In order for most patients with paraplegia to stand in KAFOs, how should the tibias be positioned relative to the ground?

For patients with paraplegia using Knee-ankle-foot orthoses (KAFOs), positioning the tibias in a few degrees of relative dorsiflexion is crucial for maintaining stability and promoting optimal alignment during standing. In this position, the line of gravity is aligned appropriately, which helps to prevent the orthotic joints from buckling under the patient’s weight.

Dorsiflexion assists in shift control of the center of mass, enabling better balance and effective use of the orthotic supports. It also facilitates the alignment of the hips and pelvis, favoring a more upright posture while utilizing the KAFOs. This configuration allows for the most functional standing position, aiding in weight bearing and facilitating rehabilitation and mobility efforts.

In contrast, if the tibias are positioned in neutral or flexed positions, or even in relative plantarflexion, it may compromise stability and alignment. A neutral position could lead to difficulty in maintaining an upright stance, while plantarflexion could result in excessive anterior sway or tendency to fall forward, thereby undermining the purpose of the KAFOs in providing support. A flexed position could place excessive stress on the knee joint and lead to instability, making standing challenging. Thus, relative dorsiflexion is