Patient information about knee ankle foot orthoses (KAFO’s)

General information

The term KAFO is an acronym that stands for knee ankle foot orthosis and describes the part of the body that the device encompasses. The orthosis extends from the thigh to the foot and is generally used to control instabilities in the lower limb by maintaining alignment and controlling motion. Instabilities can be either due to skeletal problems, muscular weakness and paralysis. With this in mind, the indications for use of a KAFO are many and varied. Your orthotist will choose the right KAFO for your needs keeping in mind your own goals and safety.

There are two very general categories of KAFO’s: Metal designs with leather covered thigh sections, calf bands and metal spurs that go into a socket in the heel of your shoe and plastic/ composite and metal designs which have a moulded plastic thigh and below knee section which fits inside you shoe. The KAFO will also incorporate some kind of knee joint. The orthotist will have chosen the correct ones for your needs.

Wearing your KAFO

Your KAFO has been prescribed for you and is intended for your use only.

Since there are many different reasons to use a KAFO, there are many different designs. Each design has its own special features and its own specific way to be put on properly. The orthotist will instruct you on the correct way to put your KAFO on and adjust the straps in order to make the best use of it.

Your KAFO is designed to conform to the shape of your thigh, foot and ankle and may feel slightly ‘strange’ due to the realignment of your lower limb, and pressure redistribution. It will therefore require a gentle breaking-in period.

Wear time

When you are first fitted with your KAFO you should wear it gradually. This allows you to get used to wearing the KAFO and allows the skin to gradually build up resistance to the pressures which the brace is applying. You should check your skin regularly during the first few weeks. You may experience some general muscle aches until you are used to wearing the KAFO.

• Start slowly, only wearing your KAFO for a maximum of one hour on the first day.
• Increase the wearing time each day, by an extra 30 minutes to one hour until you are comfortable wearing your KAFO all day or as much as it is required.
• If you experience any pain or discomfort, remove the KAFO for at least two to four hours and then try again. If pain persists, stop wearing the KAFO and make an appointment to see your orthotist for an adjustment.

Shoes

• Select good shoes with proper support and always try them on with the KAFO in place to ensure proper fit and comfort.
• The best type of shoes to wear with your KAFO feature a closed back and toe, come up over the top of the foot like laced-up sport shoes, low heels, a removable innersoles and a slightly wider width to accommodate the KAFO.
• Dress shoes and sandals are not recommended for these reasons.
• Be sure to wear tights or long cotton socks under the KAFO to minimize the possibility of skin irritation and improve comfort.
• During use, ensure that footwear is secured as tightly as is comfortable.

Skin care

Your skin should be inspected regularly, especially in the first few weeks after being fitted with a new KAFO. A close fitting orthosis can sometimes cause some redness on the skin around the edges of the orthosis and where the KAFO is applying corrective pressures. Check your skin thoroughly especially over bony areas and around the edges of the KAFO. If you see a red area that does not go away within 30 minutes of removing the KAFO, notice a break in the skin or blisters you should stop wearing the KAFO and make an appointment with your orthotist to have it adjusted.

Caring for your KAFO

Cleaning

Use an antibacterial soap and warm water to wipe the inside surfaces of your KAFO. Towel dry the KAFO completely before putting it back on. Avoid drying in direct sources of heat (for example on a heater or using a hair dryer) as this can deform the plastic.

Straps, padding and linings

The straps, padding and leather linings may become worn and can be replaced. To arrange repairs please contact the orthotic department. Please see end of leaflet for contact details.

Plastic

Inspect the plastic regularly, checking for any cracks or areas of fatigue. Never attempt to repair, trim or adjust the KAFO yourself, if a problem arises contact the department immediately. Please see end of leaflet for contact details.

Joints

KAFO’s may have joints at the ankle and knee. These should be checked before each time the KAFO is used looking for any dents or cracks and that all rivets and screws are secure.

If your KAFO has joints that lock when you are walking you should check that both are fully locked before mobilising. If you fail to do this it can cause serious damage to the KAFO and could affect the stability of the device and ultimately your safety.

If the KAFO has spur ends that go into a socket in the heel of your footwear, check that there is no excessive wear to the spur or the socket and that the socket is secure in the heel of your footwear.

Keep the joints clear of any dust and dirt and occasionally apply a small amount of WD-40 or Vaseline to the spurs (if you have them) and the knee joint. This will reduce the wear. Lubrication should be avoided from certain knee joints and your Orthotist will advise on this where appropriate.

Review

Following fitting of your KAFO your orthotist will arrange an appointment for review. This is likely to be approximately six weeks after delivery of the KAFO.

Adjustments can be made to your KAFO and we recommend that your brace is reviewed by an orthotist at least once every 12 months to ensure the device is still meeting your needs and check for any wear and tear. If you are having no issues with your KAFO we still recommend a 12 month maintenance check of all joints etc.

If you work in a particularly dusty environment or are involved with heavy manual work your KAFO should be reviewed more often. We would recommend your KAFO is reviewed every six months to ensure it continues to be safe to wear.

Children may need their KAFO reviewed and replaced more often as they grow or gain weight. We would recommend that your brace is reviewed by an orthotist at least every six months.

Never attempt to repair or adjust your brace yourself. If you are experiencing any problems or have questions regarding your brace, please contact your orthotist. Please see end of leaflet for contact details.

Remember

If you have any questions about the type of KAFO you have been recommended, please talk to your orthotist. Your orthotist is there to work with you to choose the best approach and ensure your comfort and safety.

Please remember to bring your KAFO, when attending appointments with your orthotist even if it is broken or no longer fits.

The contact details for the department are:

Addenbrooke’s Rehabilitation Clinic
Clinic 9
Cambridge University Hospitals NHS Foundation Trust
Box 120
Addenbrooke’s Hospital
Hills Road
Cambridge
CB2 0QQ

Telephone Number: 01223 217859

If you are from outside the Cambridge area and wish to receive future Orthotic treatment from a more local service you should contact your GP.