KAFO for knee valgus
mollypitcher
Description
Collection
Title:
KAFO for knee valgus
Creator:
mollypitcher
Date:
1/16/2004
Text:
Dear List,
Here's my original message. Thank you kindly for your replies. I have not included any names but appreciate the range of responses.
Dear list, An 88 year old woman with severe weightbearing knee valgus has been referred to me. I suspect this is a long standing problem although now she has pain. The valgus is correctable with moderate effort and there are no foot deformities. She is not obese but has minimal hand strength. I'm wondering about list experience with the Generation 11 KAFO with your very elderly patients. This problem cannot be solved with a KO. I will need to go with a KAFO. Have some ideas but am open to your suggestions. Thanks for your help. Molly Pitcher CPO
>I have used the G2 KAFO several times for the problems you describe and had good success. The other desirable factor in using an all inclusive orthosis is your Medicare code;s / numbers are readily paid rather than playing the add on game using part pre-fab, part custom.
>Many elderly patients will reject a KAFO. I have had improved outcomes
through the use of a Post Op KO. When the patient experiences good results
and comes back because the KO is worn out, I can then, talk to them about a
dbl upright KAFO. It's an example of the old 'bait and switch game.
>With Medicare as a primary, you will possibly not get reimbursed for a KAFO
if her diagnosis is knee related only. This has become an issue that has not
won on appeal.
>I've not been very happy with the AFO portion of the Gen II KAFO's I've
done and have had to replace them on several occasions. I would look into
the possibility of having the knee section fabricated and added to your AFO.
>I had a lady, slightly younger, but with a similar problem. I used a Townsend KAFO with excellent results. I did however have to rework the footplate a bit for comfort. The carbon epoxy used for the structure can not be adjusted easily, if at all, so casting and modification process needs to be particularly carefully done. I pre-padded all boney prominences prior to casting to ensure exact fit.
>How active is this woman? At 88 she could be really active or inactive. I'd
base my design on her goals, ADL and compliance. Also, what is her bracing
history? If you come out with a G2 kafo she may object because of size. If
she's had a knee sleeve with hinges or something then the G2 may be an
easier sell to her. I see a lot of these types of patients and you really
need to be upfront with them regarding all aspects of bracing particularly
what the brace will AND WON'T do.
>If she can tolerate the pressure for correction, I would consider a Oregon laminated KAFO. It is strong and lightweight, plus I assume she has some rotary concerns as well. The problems I have had with the Generation II is that it rotates one the lega nd does apply the corrective forces in the correct plane.
>A few comments on the G2 KAFO:
As central fabricated by the manufacturer the quality and fit is < adequate most of the time. Whoever does the cast mods and trimlines often don not accurately reflect the shape of the limb as well as the alignment.
A flexible thigh cuff and only one upright by themselves do not seem to capture and control the femoral side of things, esp if the patient is tall or obese.
Would a full plastic KAFO w polycentric kneejoints (O.B. 17B46, for example) and aggressive footplate molding (like OOS techniques) be of any benefit?
>I have never used the G2 kafo for the reason that I believe the distal section is like a PLO trim. This design does not control the internal rotation you want to control with a severe valgus knee. I have found that you must have a Gaffney style ankle to control the rotation, otherwise the brace will rotate with the leg.
>I've had mediocre success with the GII Kafo. Not rigid enough to support
the internal rotation during walking. I've used the OOS Kafo with good
success, even with the elderly.
>G2 KAFO
>I have tried the Gen II KAFO and also used the Townsend. I prefer the
Townsend with a corrective strap approx 2 1/2 to 3 above patella. The
Townsend is lighter and 3 times stronger. They can also have a very nice
trigger release system.
>Please be careful if you try to use the Gen II Kafo for this. I have
seen a few patients fitted by the Gen II rep and have had to replace them
with custom plastic Kafo's on 4 occasions. They will tell you that the
Gen II Kafo will work fine, but not in the case of a really severe
deformity. They are ok for mild OA but not more. My last one was a
failed total knee. I cast then bring the medial trim of the lower
plastic up over the medial condyle with the hinge outside that. It's
worked fairly well.
>Townsend Design has a KO with a single upright extension down to a heel cup
or foot plate. The premier fabrication gives a lightweight, cosmetic and
very durable orthosis. You pay for the cost of the KO plus an additional
$200 or so for the extension down to the foot. Ask if they can use the new
low profile TM5 hinge on the brace, too. It brings the weight down a couple
ounces, and you won't have a thick joint along the medial aspect of the
knee. (800) 432-3466 Ask for the premier AFO/KAFO department.
>I do not have experience with the Gen 2 KAFO but have seen many of this body type and alignment. I personally would want to fab this myself, or at least in house, so it could be remade easier than dealing with an outside vender. I have very seldom fit this type of person with a KAFO and had it work the first time. It is easier and I have more control if I can make modifications before the orthoses is remade.
Here's my original message. Thank you kindly for your replies. I have not included any names but appreciate the range of responses.
Dear list, An 88 year old woman with severe weightbearing knee valgus has been referred to me. I suspect this is a long standing problem although now she has pain. The valgus is correctable with moderate effort and there are no foot deformities. She is not obese but has minimal hand strength. I'm wondering about list experience with the Generation 11 KAFO with your very elderly patients. This problem cannot be solved with a KO. I will need to go with a KAFO. Have some ideas but am open to your suggestions. Thanks for your help. Molly Pitcher CPO
>I have used the G2 KAFO several times for the problems you describe and had good success. The other desirable factor in using an all inclusive orthosis is your Medicare code;s / numbers are readily paid rather than playing the add on game using part pre-fab, part custom.
>Many elderly patients will reject a KAFO. I have had improved outcomes
through the use of a Post Op KO. When the patient experiences good results
and comes back because the KO is worn out, I can then, talk to them about a
dbl upright KAFO. It's an example of the old 'bait and switch game.
>With Medicare as a primary, you will possibly not get reimbursed for a KAFO
if her diagnosis is knee related only. This has become an issue that has not
won on appeal.
>I've not been very happy with the AFO portion of the Gen II KAFO's I've
done and have had to replace them on several occasions. I would look into
the possibility of having the knee section fabricated and added to your AFO.
>I had a lady, slightly younger, but with a similar problem. I used a Townsend KAFO with excellent results. I did however have to rework the footplate a bit for comfort. The carbon epoxy used for the structure can not be adjusted easily, if at all, so casting and modification process needs to be particularly carefully done. I pre-padded all boney prominences prior to casting to ensure exact fit.
>How active is this woman? At 88 she could be really active or inactive. I'd
base my design on her goals, ADL and compliance. Also, what is her bracing
history? If you come out with a G2 kafo she may object because of size. If
she's had a knee sleeve with hinges or something then the G2 may be an
easier sell to her. I see a lot of these types of patients and you really
need to be upfront with them regarding all aspects of bracing particularly
what the brace will AND WON'T do.
>If she can tolerate the pressure for correction, I would consider a Oregon laminated KAFO. It is strong and lightweight, plus I assume she has some rotary concerns as well. The problems I have had with the Generation II is that it rotates one the lega nd does apply the corrective forces in the correct plane.
>A few comments on the G2 KAFO:
As central fabricated by the manufacturer the quality and fit is < adequate most of the time. Whoever does the cast mods and trimlines often don not accurately reflect the shape of the limb as well as the alignment.
A flexible thigh cuff and only one upright by themselves do not seem to capture and control the femoral side of things, esp if the patient is tall or obese.
Would a full plastic KAFO w polycentric kneejoints (O.B. 17B46, for example) and aggressive footplate molding (like OOS techniques) be of any benefit?
>I have never used the G2 kafo for the reason that I believe the distal section is like a PLO trim. This design does not control the internal rotation you want to control with a severe valgus knee. I have found that you must have a Gaffney style ankle to control the rotation, otherwise the brace will rotate with the leg.
>I've had mediocre success with the GII Kafo. Not rigid enough to support
the internal rotation during walking. I've used the OOS Kafo with good
success, even with the elderly.
>G2 KAFO
>I have tried the Gen II KAFO and also used the Townsend. I prefer the
Townsend with a corrective strap approx 2 1/2 to 3 above patella. The
Townsend is lighter and 3 times stronger. They can also have a very nice
trigger release system.
>Please be careful if you try to use the Gen II Kafo for this. I have
seen a few patients fitted by the Gen II rep and have had to replace them
with custom plastic Kafo's on 4 occasions. They will tell you that the
Gen II Kafo will work fine, but not in the case of a really severe
deformity. They are ok for mild OA but not more. My last one was a
failed total knee. I cast then bring the medial trim of the lower
plastic up over the medial condyle with the hinge outside that. It's
worked fairly well.
>Townsend Design has a KO with a single upright extension down to a heel cup
or foot plate. The premier fabrication gives a lightweight, cosmetic and
very durable orthosis. You pay for the cost of the KO plus an additional
$200 or so for the extension down to the foot. Ask if they can use the new
low profile TM5 hinge on the brace, too. It brings the weight down a couple
ounces, and you won't have a thick joint along the medial aspect of the
knee. (800) 432-3466 Ask for the premier AFO/KAFO department.
>I do not have experience with the Gen 2 KAFO but have seen many of this body type and alignment. I personally would want to fab this myself, or at least in house, so it could be remade easier than dealing with an outside vender. I have very seldom fit this type of person with a KAFO and had it work the first time. It is easier and I have more control if I can make modifications before the orthoses is remade.
Citation
mollypitcher, “KAFO for knee valgus,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/222331.
