KAFO, how does it work? A simple explanation.

What is a KAFO brace?

A KAFO, or Knee Ankle Foot Orthosis, is a type of brace designed to support the knee, ankle, and foot⁽²⁾. It is typically prescribed for individuals who have difficulty with leg stability⁽³⁾ due to conditions such as muscular dystrophy, spinal cord injuries, stroke or post-polio syndrome⁽⁴⁾.

This orthotic device extends from the thigh, past the knee, and down to the foot⁽³⁾. Its function is to stabilize the joints, provide support to the leg⁽⁵⁾, enabling the user to stand, walk⁽⁵⁾, and engage in daily activities.  

KAFOs have evolved significantly over the years:

1. Originally, KAFOs were made primarily from metal and leather, which made them quite heavy, bulky and uncomfortable to wear.  
2. Later, plastic versions were developed, offering a lighter and more flexible alternative. These plastic KAFOs are still widely used today, especially for children, as they are easier to replace as the child grows.  
3. In recent years, technological advancements have led to the use of composite materials, such as carbon fiber, which provide a much better balance between strength, flexibility and weight than traditional plastics.  

How is a KAFO brace composed?

A typical KAFO is composed of several key parts that work together to ensure that the leg is supported, and the joints are aligned correctly.

• Thigh Cuff: Wraps around the thigh to provide upper leg support⁽⁶⁾.  
• Knee Joints: Allow for controlled movement and stability of the knee⁽⁶⁾. These joints can be free moving, locked or motorized depending on the specific needs of the user.
• Calf Cuff: Secures the lower leg. It ensures that the orthosis remains in place during movement, preventing slippage and enhancing stability⁽⁶⁾.
• Footplate: Stabilizes the foot and aids in proper gait⁽⁶⁾.  

The ankle joint is mainly present on  KAFOs to offer support and allow ankle movement. However, this mechanical component adds extra weight to the orthosis, which can affect comfort and mobility. Mechanical ankle joints also can have issues around durability and lifespan of the KAFO. In contrast, composite KAFOs are designed with advanced materials that provide the necessary flexibility and support without requiring a separate ankle joint⁽⁸⁾. This innovative approach helps maintain natural movement while keeping the device lighter and more streamlined.

When to wear a KAFO?

The leg brace helps to:

• Stabilize the Leg: Prevents the knee from bending too much or in the wrong direction⁽⁹⁾. This is particularly important for individuals with weakened muscles who might struggle to control their leg movements.
• Control Foot Drop: Manages the condition where the front of the foot drops due to weakness. The AFO (ankle-foot orthosis) section of the KAFO controls the ankle position and lifts the foot during the swing phase of walking, reducing the risk of tripping⁽⁷⁾.
• Enhance Balance: Provides a firm base, helping the user maintain balance⁽¹⁾. The orthosis offers a wider support base, which is crucial for individuals with balance issues.
• Facilitate Walking: Helps in achieving a more natural walking pattern by aiding the movement of the leg⁽⁵⁾. The KAFO allows for smoother transitions between steps, improving overall gait efficiency.

The benefits of wearing a KAFO orthosis.

With the support and stability provided by a KAFO, users often experience an increase in their ability to move around more freely and confidently. The increased range of motion and control also allows for more efficient energy use⁽⁷⁾, reducing fatigue during daily activities.

The orthosis also helps to prevent falls and injuries by keeping the leg stable and aligned^(9,10) especially when walking on uneven surfaces, providing assurance and increasing confidence in the user's ability to navigate different environments.  

For individuals with joint pain or muscle weakness, the support provided by a KAFO can help alleviate discomfort⁽¹¹⁾, making walking and standing less painful⁽¹¹⁾. The orthosis distributes weight and reduces stress on affected areas, providing relief from chronic pain and discomfort.  

By reducing pain and improving stability, the KAFO may also help decrease reliance on painkiller medications, which can be especially beneficial for individuals managing long-term conditions.

By enabling better mobility, users can perform daily tasks more independently, have greater participation in social and recreational activities⁽⁹⁾, improving their overall quality of life⁽¹²⁾. The ability to participate in social activities and engage with the community can reduce feelings of isolation and depression. This independence can lead to improved mental health and a greater sense of personal achievement, as users can engage in activities, they previously found challenging.  

The care pathway

The process of getting a KAFO usually begins with a prescription from a doctor, often a neurologist or another specialist, who evaluates your medical condition and recommends the use of an orthosis. The next step is referral to, an orthotist or a healthcare professional specializing in orthotic devices. They will assess your specific needs and determine the most appropriate type of KAFO for your situation. This initial consultation is crucial for understanding your challenges and goals, and for ensuring that the chosen orthosis will provide effective support.

If a custom KAFO is recommended, a mold and/or a scan of the leg will be taken to ensure a perfect fit. The device will be fabricated based on these specifications, and adjustments can be made as necessary for comfort and functionality. The fitting process may involve several appointments to fine-tune the orthosis, ensuring optimal performance and comfort.

Once fitted, users will often undergo training to learn how to use the KAFO effectively. This may include physical therapy sessions to optimize mobility and adapt to the new level of support. Training is essential for helping users build confidence in using the orthosis, learning to walk with a more natural gait, and understanding how to maintain and care for the device. 
Importantly, the KAFO is designed not to immobilize the leg, but to support deficient muscles while encouraging proper movement patterns. It guides the limb in the right direction, reducing the need for harmful compensatory mechanisms and helping the user engage their muscles more effectively. This approach supports a more physiological gait and does not contribute to muscle atrophy, instead, it promotes active, supported use of the leg whenever possible.

Regular follow-up appointments with the orthotist are important to ensure that the KAFO continues to meet the user's needs. As the user's condition changes, adjustments may be necessary to maintain comfort and functionality.