LOWER LIMB ORTHOSIS

Lower limb orthosis

KNEE-ANKLE-FOOT ORTHOSIS
KNEE-ANKLE-FOOT ORTHOSIS
 A KAFO is usually prescribed when other forms of
bracing (i.e. AFO or KO) are insufficient to adequately
control knee instability due to weakness or laxity. A
KAFO can be expected to:
 successfully stabilize weak segments at the ankle and the
knee;
 control abnormal involuntary movements;
 prevent movements into painful or undesired positions
PLASTIC-METAL KAFOS
 Most KAFOs have both plastic and metal components.
Polypropylene is often used for the calf and thigh shells
and the shoe insert.
 Metal, such as aluminum, magnesium, titanium, or steel,
is used for the uprights. Joints are usually made of steel,
which tolerates friction well.
 Plastic-metal orthoses are substantially lighter in weight
than metal-leather alternatives, resulting in faster
walking at lower energy consumption.
SHELLS
 The most common proximal component is a plastic shell
that covers the posterior thigh. The thigh shell is usually
held on the limb with hook-and-pile straps.
 KAFO includes a plastic bivalved circumferential
component that encircles the thigh. The bivalved version
reduces unit pressure on the anterior thigh but is more
cumbersome to don and retains body heat.
 Regardless of the type of shell, the individual should
wear a stocking or other fabric between the skin and the
shell.
PROXIMAL PLASTIC SHELL
UPRIGHTS
 Most KAFOs have a bilateral metal uprights, for
individuals who need control only in the frontal plane.
 And most KAFO have unilateral upright.
KNEE JOINTS
 Orthotic knee joints are either single-axis or polycentric.
 Single-axis joints: to provide medial/lateral stability,
free motion joint allow full flexion and extension and
prevent hyperextension. (for genu varum and genu
valgum)
 Offset axis joints: promote maximal knee extension
during weight bearing. (when greater stability is
necessary).
CONT.
 ) Poly centric axis joint: to maintain the center of
rotation of the anatomic knee and to reduce excessive
motion of the knee.
KNEE JOINTS

Bail lock, drop lock, offset joint

KNEE LOCKS
 Most patients who need control in all planes requires a knee
joint with a lock.
 The most common design is a drop ring, which descends
over a projection on the distal part of the joint to lock the joint
in extension. Patient can use to raise the ring to flex the knee
during the sitting maneuver.
 Both uprights should be locked to maximize orthotic stability.
 For individuals who cannot use a drop ring easily, perhaps
because of hand weakness or poor balance, an alternative is a
pawl lock with a bail release.
CONT.
 When the patient presses the bail against a chair or other
rigid surface or lifts the bail with one hand, the bail
unlocks the medial and lateral knee joints so that the
patient can flex the knee.
 All of these locks require that the anatomical knee have
full passive extension.
 Special locks have been designed to stabilize the flexed
knee. These locks provide for adjustment so that the
clinician can match the angle of the orthotic knee joint to
the angle of the anatomic knee.
CONT.
 An adjustable lock is used therapeutically to reduce the
contracture. The simplest adjustable lock is the fan lock,
an alternative is the serrated lock, which includes
serrated disk on the distal uprights. One can alter the
alignment of the distal upright through a 360 degree
range.
 A ratchet lock, such as the step lock is another option.
The locking projection lodges in a depression in the
ratchet to secure the joint. This component is bulkier and
more expensive.
KNEE LOCKS

Ratchet lock Drop lock Pawl lock with a bail release

KNEE BANDS AND PADS
 In addition to some type of knee lock, the patient with
knee extensor paralysis requires an anterior component
in the vicinity of the knee.
 The component may be a rigid suprapatellar or a
pretibial band, both of which impose a posteriorly
directed force to stabilize the knee.
 A leather kneepad usually has four straps buckled to the
medial and lateral uprights above and below the knee
joint.
KNEE BANDS AND PADS

KAFO with suprapatellar band Knee pads

KNEE IMMOBILIZERS
 The KAFO or KO can be designed without a mechanical
knee joint to hold the knee in full extension.
 Knee immobilizer cover most of the thigh and leg are
used for immediate management of trauma.
SUPRACONDYLAR KAFOS
 The supracondylar KAFO stabilizes the knee, ankle, and
foot. The proximal portion encases the knee to provide
support in all three planes.
 The anterior proximal shell and the foot segment impose
posteriorly directed forces that counteract the anteriorly
directed force exerted by the calf band.
 The three point pressure system resist genu recurvatum
during stance phase while permitting knee flexion during
swing phase and during sitting.
CONT.

 The supracondylar KAFO is contraindicated in the

presence of fluctuating edema because the patient cannot
adjust the sungness of the orthosis.
SUPRACONDYLAR KAFO
WEIGHT-RELIEVING ORTHOSES

 If complete unloading is required, the KAFO must

include an ischial seat and a pattern bottom, which is
hook-like projection attached to the distal uprights.
 The pattern bottom raises the shoe off the floor,
preventing the patient from weightbearing through the
foot.
 The contralateral shoe requires a lift to maintain a level
pelvis.
WEIGHT-RELIEVING KAFO
FRACTURE ORTHOSES
 An alternative to immobilizing a fractured limb in plaster
or fiberglass is a fracture orthosis.
 It is indicated especially for distal femoral or tibial
plateau fracture that are treated either operatively or
nonoperatively.
 The shells compress the limb to maintain bony alignment
and minimize edema.
LEATHER-METAL KAFOS
 Leather-metal orthoses are required for the individual
who has sever edema and fluctuating leg volume. They
are more readily adjustable by the patients.
 Less skin surface is covered,some people find this more
comfortable than being encased in plastic, especially in
warm weather.
 The same joints that are used in plastic-metal KAFOs
can be installed in the leather-metal design.
LEATHER-METAL KAFO
KNEE ORTHOSES
 KO designs have 4 main applications:
 1. FUNCTIONAL
 2. REHABILITATIVE
 3. PROPHYLACTIC
 4. CONTRACTURE-REDUCING
1. FUNCTIONAL KOS
 For the person with an unstable knee, a KO may increase
stability enough to enable ordinary function.
 Functional KOs can have polycentric or single-axis knee
joints and can come with or without locks.
 KOs have been designed to provide anteroposterior
support for ligamentous instability, mediolateral support
for genu varum and valgum, and rotational support.
 The swedish knee cage helps to stabilize the knee when
an individual is first learning to walk after stroke. It has
no moving parts, so it is durable and easy to use.
KNEE ORTHOSES

Swedish knee cage KO providing antero-

posterior support
2. REHABILITATIVE KOS
 These orthoses are designed for short-term use while the
patient is undergoing rehabilitation and are discontinued
when treatment is completed.
 Sophisticated appliance have leg and thigh bands
constructed of webbing, semirigid nylon, or a composite
fiber, and may have a dial lock to let the clinician set the
permitted range of motion.
 Rehabilitative KOs may have single or polycentric knee
joints that may or may not lock.
KNEE ORTHOSES

Postoperative knee immobilizer with no

mechanical joint
3. PROPHYLACTIC KOS
 The most controversial kOs are those prescribed to
prevent injury.
Prophylactic knee bracing attempts to prevent or reduce
the severity of knee injuries.

No evidence to support their use.

Associated with increased energy consumption which can

impair athletic performance.
4. CONTRACTURE-REDUCING KOS
 For individuals with knee contracture, a variety of kos
can help restore range of motion. Most have bilateral
uprights and apply a constant force to the knee.
 More force can be applied and easier adjustment made
with a turnbuckle mechanism, as greater range is
achieved.

KO with a turnbuckle
SUPPORTIVE KOS
 To provide moderate support to the joint, assist in
patellar tracking, and relieve patellar chondromalacia,
several fabric KO are available.
 They are made of cotton or synthetic canvas with or
without elastic panels, rigid reinforcement, or neoprene.
 The simplest design is an elastic sleeve that surrounds
the knee. The sleeve can be modified with pads, uprights
and straps to provide the desire support. The sleeve
improves the accuracy of knee flexion.
SUPPORTIVE KO

Neoprene sleeve
.