Introduction
These are orthotics that are made in such a way that they can provide proper support and joint alignment to the knee, ankle, and foot, providing the perfect substitute in cases of muscle weakness and joint instabilities so that the lower limb can be protected. Patients who suffer from neuromuscular disorders or are in some form of rehabilitation due to a traumatic injury are prescribed to use this type of brace so that the muscle weakness they suffer from does not affect their movement. These are made using plastic, carbon composite, metal, and leather. There are varieties of these braces that can be found on the market that can be classified into non-locking, locking, and stance control. Depending on the condition the person is suffering from, the doctor will prescribe the best kind of knee joint.
What Is a Knee-Ankle-Foot-Orthosis Comprised Of?
A KAFO is made up of a shoe, ankle control, knee control, foundation, and superstructure, including a foot control. The simplest form of orthotic knee joint that is available is a hinge. Generally attached on both sides of the knee, it provides mediolateral, rotational, and hyperextension restrictions. Drop ring lock is the most common knee control of all time. The ring fully drops when the patient stands, extending their knee completely and further preventing any appendage from bending.
KAFOs are of three typical designs, metal, plastic, and hybrid. Among these, the metal KAFOs are further subdivided into - uprights, bands, joints, stirrups, and leather work. Plastic KAFOs are subdivided into thermoplastics, uprights, joints, and straps. KAFO uprights are mostly made of aluminum and stainless steel. Aluminum is used because of its light weight, and stainless steel is used because it is way stronger. KAFO knee joints provide free or limited motion, locking, and single axis free motion that further controls the hyperextension, especially when M-L control is needed. It also provides offset free motion where the axis is posterior and there is increased knee extension stability. In the case of the polycentric free motion that is provided, there are multiple axes of motion.
What Are the Advantages of Using a Knee-Ankle-Foot-Orthosis?
These are mainly used when there is a need to :
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Minimize the joint pain.
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Improvement in alignment is needed.
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Unstable joints need to be controlled.
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Excessive joint movement needs to be prevented.
Even though these orthotics are quite popular for providing the stability that the knee needs, they can also lead to muscle atrophy and non-cosmetic walking.
How to Wear a Knee-Ankle-Foot-Orthosis?
The first thing that one needs to do is ask a doctor about how to use the KAFO. No one else but the doctor can provide better guidance about it. The instructions that are generally followed are :
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All of the straps need to be opened, and the knee joints need to be bent.
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The full length KAFO sock needs to be worn. The orthotist would provide this.
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The leg and foot have to be positioned within the KAFO.
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Also, the patient has to keep the heel quite down in the KAFO since this would ensure that the fitting and functioning are properly maintained.
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The ankle strap or instep also needs to be secured properly. This prevents further motion in the KAFO.
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The fabric fastener straps should also be fastened up the thigh and calf.
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The knee should also be straightened so that the knee joints are locked. Remember to check if the joints are properly joined, before standing up is also very important.
Who Needs a KAFO?
This is the kind of orthosis that provides the ultimate security and stability for people and further boosting their confidence.
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People who suffer from polio are the ones who are in need of this.
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Muscular dystrophy affected patients also find this very useful.
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People who have suffered from multiple sclerosis need it too.
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People with neurological conditions like Charcot Marie tooth.
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People with congenital diseases like spina bifida.
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People who have suffered a spinal cord injury also find it extremely useful.
What Are the Contraindications of Using a Knee-Ankle-Foot-Orthosis?
Some of the very common contraindications are:
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Substantial impairment of patient cognition.
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Knee spasticity.
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Knee flexion contractures that exceed 10 degrees.
What Is an Alternative to the Traditionally Used Knee-Ankle-Foot-Orthosis?
It is really a tough challenge to provide effective orthotic devices that are affordable and help people with knee instability as a consequence of lower limb paralysis. Patients who have suffered from polio, weak quads, multiple sclerosis, stroke, spinal cord injury, and other neuromuscular and musculoskeletal disorders do not have any control over their knees. These people have been using traditional KAFO. What one needs to keep in mind is that knee motion is very important for having an efficient gait. These devices create an awkward and very inefficient gait, thus making it unacceptable to the patients, for whom they often choose to leave wearing these braces.
As a substitute for these braces, stance control orthoses are now used. These devices lock the knee for stability so that it can be flexed even more or sometimes less while swinging the leg. The doctor will determine what design is appropriate for the individual, depending on his or her condition. The majority of these devices are mechanical designs that help in providing an efficient gait, like ankle range of motion for locking the knee and unlocking it in the transition phase to leg swing.
Conclusion
Knee-ankle-foot-orthosis (KAFO) is also used in physiotherapy in cases of people suffering from polio, partial spinal cord lesions, nerve injuries, and strokes. It is best to wear tights or long cotton socks under KAFO. This is because this would further help in minimizing the chances of getting skin rashes and irritation and would also provide ample comfort. While using, it is also extremely important to keep a check on how tight the footwear is and if it is comfortable or not. These devices have undoubtedly been able to compensate for the muscle weakness, paralysis, or any other skeletal problems causing lower limb instability and have made standing, walking, and strolling easier, along with controlling joint instability and preventing excessive joint motion, but it is always a good idea to consult a specialist before opting for these orthotics. Only a certified medical professional can give a proper diagnosis and recommend what type of KAFO is needed for the patient to make it a bit easier to perform daily activities.
