25 February 2020
Jarrod Cahir, one of LOC’s senior orthotists, shares a recent case study that highlights the challenges of KAFO design and manufacturing, and the improvements that a modern KAFO can make to gait and strength.
Recently we had a client attend London Orthotic Consultancy’s Kingston clinic for an assessment of her lower limbs, following her polio diagnosis as a child in Kuwait. This affected the development of her left leg, leading to significantly reduced strength through the hips, knees and ankles, as well as stunting the growth of the foot and limb length. It also meant that she had developed an overreliance on the right leg to compensate and this leg had also become weakened over time. She reported that she needed to hold on to her knee, bent over whilst walking, in order to stabilise her leg with the current brace. On presentation to the clinic, she was sitting in a wheelchair, having not walked in over two years, due to deconditioning and the state of her current Knee Ankle Foot Orthosis, or KAFO.
Over the years, orthotic designs and technology have changed dramatically; from the “Forrest Gump style” steel upright callipers - used to hold the leg straight - to modern microprocessor-controlled, lightweight carbon fibre devices that lock and unlock during phases of the gait cycle to enable improved biomechanics of gait.
Following an in-depth assessment, which evaluated muscular strength and measured discrepancies between the limbs, various types of orthoses were discussed. We needed to consider what the client was accustomed to as a long time KAFO user, as well as set reasonable goals based on her current clinical presentation. We also needed to evaluate the practicalities of living in Kuwait and our ability to troubleshoot modern technology over a geographical distance. Issues arose throughout this appointment in terms of overcoming a significant language barrier and ensuring effective communication. Nonetheless, a plaster of paris cast was taken of the limb, to ensure the bespoke KAFO could be manufactured.
Due to the patients’ long history of use, she was most comfortable with keeping the design as simple and similar to her old orthosis as possible. This meant the use of an ischial seat for weight-bearing at the top of the device, connected to steel uprights with a calf band that clipped into the outside of the shoes to enable some ankle joint movement. The left shoe was raised to align the pelvis and accommodate for the leg length discrepancy, whilst incorporating a knee joint that remained locked when weight-bearing but could be unlocked to enable flexion for sitting. The main difference was the incorporation of carbon fibre around the calf section and thigh, to reduce the overall weight of the orthosis, whilst increasing strength and durability. We also recommended a second brace be manufactured for the right knee, due to the effects of deconditioning, however, the client felt that this leg would be ok and that her main priority was the left.
A plastic trial fitting took place, to assess the fit prior to carbon fibre manufacture. Modifications were made to increase comfort and congruency of the fit, prior to definitive KAFO fabrication, as it is difficult to modify the carbon fibre once the shape has been finalised.
At the definitive fitting, a final measurement to adjust the height of the shoes was necessary to pull together measurements in order to accommodate the leg length discrepancy. Adjustments to trim lines took place to facilitate greater comfort and accommodate patient requests. The client also requested a different locking mechanism, that we could accommodate, incorporating a pull cord rather than a lever mechanism.
Following the fitting and alignment of the KAFO, our client was able to stand and transfer into her wheelchair and took steps for the first time in two years with the assistance of a walking frame. Further strength and conditioning input will be necessary to further improve gait pattern, and this could be expedited with increased orthotic support on the right side. However, we anticipate with the benefit of a well-fitting orthosis and the right motivation additional improvements will be possible.
Find out more about our full range of bespoke orthotics by visiting the LOC orthotics page.
Working with LOC and Elaine has been a great experience – they really take the time to look at your child and understand their individual challenges and needs. For parents who are in the same position that we were, I would say do your research – see what clinics are available near you and what the costs are, but my feeling is it’s worth every penny.
After 10 years of daily physiotherapy and swimming, not to mention SDR, hamstring and tendon lengthening, we have finally achieved independent walking – it was a mother’s day gift that would take some beating.
LOC’s video vector technology measures exactly where Austin’s weight is being distributed, how his hips are moving and how his legs are moving. It’s those insights that have made his new AFOs so effective. Even within a few days, LOC’s splints have had more impact on his independence of movement than anything else we have done.
Since his new orthoses, his change has been remarkable. He is more mobile and can walk independently. Jason is now walking indoors and outdoors and is unrestricted. He is now properly enjoying the summer sunshine for the first time in a few years with no complaints of pain.
It has been a breath of fresh air – LOC’s ability to accommodate Sophie’s circumstances and manufacture her orthotics so quickly has taken a huge amount of potential stress away. Alan talks to Sophie as well - she looks forward to seeing him. He has even been able to fulfil her request to have her SMOs decorated with unicorns! It makes her feel special and much happier about wearing them.
I can now go a mile without having to stop, so it is a lot better and I’m walking in a regular pattern now. The orthotic fits perfectly because LOC took proper mouldings and photographs; they were very thorough.
We have the following facilities and amenities at our Kingston Upon Thames location:
We also have the Gait Laboratory for orthotics patients and Onsite Manufacturing for speedy turnarounds and adjustments whilst you wait.
We have the following facilities and amenities at our Cambridge location:
We have the following facilities and amenities at our Bristol location:
For more information, visit Litfield House Medical Centre.
LOC’s clinic is based in the University of Salford’s Podiatry Department and provides treatments for orthotics, scoliosis, pectus deformities, positional plagiocephaly and club foot.
It is also the base for LOC’s northern OSKAR clinic which is run by Sam Walmsley, clinical director of LOC, in conjunction with Elaine Owen MBE MSc SRP MCSP.
Due to COVID-19, we have had to temporarily close the Salford clinic and are operating out of another clinic in Bolton.
508 Blackburn Rd,
For more information, please visit The Good Health Centre