by Richard J. Feltes
I contracted polio before my first birthday. Although the virus caused paralysis in both legs, I was fortunate that only one requires a full-length leg brace-known within the medical field as a KAFO or Knee Ankle Foot Orthosis. The style of leg brace fitted to me in the early 1950s, which I continued to use for over 50 years, was essentially the same that Franklin Roosevelt used in the ’30s and ’40s-stainless steel uprights joined by leather covered steel bands. A strapped leather pad stabilized the knee, and a brace shoe attached to steel uprights rounded out this tested—but rather dated—orthosis.
Over the years, after frequent breaks in the uprights, knee joint, and foot stirrup, I periodically asked my orthotist about advances in leg brace technology. He was reluctant to recommend a plastic leg brace because of my history of frequent breakdowns and the general difficulty in changing bracing systems for older, post-polios. So it was until my friend and fellow post-polio, Kim Pollock, visited my home in September 2001. I’ve known Kim since our collegiate days at the University of Illinois, where we competed in wheelchair athletics. Kim was elated over his new plastic/metal hybrid orthosis, crafted by Glenn Ham-Rosebrock, Co., at Beverly Hills Prosthetics & Orthotics, Inc., in Van Nuys, California. Ham-Rosebrock, a post-polio orthotist, spent years perfecting innovative, lightweight, and comfortable KAFOs using the latest components.
After listening to Kim’s testimonial on the improved comfort and stability of this updated leg brace technology for postpolios, I decided to take the plunge. My wife provided invaluable encouragement by pointing out, “It’s now or never!” Within a few months, I secured the necessary insurance approval and was on my way to California.
This article is intended to convey what I learned in making the transition to a modern orthosis so that other people who are post- polio may benefit from my experience.
Advantages of Plastic/Metal Hybrid Brace
I’m experiencing greater comfort, improved stability, and a reduced profile under my pant leg. The brace goes on and off easier and faster and is lighter than my previous brace. The absence of leather eliminates the need for replacement with age and wear. Pressure from knee pad straps, which in some cases reduce circulation when standing and/or sitting, is eliminated.
A gentle, one-finger tug on the cable release, located seven inches above the knee, unlocks the brace. Minor buildups can be placed on the bottom of the molded footplate allowing use of normal shoes. I’m experiencing far fewer breakdowns than with the traditional aluminum brace with stainless steel knee joints. Annoying squeaks while walking are eliminated.
For me, the advantages of the plastic/metal hybrid leg brace more than compensate for the multiple fittings, added expense, and temporary discomfort during break-in.
Components
My new brace consists of a molded polypropylene thigh shell, Becker stainless steel uprights, an Otto Bock wedge-lock titanium knee joint with spring-loaded cable release, a plastic pre-tibial shell, and a molded polypropylene foot plate with a double-action ankle joint. My orthotist underscored that Becker makes the best stainless steel uprights on the market and that the top-of-the-line Otto Bock titanium knee joint would virtually eliminate the breakage that plagued my aluminum brace with stainless steel knee joints. Springs in the posterior aspect of the double-action ankle joint prevent my “drop foot” from dragging. The anterior channels of the ankle joint have steel pins that stop the leg from going forward during ambulation, which helps stabilize the knee.
I’m very glad I chose the Otto Bock knee joint (although some insurance carriers will not pay for a titanium joint). The extra security and longevity of a top-of-the-line knee joint has been well worth the additional expense.
Sizing and Fitting
Older people who are post-polio do not readily adapt to new bracing systems. Thus, if you decide to invest in a plastic/metal hybrid orthosis, be mentally prepared to do whatever it takes to complete a successful transition. Your odds of success will increase if you start by outlining a plan with your orthotist on the best way to merge the benefits of a plastic/metal hybrid orthosis with the overall set up of your existing leg brace (i.e., lift-on foot plate, knee flex, ankle rotation, etc.).
The fitting process of a plastic/metal hybrid orthosis begins by taking a mold of your leg, which is then filled with plaster to create a model that is used for shaping the polypropylene shells and metal components.
In my case, a separate plaster cast of the foot was taken to serve as a model for forming the plastic foot plate. In other cases, the leg and foot are cast together.
The next phase of the process, fitting and adjustments, requires patience, persistence, and plenty of positive attitude by the patient and orthotist. Both parties must display a spirit of trust and commitment. Know that fitting a new KAFO to “mature” post-polios is difficult even for experienced orthotists. You’ll expedite the transition if your orthotist can duplicate the position and elevation of the foot as closely as possible with your original orthosis.
In my case, I have both a pelvic tilt and shorter leg which, together, require a sizeable lift. We initially tried to place all of the necessary elevation on the bottom of the plastic footplate instead of duplicating my existing design, which splits the rise between my footplate and external shoe. Once we duplicated my prior elevation scheme, the process of adjustment and adaptation proceeded in an orderly manner.
Major modifications should be tackled before moving onto minor adjustments. Then start wearing your new orthosis for one to two hours a day. Keep scheduling appointments with the orthotist (or return the brace by a delivery service such as UPS®) until a reasonably accurate fit is achieved. Have confidence that your leg will adjust to the new orthosis as usage is gradually increased. Within a few weeks you’ll be enjoying a superior bracing system and wondering why you didn’t make the change earlier.
Helpful Hints
• Ask your orthotist for stainless steel uprights if your brace undergoes repeated stress. Although somewhat heavier than aluminum, steel provides extra strength, rigidity, and reliability.
• During initial fittings, be sure the orthotist leaves enough material to increase the depth of the upper thigh shell if you feel pressure on your thigh when sitting or driving. I had the thigh shell depth increased on both of my braces.
• Rather than securing the foot in the plastic foot plate with a strap, consider pulling a stretchy sock over both your foot and plastic foot plate. You’ll find that a sock over the foot orthosis is not only more comfortable, but it also conceals the stainless steel uprights. Wrap the double-action ankle joints with black electrical tape to avoid tears if you go the sock route.
• Sheering of copper rivets is the only problem I’ve encountered thus far. Ask your orthotist to secure both the tibial and thigh shells to the uprights with stainless steel rather than copper rivets.
• If you wear a thigh sock (highly recommended) be sure to install a small strip of sticky backed Velcro® (the prickly side) on the external outside top of the thigh shell to secure the thigh sock (which is folded over the top of the thigh shell).
• Be sure to request beige-colored material for the two straps located on the upper thigh shell and calf, as beige straps stay cleaner than white.
• Wear lightweight 100% polyester long underwear if you are annoyed by perspiration on the upper thigh shell. REI Item Number 705476 is an excellent product and is available in a variety of sizes at www.rei.com.
• Finally, to avoid damage to your clothing, cover all rivets with small strips of adhesive Velcro (plush side).
Maintenance and Backup
Preventative maintenance will reduce the odds of untimely breakdowns. I would suggest returning your brace to the orthotist twice yearly for lubrication, rivet check, and thorough inspection of all working parts. Between brace shop checkups, some orthotists recommend applying a drop of bicycle shop oil monthly to the ankle joints and Door-Ease, available at auto supply stores, to the ankle joint springs. I prefer applying Door-Ease to all moving parts in the ankle joint to prevent oil from staining carpets and clothing. You may wish to order a back-up brace, so be sure the orthotist saves your leg/foot cast.
After completing all the necessary adjustments on my new brace and experiencing the many advantages of a modern KAFO, I decided to order a back-up leg brace. I took the initiative of meeting with my company’s health insurance officer with a physician’s note in hand underscoring the importance of a back-up orthosis in maintaining a consistent work schedule.
Final thoughts
The change from a conventional to a metal/plastic hybrid leg brace takes time, patience, and commitment from all parties. I can attest to the challenge, but feel strongly that the payoff is worth the effort. An orthopedic doctor I consulted during my transition summed it up best by emphasizing the importance of “regularly reinventing yourself.” Leg brace design and materials have come a long way since the 1950s-all you need to do is enter the transition process with a determined attitude to “reinvent” your walk.
One last item-my successful transition to a modern leg brace was aided by the prayerful support of family and friends-consider asking the Almighty to lend a hand as well.
A modern KAFO can improve your quality of life! Good luck!
Contact Info
My new plastic/metal hybrid leg braces were made by Beverly Hills Prosthetics and Orthotics, Inc, 15230 Burbank Blvd., Suite 103, Van Nuys, CA 91411- contact Keith Vinnecour at 818-988-0033, visit www.bhpoinc.com or e-mail keith@bhpoinc.com.
Tom Lottermoser at Ballert Orthopedic- 1250 N. Mill Street, Naperville, IL 60563, has performed expert adjustments and repairs on my leg braces. A great craftsman in Illinois for making orthopedic shoe modifications is Frank Sorrentino at Montclare Shoe Repair, 7181 W. Grand Ave, Chicago, IL 61707-773-637-3872. Frank follows well-written instructions to a “T” and will return your shoes promptly via UPS.
Rich Feltes lives in Lisle, Illinois, and can be contacted at rfeltes@refco.com.
I HAVE BEEN TRYING TO BE FITED FOR A KAFO SINCE JUNE WITH NO RESULTS. IS THERE ANYONE IN THE DETROIT AREA ABLE TO MAKE THE BRACE YOU DESCRIBE? IT SOUNDS PROMISING.