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A KAFO or knee-ankle-foot orthosis is a specially molded plastic shell with metal uprights and knee joints designed to provide corrective and supportive functions to the ankle, foot, and knee areas. It can improve posture, body alignment, mobility, and bone and muscle strength. It also increases independence and confidence levels in patients.

Whether you’re a patient, caregiver, or healthcare professional, this post covers everything you need to know about KAFO, from its design and function to its benefits and limitations.

How to Put on a KAFO

Here is a simple process for putting on a KAFO:

  1. Begin by releasing all Velcro straps and unlocking and flexing the knee joints.
  2. Put on the full-length KAFO sock provided by your orthotist.
  3. Gently position your leg and foot inside the KAFO, ensuring your heel is securely placed all the way down inside.
  4. Ensure that the ankle (instep) strap is the first to be fastened, ensuring it’s snug enough to restrict any motion in the KAFO.
  5. Continue by fastening the fabric fastener straps along your calf and thigh.
  6. Straighten the knee to lock the knee joints (if applicable).
  7. Check that the joints are properly locked before standing up.

How to Remove a KAFO

Although KAFOs are designed to be worn for extended periods, they must be removed occasionally for activities like bathing, sleeping, and skin inspection.  Proper KAFO removal technique is essential to prevent injury and ensure the long-term effectiveness of the device.

Follow these steps to remove your KAFO safely:

  1. Loosen all the straps and buckles holding the KAFO. 
  2. If any padding or liners are inside the KAFO, remove them carefully.
  3. You may need help getting seated on the edge of a bed or chair.
  4. Unlock the knee, ankle, and foot joints of the KAFO.
  5. Gradually lift the KAFO off your leg while gently bending the knee and ankle.
  6. Once the KAFO has been removed, check your skin for any signs of irritation or redness.
  7. Clean the KAFO with a damp cloth and store it in a dry, cool place.

It’s important to note that the specific steps for removing a KAFO may vary depending on the orthosis design and the patient’s needs. It’s best to follow the instructions provided by the healthcare provider or physical therapist.

How to Take Care of Your KAFO

Ensuring the proper upkeep of your KAFO is crucial. To maintain it, use a damp cloth to clean and towel dry. Avoid exposing it to direct heat. If you notice any wear and tear on the hook and loop straps, linings, or padding, contact your orthotic facility for repair. Additionally, attend the clinic annually for knee joint service or as per your orthotist’s instructions.

Types of KAFOs

KAFOs, or knee-ankle-foot orthoses, come in various types that cater to the diverse needs of patients. Different types of KAFOs available, each with its specific features and benefits.

1. Total Surface Bearing/Thermoplastic KAFOs

Total Surface Bearing (TSB) or Thermoplastic KAFOs are commonly prescribed for patients with a flaccid or weak lower limb requiring full leg support. These KAFOs are custom-made from a mold of the patient’s leg using a thermoplastic material that becomes pliable when heated. 

The mold creates a socket that distributes pressure evenly over the leg’s surface, reducing the risk of skin irritation or pressure sores. These KAFOs also provide medial and lateral support to the knee and ankle joints, making them an effective option for patients who need joint stability.


Here are some advantages of Total Surface Bearing/Thermoplastic KAFOs:

  • Even pressure distribution: The custom-made socket distributes pressure evenly over the leg’s surface, reducing the risk of skin irritation and pressure sores.
  • Greater joint stability: The medial and lateral support TSB/Thermoplastic KAFOs provide improves joint stability. That makes it an ideal choice for patients who need substantial joint support.
  • Improved mobility: The TSB KAFOs can improve mobility by providing a stable base of support for the leg helping patients stand and walk more confidently.
  • Custom-fit: These KAFOs are custom-made from a mold of the patient’s leg, ensuring a perfect fit tailored to their needs.
  • Lightweight and durable: Thermoplastic materials are lightweight yet durable, providing patients with a comfortable and long-lasting orthotic solution.


Here are some potential disadvantages of Total Surface Bearing/Thermoplastic KAFOs:

  • Time-consuming fabrication: Creating a custom mold for TSB/Thermoplastic KAFOs can be time-consuming, which may delay the patient’s treatment.
  • Limited adjustability: There is limited adjustability once the KAFO is made. Any changes in the patient’s condition or requirements may require the fabrication of a new orthosis.
  • Difficulty with donning and doffing: Due to the rigid nature of the thermoplastic material, the TSB KAFOs may be more challenging to put on and remove compared to other types of KAFOs.
  • Cost: TSB/Thermoplastic KAFOs are generally more expensive than other types of KAFOs due to their custom-made nature and the materials used in their fabrication.
  • Skin irritation: While TSB/Thermoplastic KAFOs are designed to distribute pressure evenly over the leg’s surface, some patients may still experience skin irritation or pressure sores.

2. Stance Phase Control KAFO

Stance Phase Control (SPC) KAFOs are designed to provide stability and control during the stance phase of walking. They are typically prescribed for patients with weakness or paralysis of the quadriceps muscle, which can cause knee buckling or collapse during weight-bearing activities. 

SPC KAFOs use a combination of mechanical joints and spring mechanisms to provide the necessary support and stability for the patient. They are usually custom-made to ensure a proper fit and function for each patient’s needs. SPC KAFOs are an effective orthotic solution for patients with gait abnormalities caused by quadriceps weakness or paralysis.


Here are s few advantages of SPC KAFOs:

  • Improved gait: SPC KAFOs are designed to provide support and stability during the stance phase of walking, which can improve the patient’s gait pattern and overall mobility.
  • Increased confidence and independence: Patients who use SPC KAFOs may experience increased confidence and independence during weight-bearing activities like walking or standing.
  • Customizable: They can be custom-made to fit each patient’s needs, ensuring optimal function and comfort.
  • Adjustable: The KAFOs can be adjusted as needed to accommodate changes in the patient’s condition or gait pattern.
  • Durability: They are typically constructed using durable materials, making them a long-lasting orthotic solution for patients who require support and stability during the stance phase of walking.


Here are the main disadvantages of Stance Phase Control KAFOs:

  • Limited functionality: SPC KAFOs are designed specifically for the stance phase of walking, which means they may not provide adequate support or control during other phases of gait.
  • Bulky: They can be relatively bulky and may limit the patient’s ability to wear certain clothing or footwear.
  • Cost: They can be more expensive than other orthoses due to their custom design and construction.
  • Maintenance: The KAFOs may require regular maintenance to ensure proper function and fit, which can be time-consuming and costly.
  • Discomfort: SPC KAFOs can be uncomfortable for some patients, particularly if they are not properly fitted or adjusted.

Take the First Step Toward Pain Relief

Knee orthotics have the potential to greatly reduce pain and improve mobility, enabling individuals to maintain an active lifestyle. You can make wise decisions regarding treatment options with the information provided in this guide.

At Align Clinic, we strive to assist patients in selecting the most appropriate option for their needs. Contact us today and we’ll be happy to help you find an optimal solution for your knee pain.