(Microsoft PowerPoint - Good Shoes for Elderly Foot [\310\243\310\257 \270\360\265\345])

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1 Good Shoes for Elderly Foot 인제대학교부산백병원김현동

2 CONTENTS 1. Age-related changes in the feet 2. Shoe construction 3. Foot care by shoe

3 Age-related changes in the feet Skin Toenails Foot contour Sensory Joint mobility Muscle-force production

4 CHANGES OF SKIN

5 Dryness Cuase) lack of hydration and lubrication Results) Fosters formation of fissure Bacterial invasion

6 Hyperketatoses Cause) keratin dysfunction and persistent shear stress

7 Plantar fat pad atrophy Painful calluses to form under the metatarsal and heel

8 CHANGES OF TOE-NAILS

9 Changes in the toe nails Accelerated by persistent trauma, such as that inflicted by abrasion from the anterior portion of a shoe that is too short or snug. 평소신던신발을신기어렵게한다 Ram s horn nail

10 CHANGES OF FOOT CONTOUR

11 Morphologic changes Caused by the static and dynamic loads carried for many years 신발은 roomy space 를필요로한다 Wide High forefoot Exaggeration of early patterns of Pes planus or pes cavus

12 Changes of Foot contour by shoe Stiff - soled shoe: force the feet to absorb shock and create microtrauma Hard surface shoe: reduce the function of the intrinsic foot muscle, with eventual atrophy of the of the small toe muscles Tight shoe: abrade the skin, and lack of plantar cushioning in the shoe increase the tendency to form thick callosities

13 CHANGES OF SENSORY ACUITY

14 Sensory change Diminished sensory acuity: unaware of undue pressure Proprioceptive loss: gait disturbance Reduced temperature sensitivity: burn 신발은발을보호해야한다 (protection)

15 CHANGES OF JOINT MOBILITY

16 Reduced joint mobility Subtalar eversion and MTP flexion diminish with the aging Restriction of ankle and subtalar motion accentuates stress on the forefoot Gout arthritis

17 CHANGES OF MUSCLE POWER

18 Diminished muscleforce production Cause) Loss of number and size of muscle fiber Fiber-type differentiation decreases Transmission of impulses become less rapid Skeletal muscles replaced by fibrous tissue Change in life style and decreased use of the neuromuscular system

19 Age-related changes elsewhere in the body that affect the feet Diminished visual acuity Lessened manual dexterity Reduced flexibility of the back, hips, and knees Obesity Psychosocial: loneliness Economic: loss of income

20 SHOE CONSTRUCTION

21 Upper( 갑피 )

22 vamp( 앞쪽갑피

23 toe cap

24 shoe tongue

25 eyelet

26 quarter

27 counter

28 back stay

29 heel

30 Lining( 안감 )

31 인솔 (insole= 안창 )

32 까래 (=sock lining)

33 아웃솔 (outsole= 구두창 )

34 FOOT CARE BY HOSITERY

smoothly, neither constricting the foot nor wrinkling 구멍난양말을꿰매어사용하지말고버려라

35 Foot care by hositery Never to wear shoes without hose, to avoid subjecting the feet to irritation from the stitching and dyes in the shoe lining Hositery should fit smoothly, neither constricting the foot nor wrinkling 구멍난양말을꿰매어사용하지말고버려라 팬티스타킹은너무쪼이지않는것을선택 혈관질환이있는사람에게는울양말이더좋다 ( 안쪽은땀을흡수하고바깥쪽은보온효과와충격흡수효과가있다. unbleached white cotton socks

36 FOOT CARE BY SHOE

37 고령자용신발 (Senior shoes) 제정 : 기술표준원고시제 호 ( ) 안전 품질표시기준 안전품질표시부속서 적용범위 이기준은일상생활에서고령자가보행할때신는일반보행용신발로벨크로나지퍼, 밴드등을이용하여편리하게신고벗을수있도록고령자용으로고안된신발에대하여적용한다. 관련규격 : KS A ISO IEC Guide 71, 고령자와장애인의요구를반영하기위한규격개발자지침등

38 일반사항 아래일반사항은참고사항으로한다. 5.1 고령자가신발을신고벗기가쉽고편리해야한다. 5.2 고령자의특성에따라기능성깔개를넣어서신을수있도록신발내부의여분이있어야한다. 5.3 고령자의발에무리를주지않기위하여아주가볍게제작되어야한다. 5.4 고령자의발등과볼부위에압력이가해지지않도록신발앞부분의공간이충분하여야한다. 5.5 겉창, 굽, 기타접착시켜서만든부분은잘밀착되어있어야하며, 기타해로운흠이없어야한다. 5.6 신발의겉감의봉제상태는양호하여야하며, 재봉땀이바르게되어있어야한다.

39 5.7 고무표면에황이나다른배합제가배어나와서는안된다. 5.8 고무면및염화비닐면은끈적거리지않아야한다. 5.9 겉창은미끄럽지않아고령자가보행시안전하여야한다 사용상해로운흠, 벌어짐, 기포, 이물의혼입, 신발의겉감의주름및기타이와비슷한결점이없어야한다 눈에띄게겉모양을해치는반점, 더러움, 무늬의불선명, 신발의겉감색의불균일, 광택의불균일및기타결점이없어야한다 부속품의붙임은견고해야한다.

40 미끄럼저항 치수 무게 ( g ) 항목 건식 ( 마찰계수 ) 습식 ( 마찰계수 ) 신발높이 ( mm ) 신발너비 ( mm ) 신발볼둘레 ( mm ) 굽높이 ( mm ) 갑피겉창접착박리강도 ( N/2.5cm ) 안감 갑피 고무신발 염화비닐신발 0.8 이상 0.6 이상 45 이상 73 이상 211 이상 55 이하 가죽신발 편족 420 이하 80 이상 폼알데하이드 ( mg/kg ) 75 미만 ph 값 인장시험 4.0 이상 7.5 이하 인장강도 ( Mpa 10.0 이 15.0 이 ) 상상 발포신발 신장률 ( % ) 360 이상 40 이상 내한시험 끊어지지않을것 파열강도 ( Mpa ) 0.49 인열강도 ( kn/m ) 이상 0.98 이상 수축률 ( % ) 3 이하 3 이하 3 이하 굴절시험 끊어지지않을것 재봉사 ( N/ 가닥 ) 이상 안창 / 깔개 ph 값 4.0 이상 7.5 이하

41 10.1 제품표시 고령자용신발의제품또는최소포장단위마다보기쉬운곳에쉽게지워지지않는방법으로, 다음사항을표시한다 품명 모델명 재료의종류 치수 제조연월 제조자명 수입자명 ( 수입품에한함 ) 주소및전화번호 ( 지역번호포함 ) 제조국명

42 Shoe modification Internal Modification : Counter, Arch pad, M-pad, Wedge, Heel Cushion. Inserted Modification : Wedge, SACH Heel. External Modification : Tomas heel, Rocker Bottom, etc Counter & Arch pad Wedge M-pad & Wedge Flared heel

Foot care by shoe Last Upper portion Sole Heel made

ankle support heel counter: snug Extradepth for FO

provide enough space for any toe deformities Shoe

43 Foot care by shoe Last Upper portion Sole Heel made of washable fabric or soft leather Easy closure & ankle support heel counter: snug Extradepth for FO or modified insole Distal part of the upper should provide enough space for any toe deformities Shoe closure: VELCRO Sole: nonslip &nonskid material, Sole thickness: 0.5 cm for foot protection Heel: Low, broad heel Distal portion should curve upward slightly

44 감사합니다.

Fitting Orthosis in Footwear 관동의대분당제생병원이태임 발의여러가지질환을치료하는데 Foot Orthosis가유용하게사용되고있지만아무리좋은 foot orthosis를처방한다하여도적절한 footwear가함께제공되지않는다면성공적인결과를얻기는어렵다. 일반

Fitting Orthosis in Footwear 관동의대분당제생병원이태임 발의여러가지질환을치료하는데 Foot Orthosis가유용하게사용되고있지만아무리좋은 foot orthosis를처방한다하여도적절한 footwear가함께제공되지않는다면성공적인결과를얻기는어렵다. 일반적으로 mild, corrective, frontal plane control을위해서는 functional