongue  155  to elastically return to its natural location after being bent forward to allow more convenient donning of the shoe  150 . The present invention thus discloses an optional Shoe Tongue Retainer  200  to assist in maintaining the shoe tongue  155  out of the way as the foot is inserted into the shoe  150 . Using such shoe tongue retainer  200  increases the opening size of the shoe  150  and affords easier donning of the shoe  150 . The shoe tongue retainer  200  is preferably constructed of a resilient elongated clip portion having at one end a concave toe holder  210  constructed to engage the toe portion of a shoe  150 , and a tongue hook  205  disposed at the its other end. The tongue hook  205  may comprise a hook, pincers, a bent portion of the rod, or any convenient means to engage the shoe tongue  155 . In the preferred implementation the shoe tongue retainer  200  comprises a C-shaped flat metal spring, with an acute angle bend forming the tongue hook  205  and several bends or curves forming the toe holder  210 , as can be seen for example in FIG.  4 . 
     In use, the patient inserts an AFO  100  into the shoe  150 , and places the shoe  150  with the AFO  100  in the device so that the heel of the shoe  150  is near the joint  75 . If desired, the shoe tongue retainer  200  is applied so that the toe holder  210  is pressed against the toe portion of the shoe  150 , and the tongue  155  is bent or ‘peeled’ forward and engaged in the hook  205  so that the retainer yieldingly maintains the tongue  155  away from the shoe  150  opening as shown. The assembly of shoe  150 , AFO  100  and shoe tongue retainer  200 , ready for insertion into the L-shaped channel  50 , is shown schematically in FIG.  5 . The shoe  150 /AFO  100  assembly is placed into the L-shaped channel  50  so that the shoe  150  sole fits generally over the foot portion  90 , the heel of the shoe  150  fits into the joint area  75 , and the calf portion of the AFO  105  rests in the calf portion  80  of the present invention. Preferably, the application of the shoe tongue retainer  200  is done prior to placing the shoe  150 /AFO  100  in the channel  50 . The channel  50  shape of the foot portion  90  prevents the shoe  150  from sliding sideways, and the channel  50  shape of the calf portion  80  prevents the AFO  100  from sliding sideways. Clearly, it is advantageous to construct the calf portion  80  with a concave arcuate forward surface to better maintain the position of the AFO  100 , and thus the preferred implementation uses a calf portion  80  having at least in part thereof a semicircular cross section. In the alternative implementation described above, other means for maintaining the shoe  150  in the desired position may be employed, with, or as an alternative to the channel  50 . Those means include, but are not limited to, springs, molding or otherwise manufacturing the foot portion  90  to conform to general shape of at least a portion of a shoe  150 , protrusions placed strategically to hold the show  150  in place, elastic walls to yieldingly maintain the shoe  150 , and any commonly known means to perform the function of supporting the shoe  150  while preventing it from swaying. 
     The placement of the shoe  150 /AFO  100  assembly in the device is eased by using the calf portion  105 of the AFO as a handle for the shoe  150 /AFO  100  assembly, to thus overcome the need to bend, which is often difficult to a patient. In order to further ease placement, a strap or handle may be attached to the calf portion  80  to support the device, and alternatively to allow easy pick up of the device as a whole for placement of the shoe  150 /AFO  100  therein and than to ease placement of the device on the ground. 
     FIG. 6 depicts an implementation of the device during use with the shoe  150 /AFO  100  in the device and the device placed on the ground so that it rests on rail  25 . The patient places his/her foot on the calf portion  80 , preferably at its upper portion. The added weight causes the device to tilt about the cam-like surface of the roll rail  25  into an inclined position, and brings the shoe  150  to a comfortable angle to accept the foot, toes first, in an anatomically correct and comfortable manner. The AFO  100  and the channel-like calf portion  80  form a guide to ease the placement of the foot into the shoe  150 . The patient can thus slide his/her foot into the shoe  150  comfortably and the guide naturally guides his/her foot into the shoe  150 . After the foot is placed in the shoe  150 , the strap of the AFO  100  may be tightened around the patient&#39;s calf and the leg removed from the device. The device then returns to its upright position due to the weight distribution discussed above. The shoe tongue retainer  200  is kicked or otherwise removed out of the way to allow the tongue  155  to elastically return to its natural position and complete donning the shoe  150 . 
     It should also be noted that while the preferred implantation calls for a joint  75  formed at the joining area of the foot portion  80  and the calf portion  90 , such a join may exist even if the foot portion and calf portion do not physically meet, but are kept apart from each other at a substantial orientation as described. In such case the area described inhere as the joint  75  is located where an extension of the foot and/or calf portions ( 90 / 80 ) meet either the other portion or its extension. Thus the invention is also aimed at such implementation where a portion of the L shaped channel  50  is missing. 
     While there have been described what are at present considered to be the preferred embodiments of this invention, it will be obvious to those skilled in the art that various other embodiments, changes, equivalents, and modifications, may be made therein without departing from the spirit or scope of this invention. It is therefore aimed to cover all such changes modifications and equivalents as fall within the true spirit and scope of the invention, and for which letters patent is applied.