• (H)KAFO/KO Order Form v5.3

    (H)KAFO/KO Order Form v5.3

    Standard Fabrication 7 Business Days
    • Account Information 
    • Order Information 
    • Today's Date
       - -
    • Requested Due Date*
       - -
    • Device 
    • Modification*

    • Orthosis Type*

    • Standard Modifications Include:

      • Thigh & knee sections modified to given measurements with 6 - 10 mm (1/4 - 3/8") of clearance for double uprights
      • Squaring and leveling the plantar surface of the cast
      • Adding 5 mm (3/16") build-ups to the medial and lateral malleoli. This will increase the overall ML by 10 mm (3/8")
      • Adding 3 mm (1/8") build-ups to the navicular and calcaneal tuberosity
      • Modifying the plantar surface of the cast to a depth of 6 mm
      • If the order calls for a medial/lateral tibial extension to control varus/valgus, a build-up is made to emphasis the extension side but still maintain a 10 mm (3/8") build-up
      • If the order calls for a raised forefoot trimline, 3 mm will be added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups will be added to any marked bony areas

    • Minimum Modifications Include:

      • Thigh & knee sections modified to given measurements with 6 - 10 mm (1/4 - 3/8") of clearance for double uprights
      • Squaring and leveling the plantar surface of the cast
      • Adding 3 mm (1/8") build-ups to the medial and lateral malleoli. This will increase the overall ML by 6 mm
      • Adding 3 mm build-ups to the navicular and calcaneal tuberosity
      • Arches at the plantar surface are NOT modified
      • If the order calls for a medial/lateral tibial extension to control varus/valgus, a build-up is made to emphasis the extension side but still maintain a 6 mm build-up
      • If the order calls for a raised forefoot trimline, 3 mm will be added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups will be added to any marked bony areas

    • Tone Reduction Modifications Include:

      • Thigh & knee sections modified to given measurements with 6 - 10 mm (1/4 - 3/8") of clearance for double uprights
      • Squaring and leveling the plantar surface of the cast
      • Adding 5 mm (3/16") build-ups to the medial and lateral malleoli. This will increase the overall ML by 10 mm
      • Adding 3 mm (1/8") build-ups to the navicular and calcaneal tuberosity
      • Modifying the plantar surface of the cast to a depth of 3 mm
      • If the order calls for a medial/lateral tibial extension to control varus/valgus, a build-up is made to emphasis the extension side but still maintain a 6 mm build-up
      • If the order calls for a raised forefoot trimline, 3 mm will be added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups will be added to any marked bony areas
    • Edema Present*
    • Set Ankle To*

    • Heel Height

    • Hindfoot Correction*

    • Forefoot Correction*

    • Troughing*
    • AFO Section Trimlines*

    • Design 

    • KAFO Options

    • Image field 163
    • Proximal Wings (AFO)*
    • Flares*

    • Condylar Extension

    • Extension Location*
    • Reinforcements

    • Ankle Joints*

    • Dorsi Assist*
    • Plantar Stop*
    • Image field 51
    • Image field 52
    • Foot Plate Length*
    • Midfoot Coverage*

    • Forefoot Coverage*

    • Anterior Shell

    • Anterior Shell Lining*
    • Shell Lining Material*

    • Shell Lining Thickness*

    • Sabolich Trimline
    • Lining/Padding Location

    • When to Pad*
    • Padding Material*

    • Padding Color (Plastazote)*
    • Padding Color (Multi-Density)*
    • Padding Color (Spenco)*
    • Padding Thickness (Aliplast)*

    • Padding Thickness (P-Cell)*

    • Padding Thickness (Pelite)*

    • Padding Thickness (Plastazote)*

    • Padding Thickness (Multi-Density)*


    • KO Options

    • Condylar Extension

    • Extension Location*
    • Lining
    • Lining Thickness*

    • Anterior Shell

    • Anterior Shell Lining*
    • Shell Lining Material*

    • Shell Lining Thickness*

    • Thermoforming 
    • Plastic Type*

    • Plastic Thickness*

    • Finishing 

    • KAFO Finishing

    • Uprights Finish*

    • Knee Joints Under or Over Plastic*
    • Ball Retainers*
    • Straps*

    • Slot Location*
    • Strap Material*

    • Strap Color*
    • Pad Straps*
    • Slider Material*

    • Padding Thickness*

    • KO Finishing

    • Uprights Finish*

    • Knee Joints Under or Over Plastic*
    • Ball Retainers*
    • Straps*

    • Strap Material*

    • Strap Color*
    • Pad Straps*
    • Slider Material*

    • Padding Thickness*

    • Additional Instructions 
    • Guidelines
    • Anatomical Measurements 
    • If a Discrepancy Exists, Go By*
    • Units of Measure*
    • Show Additional Measurements
    • AOPS Billing 
    • Should be Empty: