Casting and Measuring for KAFO

Question 1

Patient preparation

Answer 1

Patient in supine

Rubber tube placed along anterior of leg

Stockinette as high up the leg as possible. Preferably stockinette with some compression.

Question 2

Landmarks and Measurements

Answer 2

Proximal edge of thigh-
Just inferior to trochanter and as high medially as possible without impingement on perineum

Knee center- level of the adductor tubercle. Midpoint sagittally. axis should be parallel to floor.

Other landmarks: head of fibula, medial and lateral malleoli, met heads, navicular. other bony prominences.

ML- knee, malloli, met heads

circumference- proximal and distal thigh, proximal calf, and proximal malleoli

Question 3

Casting

Answer 3

First wrap- from toes to just proximal of the fibular head. Make sure to hold foot in dorsiflexed neutral position. Do not dorsiflex beyond certain point if calcaneus starts to pull into values. wedge later.

Second wrap- wrapped up to proximal thigh section

Question 4

Preparation of the negative cast

Answer 4

Check dorsiflexion- midpoint of proximal medial border should fall between the navicular and met heads.

Question 5

Fitting

Answer 5

Hold off on adding straps until fitting of brace is appropriate.

Thigh section- below greater torch and perineum comfortably.

Anterior opening of thigh- wide enough for donning . Avoid bridging of anterior straps

Distal edge- proximal to patella. should allow 90 degrees of knee flexion.

Knee joint- should provide clearance of skin throughout full motion. medial or lateral control strap may be needed.

Shank and foot section-
Full length toe plate if spasticity or toe curling is a problem, cut to crease if not a problem.

KAFO should be set in alignment that allows GRF to be behind hip joint to provide stability in those with hip weakness.