Knee / Ankle Foot Orthoses (KAFO / AFO)

Specialized devices designed to provide support, stability, and improved mobility for individuals with various conditions affecting the lower limbs.

Support

AFOs, are orthopedic devices that provide support and alignment to the ankle and foot. AFOs play a crucial role in enhancing quality of life.

Lightweight

Made from lightweight materials such as plastic or carbon fiber and are designed to fit the individual’s unique needs and measurements.

Custom

Custom made to a patient’s limb or custom-fit based on diagnosis and presentation. Worn inside the shoe or as a standalone, depending on the user’s needs.

Silicone Ankle Foot Orthosis brace with Revo Closure

Benefits of K / AFOs

Knee / Ankle Foot Orthoses (K / AFOs) are invaluable devices that have transformed the lives of individuals with mobility challenges. From improving mobility and balance to enhancing comfort and facilitating rehabilitation, AFOs play a vital role in enhancing the quality of life for people of all ages.

Improved Mobility

KAFO / AFOs are designed to compensate for muscle weakness, joint instability, gait abnormalities, or a combination of these. They can also be used to reduce pain that affects mobility. They allow individuals to walk with greater ease and confidence. By providing support and alignment, AFOs help improve balance, reduce the risk of falls, reduce pain and enhance overall mobility.

Rehabilitation and Recovery

KAFO / AFOs are often used as part of a comprehensive rehabilitation program for individuals recovering from stroke, spinal cord injuries, or other neurological conditions. They assist in retraining muscles, improving balance, and facilitating the recovery process.

Enhanced Comfort

Custom-made KAFO / AFOs ensure a personalized fit, minimizing discomfort and pressure points. They are designed to distribute weight evenly, reducing strain on the joints and muscles. Additionally, advancements in materials and design have led to AFOs that are lightweight, breathable, and more comfortable to wear for extended periods.

Correcting Gait Abnormalities

KAFO / AFOs can help correct gait abnormalities such as foot drop, equinus, or excessive pronation. By providing the necessary support and alignment, AFOs promote a more natural and efficient walking pattern, reducing fatigue and improving overall gait mechanics

Types of AFOs

(can be used in KAFO designs)

Static – Restrict motion in all 3 planes of the foot and ankle complex.

Solid AFOs

These AFOs provide maximum support and stability and are commonly used for individuals with severe muscle weakness or joint instability. Solid AFOs immobilize the ankle and foot, preventing excessive movement and promoting proper alignment. This design can be utilized for night time stretching braces as well. This design aids in holding the ankle foot complex through the night to stretch calf muscles.

Tone Inhibiting

These AFOs elevate toes 2-5 to unlock the midfoot and aid in propulsion of the foot through gait. Indicated for patients with hypertonicity and impaired control of the ankle and knee.

Dynamic – Lesser degree of restriction and allows for store energy storage and release throughout the gait cycle.

Articulated AFOs

These AFOs have hinged or flexible components that allow limited movement at the ankle joint. Articulated AFOs are often prescribed for individuals who require some degree of ankle movement while still benefiting from support and stability.

PLS

These AFOs aid in limb clearance during the swing phase of gait. This design incorporates dynamic materials and trimlines that store and release energy during walking. They assist in propelling the foot forward and reducing increased energy expenditure caused by compensatory gait patterns.

Conventional Metal and Leather AFO

These AFOs incorporate articulating ankle joints that attach between the heel and sole of a patient’s shoe. Springs or pins are utilized in the ankle joints to store and release energy during walking and prevent unwanted motion.

Technology and Personalized Care

With advancements in technology and a focus on personalized care, KAFO / AFOs continue to evolve, providing individuals with greater independence and the ability to navigate the world with confidence. Our skilled Orthotists will evaluate each patient and determine the best choice of KAFO / AFO design and materials for each patient’s unique needs. In conjunction with our in house fabrication capabilities our clinical and technical teams work together side by side to ensure the best possible outcomes.

3D Printing

The advent of 3D printing technology has revolutionized the production of AFOs. It allows for precise customization, faster production times, and the ability to create complex designs that optimize comfort and functionality.

Ottobock C-brace photo Black and Gray custom KAFO

Sensor Technology

Some lower limb orthotics now incorporate sensors and microprocessors that can detect changes in gait and adjust the level of support accordingly – similar to microprocessor prosthetic knees. This technology enables real-time adjustments, providing a more natural and responsive walking experience. These are currently limited to KAFO’s. The C-brace and Tectus Microprocessor-controlled KAFO’s measure patients’ flexion of the knee joint and its angular acceleration. This brace responds in real-time to aid in the user’s current walking phase. This brace is indicated for individuals with diagnoses such as post-polio syndrome, multiple sclerosis, incomplete spinal cord injuries, muscular dystrophy, spina bifida. Candidates must be properly evaluated to see if they are candidates for this device.

Click here to learn more about the C-Brace.

Lightweight Materials

AFOs made from lightweight materials such as carbon fiber or prepreg offer improved strength, durability, and comfort. These materials allow for a more streamlined design, reducing bulkiness and facilitating a more natural gait.

1. Prepreg: This material is a carbon fiber matrix pre-impregnated with resin. This better controls resin content and distribution allowing for a lightweight device and more control over biomechanical features of the orthosis. Depending on the chosen fiber orientation and layers of material, the clinician can accomplish varying degrees of flexibility or rigidity of the device. Read more about Pre-preg here.
2. Resins: There are now multiple types of resins used in conjunction with prepreg that allow increased rigidity or flexibility control of the finished product. Areas of volume fluctuation can be accommodated with flexibility while areas that require more control can be stiffened.

Bioness L300Go Plus system for Foot Drop and Knee Instability

Functional Electrical Stimulation (FES)

This is a technique that applies small electrical charges to a muscle that has become paralyzed or weakened due to damage in the brain or spinal cord. Examples include stroke, traumatic brain injury, spinal cord injury and neurological disorders. This device is commonly used on those with drop foot or dorsiflexion weakness.

To learn more about FES devices, click here.

AFO STYLES

General Category	Pros/Indications	Cons/Contraindications	Additional Info
Prefabricated Plastic	Quick fit for rehab Easy diagnostic tool Best for acute situations	Limited spasticity Does not accommodate unique anatomy Not ideal for long term use	Usually a PLS or Semi-Solid style
Prefabricated Carbon	Sagittal Instability/weakness (drop foot or knee buckling) Lightweight material	Frontal plane instability Limited spasticity	PLS, Spiral, or Anterior shell usually with flat footplate Options for contoured footplates available Different strut stiffnesses/side placement exists between brands
Custom Molded Plastic	Accommodates unique anatomy for intimate fit Accommodates high spasticity/contractures	Intimate fit does not accommodate large swelling changes	Wide variety of styles/trimlines available Requires casting and fabrication
Custom Fab PrePreg	Accommodates unique anatomy for intimate fit Slim lightweight design Can customize strut stiffness/placement	Limited adjustability to shape of brace Sometimes requires a check brace during fitting process	Wide variety of styles/trimlines available Requires casting and fabrication
TurboMed	Able to be worn on the outside of shoe Does not require specific shoe styles Can be changed easily from shoe to shoe Trial kit is easy for diagnostics	Higher profile build outside of shoe Different shoes need to be similar in style Sometimes need to drill holes in shoes for the clip to anchor	Clips are zip-tied to shoe to allow the brace to attach Brace comes with 5 clips
Silicone	Can be high realism Can be worn with or without socks	Not as durable as other materials Decreased function compared to other materials	Requires casting and fabrication and painting sessions for high realism
FES	Helps with upper motor neuron disorders Slim design Does not have to wear bracing inside of shoe Training mode can help break spasticity and have lasting results without the stim	Can not be used with lower motor neuron disorders High spasticity Pregnant Does not tolerate stim Weakened skin Mental cognition	Usually not covered by insurance Requires charging of device Need to replace electrodes once worn
Conventional Metal and Leather	Metal and leather constructions with caliper built into shoe Minimal contact with skin: Good for volume fluctuations T-Strap can be added to help with ankle varus/valgus Can adjust ROM and forces in ankle joints	Heavier and bulkier Shoes need to be customized to secure caliper Shoes can wear out causing unwanted motion Joints need to be maintenance Limited to one style of shoes	Usually used for patients who have a lot of swelling or have had the same or similar bracing in the past Made off of a tracing of the limb and measurements
Posterior Leaf Spring (PLS) AFO	Low Profile Sagittal instability/weakness (foot drop) Allows for DF in terminal stance Limited PF in swing phase	Triplaner instability Quad or hamstring instability	Plastic (Custom and Pre-fab) Carbon (Custom and Pre-fab)
Semi Rigid (semi-solid) AFO	In between stiffness of PLS and Solid Can help with mild quad and hamstring weakness (Buckling or Hyperextension)	Requires more control of ankle and knee Does not accommodate swelling very well	OTS Plastic Custom Plastic
Solid AFO	Full control of ankle and foot in all planes Can be quad or hamstring weakness (buckling or hyperestension) Night time braces for static stretch to prevent/stretch contractures	Good strength and ROM Does not accommodate swelling very well	Custom Plastic Custom Carbon
Articulated AFO – Free Hinge (Richie Style)	Frontal instability Allows full ROM in frontal plane Increased ML stability over ASO (Lace up Brace) Can be made to allow night time wear with stretching straps for contractures	Sagittal instability Need to find shoes to accommodate braces	Custom Plastic Custom Carbon
Articulated AFO limited motion	Usually used with need to stop Plantar flexion – full Dorsiflexion ROM PF stop used to stop or limit knee hyperextension Can add a Check Strap to help limit the amount of DF	Does not accommodate swelling very well Need to find shoes to accommodate braces	Custom Plastic Custom Carbon
Toe Walking AFO	Pediatric only Usually articulated with a plantar flexion stop at 90 deg. Adjustable over time	Can sometimes use toe walking SMOs if mild Need to find shoes to accommodate(Billy Shoes are a great option) Severe PF contractures may require different style of AFO	Usually custom plastic due to growth
Ground/Floor Reaction AFO	Provides posterior push on the proximal tibia to prevent knee flexion Crouch gait Quad weakness Custom, can provide contoured foot plate for increase ML control	Knee hyperextension Strong quads	Custom Plastic Pre-fab Carbon Custom Carbon

If you or a loved one could benefit from the support and mobility-enhancing properties of AFOs, a Westcoast Brace & Limb specialized orthotist can provide a free evaluation to determine the most suitable option for your specific needs.

Discover the possibilities that AFOs offer and take a step towards a more active and fulfilling life.

Contact us to learn more