Hear you will find some commonly asked questions about the PRAFO range of
orthoses - as well as our own answers of course.

The term PRAFO® stands for Pressure Relief Ankle Foot Orthosis - a family of devices manufactured by Anatomical Concepts Inc and developed since 1995 into a family of orthotic products.
 

1. What is a PRAFO®?

2. Do other companies make PRAFO’s?

3. What are the main applications?

4. I’ve seen cheaper devices that look similar to yours - why should we use yours?

5. Won’t the metal upright damage the persons other leg?

6. There is a slim bar on the calf section - what is this for?

7. What about options? Choices of liner styles?

8. What about sizes?

9. Who uses the PRAFO®?

10. Can you demonstrate what the devices can do?

11. Where can we buy PRAFOs?

12. References

What is a PRAFO®?

The term PRAFO® stands for Pressure Relief Ankle Foot Orthosis - a family of devices manufactured by Anatomical Concepts Inc and developed since 1995. The adjacent image shows the "original" 650 PRAFO Orthosis developed to provide pressure relief at the heel whether the client is recumbent or ambulant

Do other companies make PRAFO’s?

N0 - The term PRAFO® is a registered trademark and shouldn’t be used to refer to anything other than our products.  The PRAFO® range are patented and trademark registered products because we know that they have benefits that rival products cannot claim.  If you compare a rival product side by side with a PRAFO® you will understand this.

What are the main applications?

There are actually a broad range of applications and you will find a page later that lists many of them.  You will see that these devices are very versatile.

In simple terms, the PRAFO® range is perfect for all patients with compromised mobility at risk of pressure sores at the heel.  Lack of mobility tends to increase the risk of pressure sores and we all know that the heels and malleoli are vulnerable.  Whether a patient is in bed or in a wheelchair, pressure sores at the heel are important to prevent and difficult to treat.  These devices ensure ZERO pressure and shear at the heel - eliminating the main cause of ulceration.

Research suggests that whenever the risk of pressure sores at the heel is high, it is vital to take ALL pressure, and particularly shear force, off the area.  NO device that touches the area can do this.

The PRAFO® range is particularly impressive because they are the only designs on the market that can serve to protect when a patient is immobile and continue to protect when the rehabilitation process requires mobility.   The design ensures that the patient is protected around the vulnerable areas of the foot and heel and will remain so during ambulation.

The structure was designed from the outset to allow safe ambulation and still keep vulnerable areas protected.  It’s integral walking base gives good stability and security.  Many rival products have a detachable foot base that is insecure and puts the patient at risk.

I’ve seen cheaper devices that look similar to yours - why should we use yours?

Product cost is always important but make sure that you really compare like - with like.  As you know, prescription should be made on the basis of clinical effectiveness.  Think about what you actually expect a product to do and then first of all identify products that meet that requirement.  The PRAFO® range of products are competitively priced with features that mean you only pay for the benefits you need.

Some other devices are certainly cheaper and do not have the same level of mechanical stiffness as our products.  
Our products have a metal upright section where all other designs are plastic.  This ensures that ours has a mechanical stiffness that is vital for effectiveness.

This mechanical stiffness is also important when there is a tendency for a deformity/contracture to develop - where the foot/ankle/toes become fixed in a plantarflexed position.   This makes the achievement of walking at some later date very difficult.  Also if the structure is not stiff enough, even movement of the patient can be enough to flex the device and place pressure on vulnerable tissue areas.

What has always been important with the PRAFO® is the ability to eliminate pressure at the heel, have sufficient mechanical stiffness to prevent contracture development, but most of all to allow the patient to be safely mobilised with the device. This allows limited ambulation as part of rehabilitation and ultimately wider-range ambulation whilst remaining protected.

Won’t the metal upright damage the persons other leg?

We have never had any episodes of this happening and we have supplied thousands of these devices around the world since 1996.  On the other hand, if you use a “plastic” splint, the risk of a patient developing a contracture or pressure ulcer is much greater than with the PRAFO®.

There is a slim bar on the calf section - what is this for?

When the device is being worn by a recumbent patient this bar can be positioned medially or laterally to prevent the leg rotating and putting pressure on the malleoli.  It’s present if you need it.  If you don’t need it, it can be left in the vertical position or easily removed.

What about options? Choices of liner styles?

There are quite a few variations of the PRAFO®.  There are choices you can make about the style of upright and the liner - both colour and type.
The original PRAFO® - the 650 - has a curved metal upright section and can be supplied with different liners or as a “pad & strap” version.  The pad and strap version allows bulky wound dressings to be accommodated and can allow superior foot control when the PRAFO® is to be used in walking training and other circumstances when mobility is the primary focus.  The range also includes the 650APU and the 650D.  The APU version allows precise control of the degree of plantarflexion/dorsiflexion and the 650D version provides both plantarflexion/dorsiflexion and valgus/varus positioning of the foot and ankle.

What about sizes?

We have a wide range of Adult products and the key variations are available as Paediatric and infant products.  The sizes are adjustable and work for left and right so you have no complex stock holding requirements.

Who uses the PRAFO®?

Quite a number of different healthcare professions coordinate the use of the PRAFO® in their organisations.  To some extent, who is most involved depends on the application area. 
When we first started to work with the range in 1996 we primarily worked with orthotists and coordinated the use of the devices in a hospital setting along with Tissue Viability nurses.  One of our own specialities has been diabetic foot care and this has often resulted in our working alongside the podiatrist, nurse specialist, orthotist and doctor as part of a coordinated  care plan.  All members of the team need to understand how and why these devices are used and how they fit in with everything else that goes on.

As we have broadened the application of the PRAFO into areas such as stroke rehabilitation, the physiotherapists have started to play a leading role.  By very early application following a stroke, therapists have realised that the PRAFO can resist contractures developing through abnormal tone and they can take advantage of the devices to get patients standing and moving early in recovery to facilitate the rehab process.

Can you demonstrate what these devices can do?

We welcome the opportunity to support you through in-service training and other opportunities.  As we use these devices ourselves clinically, we do have “hands-on” experience to share.  We will leave you to decide how you might benefit.

Tell me about your company?

Established in 1996, Anatomical Concepts (UK) Ltd was founded by clinicians, engineers and business professionals.  As part of a group of three companies in related areas of rehabilitation, we are well placed to serve clients with diverse and complex needs.  The company designs, develops and distributes innovative and clinically effective healthcare solutions on an international basis.  The core products we offer are widely used in rehabilitation - whether in a hospital or home environment.
Based in Clydebank Scotland, Anatomical Concepts works with distribution partners throughout Europe and directly with hospitals, other care providers and private individuals.  The products and services we offer aim to improve the quality of life of people affected by conditions such as stroke, diabetes, spinal cord injury, arthritis and multiple sclerosis.
The company directors work closely with clinicians such as orthotists, surgeons, therapists, podiatrists and nurse specialists to ensure that our products are effective and refined in practice.
Cross appointments with University and research organisations have always allowed us to maintain awareness of emerging technologies and concepts.  We are represented at conferences and seminars around the world and recognised for our own research and educational expertise.

Where can we buy PRAFOs?

Contact us for details.  We work with distribution partners across the UK.  The range is on the SFD19 contract for NHS supply in Scotland.

References

Munro, WAM (2005) “Orthotic prescription process for the diabetic foot” The Diabetic Foot, Vol. 8, No 2 p72, Summer 2005
Munro WAM, Jones D,  Stang D Benbow S (2005) “Clinical experience of the PRAFO in the management of the diabetic foot”  First Prize Poster Presentation, Allied Health Professions Clinical Effectiveness Meeting, Polmont, Scotland
Edmunds, ME; Foster, AVM (2006) “ABC of Wound healing: Diabetic foot ulcers”BMJ 2006;332;407-410
Munro WAM, Jones D,  Stang D (2006) “Clinical Effectiveness of the PRAFO - Diabetic for ulcers” BAPO Magazine, Feb 2006
Munro, WAM; Stang, D; Jones, D (2007)  “Clinical effectiveness of the PRAFO® - Diabetic foot ulcers” Orthopaedie Technik, p114, Feb 2007
Jones, D; Sealey, R; Munro WAM (2007) “Effective orthotic management and stroke”  1st Prize Orthotic Paper, BAPO Congress, Bolton 2007

For copies of articles and other published papers please contact our office