Patent Publication Number: US-2005131324-A1

Title: Boot for treatment of plantar fasciitis

Description:
BACKGROUND OF THE INVENTION  
      1. Field of the Invention  
      This invention relates generally to a boot that can be used for the treatment of plantar fasciitis and, more particularly, to a boot that is worn both day and night during the treatment period.  
      2. Description of Related Art  
      Plantar Fasciitis is a medical condition that results in pain in one or both feet, generally localized in the heels. The pain associated with Plantar Fasciitis, ranging from a dull intermittent pain to a sharp persistent pain, may continue for months or even years and in some cases the pain may never completely disappear. It is often most severe immediately after getting out of bed in the morning or after other periods of inactivity. The condition is more common in people who spend a lot of time on their feet, walk or run on hard surfaces, have put on extra pounds, have tight Achilles tendons, or have had a sudden increase in activity after a period of inactivity.  
      The cause of Plantar Fasciitis is unknown but is believed to be damage to and inflammation of the plantar fascia, especially where it connects to the heel. The planter fascia is a highly elastic collagen-based connective tissue that runs between the heel and the toes. It helps to support the arch of the foot as well as helps check the motion of the various joints in the ankle and foot. When these joints are stressed, the plantar fascia may become inflamed. In addition, both the plantar fascia and the Achilles tendon tend to shorten up to some extent at night and during other periods of inactivity. This shortening results in increased amounts of stress being placed upon the connection between the plantar fascia and the heel, upon the resumption of movement. It is the additional stress applied to either the joints in the foot or the connection between the plantar fascia and the heel that is believed to result in the inflammation and pain associated with Plantar Fasciitis.  
      For mild cases, a number of simple remedies have been used with some degree of success. For example, stretching exercises have been used to loosen the Achilles tendon and the plantar fascia so as to place less tension on the connection between the fascia and the heel. Cutting back on pounding exercises, such as jogging on hard surfaces may also help. Alternatively, anti-inflammatory drugs such as naproxen or ibuprofen may also help in some cases. Orthotic inserts for the shoe and walking boots can also be used to minimize stresses applied to the foot when standing or walking and help protect the plantar fascia from further damage and inflammation, thereby allowing the plantar fascia to properly heal.  
      Wearing a splint at night may also provide some relief. The splint holds the plantar fascia tensioned during the night. This is accomplished either by applying a compressive force directly against the plantar fascia or by placing the foot in a slight dorsiflexion position to tension the plantar fascia by stretching it slightly. The tension is believed to help ease inflammation or decrease the stress applied to the plantar fascia in the morning when activity resumes, thereby reducing the pain associated with plantar fasciitis. However, it is not intended that these splint devices be used when weight is being placed on the foot, other than brief occasions such as walking to the bathroom during the night. As such, these splints are not designed to allow a user to have a near natural walking gait while wearing the brace or for protecting the foot while standing or walking. Therefore, night splints are not useful for providing protection or relieving pain during the day because the wearer cannot carry out normal ambulatory movements. Daily activities allow additional stress and micro tears to occur in the plantar fascia due to normal stresses that are applied upon already inflamed and injured tissues. This aggravates the plantar fasciitis and minimizes the effectiveness of the night splint, especially for more severe cases of plantar fasciitis.  
      For the most severe cases, surgery may be necessary to loosen the plantar fascia by snipping a part of it. However, this requires an extended recovery period during which pain is often more severe. Therefore, while a number of treatment options are available to treat plantar fasciitis, there is still a need for a device that has the ability to treat plantar fasciitis across a wide range of severity while allowing the patient to continue to engage in their normal daily activities.  
     SUMMARY OF THE INVENTION  
      A boot for use in the treatment of plantar fasciitis. The boot places the foot in the desired amount of dorsiflexion, preferably from 5° to 20°, which stretches the Achilles tendon and is believed to prevent the shortening of the plantar fascia. The boot also provides protection for the foot while walking or engaging in other load bearing activities, to minimize further damage to and/or inflammation of the plantar fascia. The boot has a sole that is shaped to allow as close to a natural walking gait as possible while maintaining the foot in the desired degree of dorsiflexion. Preferably, the amount of dorsiflexion of the foot is controlled through the addition of a number of wedges on the base of the boot.  
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
      The apparatus of the invention is further described and explained in relation to the following figures wherein:  
       FIG. 1  is a perspective view of a preferred embodiment of the boot of the current invention using three wedges and fitted onto a patient&#39;s foot;  
       FIG. 2  is a perspective view of the boot shown in  FIG. 1  with all of the straps, pads and cuffs removed;  
       FIG. 3  is a side elevation view of the base of the boot shown in  FIG. 1 ;  
       FIG. 4  is a is a plan view of the cuff of the boot show in  FIG. 1 ; and  
       FIG. 5  is a side elevation view of a wedge.  
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT  
      The current invention provides a novel device for the treatment of plantar fasciitis. In a preferred embodiment, this is accomplished by maintaining the plantar fascia is a position where it can properly heal and protecting it from further damage from walking or bearing weight upon the foot. It has been found that approximately 70% of patients with plantar fasciitis have tightened Achilles tendons. Stretching provides temporary relief of minor to moderate cases of plantar fasciitis, however, the Achilles tendon will begin to shorten back up again once it is relaxed. In the preferred embodiment, the boot positions the foot in a degree of dorsiflexion. This continuously maintains the Achilles tendon in a moderately stretched state. Preferably, this stretched state is slowly increased over time, e.g. a couple weeks, to further stretch the Achilles tendon and provide further relief as directed by a physician. It is believed that maintaining the foot with a certain amount of dorsiflexion also provides tension on the plantar fascia itself. This tension is believed to help the plantar fascia remodel itself as it heals so that it is less likely to be re-injured from normal activities.  
      The boot of the preferred embodiment can also be worn while standing or walking. This allows the boot to continue to maintain the Achilles tendon in a stretched position and provide tension on the plantar fascia to allow it to properly heal. It also provides protection of the plantar fascia during walking and standing activities that normally produce additional strain upon the foot and plantar fascia and could cause additional damage and inflammation. The protection is provided both by cushioning foot  58  and by transmitting forces through base  22  and up upright arms  24  to leg  60  instead of allowing the forces to pass through foot  58 . As such, it is contemplated that boot  20  will be worn all day and night during the treatment period. For use at night, a spandex/lycra cover (not shown) can be used to cover base  22  so that it does not soil the bed linens. Boot  20  can be removed for range of motion and strengthening exercises or they can be carried out while wearing the boot, as recommended by the treating physician.  
      Referring to  FIG. 1 , boot  20  is generally made up of base  22 , upright arms  24 , cuff  26 , and wedges  44 . In addition, foot straps  28  and leg straps  30  are provided to help hold the foot and leg in boot  20 . Calf cuff  26 , footpad  34 , heel pad  36  and ankle pads  38  are made of a breathable foam in order to keep the skin cool and comfortable while wearing boot  20 . Straps  28  and  30  as well as calf cuff  26 , footpad  34 , heel pad  36  and ankle pads  38  have pile surface  39  on at least one side that allows hook fasteners  28  to be secured to them to form a hook and loop fastening system, e.g., Velcro. Pile surface  39  may be an integral part of the respective strap or pad or may be a separate layer that is secured to the strap or pad through means known to those of skill in the art, e.g. heat fusion, adhesive, stitching, etc. In addition, those skilled in the art will recognize that other type of fasteners, e.g. snaps, buckles, or other methods to secure the straps, pads and cuff of boot  20  together may be used without departing from the current invention. Hook and loop fasteners are preferred because they are sufficiently sturdy, easy to adjust, and simple to construct and use.  
      Referring to  FIG. 2 , base  22  is made up of shell  78 , sole  40  and insole  80 . Shell  78  is preferably made of an aluminum alloy in order to impart form and rigidity to base  22 . Shell  78  has lip  84  running around the edge of shell  78 . Lip  84  widens into sides  86  where shell  78  connects to upright arms  24 . D-Rings  48  are attached by rivets  46  to either side of shell  78 . Also slots  52  are located in both sides  86  of shell  82  to accommodate heel strap  62 . Insole  80  is dense foam cushion material that is attached to the interior of shell  78 . Insole  80  provides a cushioned surface for foot  58  to rest on when boot  20  is worn. However, insole  80  is firm enough to prevent foot  58  from moving significantly out of the desired degree of dorsiflexion. Pad  82  is located at the rear of shell  78  on lip  84  and also provides padding to protect foot  58  from contacting shell  78 . Sole  40  is attached to the bottom of shell  78 .  
      Referring to  FIG. 3 , sole  40  is shaped to allow the patient to have a near normal gait while walking in boot  20 . Sole  40  is preferably made of microcellular polyurethane so that it is light and very durable. Sole  40  also has treads  42  on the bottom in order to help provide traction and prevent slips. Sole  40  is made up of three generally flat surfaces, front surface  66 , center surface  68  and rear surface  70 . Surfaces  66 ,  68 , and  70  are connected to each other with arcuate areas to allow boot  20  to smoothly rock from one surface to the next. Rear surface  70  absorbs the shock of boot  20  striking the ground and thereby protects the joints of foot.  58  from these forces. Center surface  68  provides a surface suitable for supporting the wearer&#39;s weight without placing undue stresses on either the plantar fascia or the joints in foot  58 , when the wearer is in a standing weight bearing position. Front surface  66  is angled to allow the wearer to easily push off the ground when taking a step.  
      During walking, boot  20  generally first strikes the ground on rear surface  70 , which is at an angle Φ to help cushion the impact with the ground and then rocks through center surface  68  to front surface  66 , which is at an angle  0  to aid in pushing the boot off the ground to take the next step. In this manner, the shape of sole  40  allows the wearer to have as close to a normal walking gait as possible while maintaining foot  58  at the desired degree of dorsiflexion. Thus the shape of sole  40  minimizes the decrease in mobility from wearing a walking boot. This decreases the inconvenience of the boot to the wearer and increases the chance that boot  20  will be worn for the entire time prescribed by the treating physician.  
      Referring back to  FIG. 2 , upright arms  24  are flat strips of metal on either side of base  22  that extend upward in a generally vertical direction. Rivets  46  connect the bottom of upright arms  24  to shell  78  at sides  86 . Upright arms  24  preferably have a slight outward flare to better conform to the shape of the leg  60 . Upright arms  24  are preferably composed of an aluminum alloy with a fabric cover sewn over it. Each upright arm  24  contains a number of hook fasteners  32  on both the outside and the inside of upright arms  24 . Hook fasteners  32  can attach to pile surface  39  on the outside of cuff  26  as well as leg straps  30 . Also, at the bottom of the interior side of each upright arm  24  are hook fasteners  32 . Hook fasteners  32  attach to pile surface (not shown) on ankle pads  38  in order to secure ankle pads  38  to the inside of upright arms  24 . As can be seen more clearly in  FIG. 1 , ankle pads  38  serve to cushion foot  58  and protect it from rubbing against upright arms  24  or rivets  46 .  
      Referring to  FIG. 4 , cuff  26  is made of flexible breathable foam that can be wrapped around leg  60 . Hook fastener  32  runs along one vertical edge of cuff  26  and allows one end of cuff  26  to be secured to pile surface  39  on the outside of the other end of cuff  26  after it has been wrapped around leg  60 . Preferably the length of cuff  26  is adjusted by trimming cuff  26  along the edge opposite from fastener  32  in order to provide approximately 2-3 inches of overlap when cuff  26  is wrapped around leg  60 .  
      As can be seen in  FIG. 1 , each wedge  44  is shaped to fit on top of base with front edge  72  lined up with the front edge of base  22 . Referring to  FIG. 5 , each wedge  44  has a thick front edge  72  that angles down to a thin rear edge  74 . The angle of wedge  44  is such that angle θ′ is 5°. When positioned on base  22 , rear edge  74  of wedge  44  does not cover all of base  22  but rather terminates short of the rear of base  22 . Wedges  44  are made of dense foam. On the bottom of each wedge  44  is adhesive strip  64 . Adhesive strip  64  preferably contains a paper cover  76  that peels off when ready for use. Adhesive strip  64  is used to secure each wedge  44  to either wedge  44  below it or base  22 , in order to prevent wedges  44  from slipping, especially while the wearer is walking in boot  20 . There are preferably three wedges  44  provided with boot  20  so that the degree of dorsiflexion of foot  58  can be controlled in 5° increments between 5° and 20°.  
      Foot straps  28  are secured to D-rings  48  on one side of base  22 . Foot straps  28  have one side that has a loose pile surface for attachment to two-sided hook fasteners. Two sided hook fasteners are the same as hook fasteners  32  except they have hook fasteners on both surfaces so that they can secure two pile surfaces  39  together. Hook fasteners  32  are secured on the other surface of foot straps  28  in order to locate footpad  34  on top of foot  60 . Foot straps  28  are passed through D-rings  48  on the other side of base  22  and secured to themselves using two-sided hook fasteners. In this way foot straps  28  can be secured snugly around foot  60  and hold it in place on base  22  with footpad  34  providing cushioning between foot straps  28  and foot  60 . Likewise heel strap  62  is passed through slot  52  and secured to itself using a two-sided hook fastener. Hook fastener  32  is located on the inner surface of heel strap  62  to secure heel pad  36  in the desired location.  
      Leg straps  30  are formed of a thick breathable foam material with piled surface  39  on the outer surface for hook fasteners  32  to attach. Hook fasteners  32  are disposed at one end of each leg strap  30 . At the other end of each leg strap  30  is ring  54 . The end of leg strap  30  that has hook fastener  32  passes through ring  54  and doubles back so hook fastener  32  can attach to a portion of leg strap  30 . Each leg strap  30  is also secured to cuff  26  by two-sided hook fasteners that are placed on the back of cuff  26  after it is wrapped around leg  60 . Hook fasteners  32  are located on each upright arm  24  to secure each leg strap  30  to upright arms  24 , as seen in  FIG. 7 . In this manner, leg straps  30  assist in securing cuff  26  to upright arms  24 , thereby maintaining leg  60  in alignment with upright arms  24  and helping transmitting forces from the bottom of boots  20  to leg  60  so they avoid adding stress to the joints of foot  58 . This helps ensure that foot  58  remains in the desired degree of dorsiflexion and is protected from forces generated while standing or walking.  
      Boot  20  may be secured to foot  58  and leg  60  in the following manner. First, a dry sock (not shown) is preferably placed on foot  58 . Next, cuff  26  is wrapped snugly around leg  60  with the bottom just above the anklebones of leg  60 . Cuff  36  is secured to the outside of itself through the use of hook fastener  32 . Then foot  58  is placed directly on base  22  without any wedges  44  between the two. Foot  58  should be facing forward and leg  60  is lined up with upright arms  24 . Hook fasteners  32  on the inside of upright arms  24  are attached to the outside of cuff  26 , by pressing upright arms  24  together, to secure cuff  26  to both upright arms  24 .  
      Heel pad  36  is then positioned on heel strap  62  using a two-sided hook fasteners and heel strap  62  is tightened snugly against the back of the heel by attaching to itself using two-sided hook fastener  50 . Footpad  34  is then similarly located on foot straps  28  and foot straps  28  are secured back onto themselves also using two-sided hook fasteners to snugly hold foot  58  on base  22  and minimized movement of foot  58 . Finally, leg straps  30  are wrapped around uprights  24  and cuff  26 , and secured to hook fasteners  32  on upright arms  24  and two-sided hook fasteners placed on the back of cuff  26 . Leg straps  30  are then passed through rings  54  and attached back onto themselves using two-sided hook fasteners.  
      Without the use of wedges  44 , boot  20  preferably places the foot in 5° of dorsiflexion. After a period of time specified by the treating doctor, such as a week, one wedge  44  is added to the top of base  22  with the thick end of wedge  44  lined up with the front end of base  22  and secured to base  22  through the use of adhesive strip  64  on the bottom of wedge  44 . Boot  20  is then refitted onto foot  58  and leg  60  as described above. The use of one wedge  44  increases the dorsiflexion of the foot by an additional 5° for a total of 10° of dorsiflexion. After successive time periods, additional wedges  44  are added one on top of the other and secured through the use of adhesive strips  64  on the bottom of each wedge  44 . The degree of dorsiflexion of foot  58  is increased 5° for every additional wedge  44  that is used. In this way the desired degree of dorsiflexion can be controlled and slowly increased over a period of time. In addition, boots  20  serve to absorb some of the forces of impact of foot  58  on the ground and instead transmits such forces up upright arms  24  to leg  60 , thereby protecting the plantar fascia and joints in foot  58  from receiving stresses that could cause further injury, inflame the plantar fascia, or delay healing.  
      The above descriptions of certain embodiments are made for the purposes of illustration only and are not intended to be limiting in any manner. Other alterations and modifications of the preferred embodiment will become apparent to those of ordinary skill in the art upon reading this disclosure, and it is intended that the scope of the invention disclosed herein be limited only by the broadest interpretation of the appended claims to which the inventor is legally entitled.