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Clinical Summary: The PRAFO® ankle-foot orthosis suspends the heel to eliminate direct pressure while keeping the ankle in a neutral position. Three independently published clinical studies show it improves gait in patients with hemiparesis, provides clinically useful plantarflexion resistance, and has helped patients with severe diabetic foot ulcers avoid amputation.
Why heel pressure and plantar flexion matter
Patients who spend long periods in bed, recovering from stroke, or living with diabetes and neuropathy are all vulnerable to two related problems: pressure injury at the heel and a tight, downward-pointing ankle called plantar flexion contracture. Once either starts, both can escalate quickly — a heel pressure ulcer can expose bone within weeks, and a contracted ankle makes safe walking and transfers far harder.
Clinicians address these risks by suspending the heel away from the mattress and holding the foot and ankle in a neutral position whenever the patient is resting. When the same brace can also be used for short periods of standing or walking, recovery and skin integrity both benefit.
About the PRAFO® Ankle-Foot Orthosis
The PRAFO® orthosis is a Pressure Relief Ankle-Foot Orthosis designed and patented by Anatomical Concepts, Inc. Its construction minimises direct contact with the bony prominences of the ankle and foot, suspends the heel, and holds the ankle in a neutral position. A removable rubber sole turns the brace into a limited-ambulation device, so it can be used for protected walking as well as bedrest.
The PRAFO® is available in several configurations (650, 650HD, 650APU, 650SS) to match different patient weights, activity levels, and clinical needs.
View the PRAFO® product page →
What the clinical evidence shows
Three independent studies — a 3D gait analysis, a biomechanical comparison of 18 ankle-foot orthoses, and a long-term diabetic foot case series — point to the same conclusion: the PRAFO® orthosis performs across three different clinical jobs.
Hemiplegic gait
Corrects excessive equinus in swing, restores heel contact, and increases knee flexion and step length.
Plantarflexion resistance
Delivers clinically useful resistance in the PFR range (10–16 lb neutral, 20–25 lb from 10° dorsiflexion), with the heavy-duty variant providing stop-level resistance.
Diabetic foot protection
Used over 156–160 weeks of wound care, helped two patients with severe, amputation-threatening ulcers achieve healing.
Featured Studies
Evaluation of the Pressure Relief Ankle Foot Orthosis in Individuals with Hemiparesis Using Three-Dimensional Gait Analysis
Lin RS, Ounpuu S, Oppedisano MJ, Kamienski K
Lin R et al. Journal of Prosthetics and Orthotics. 2009; 21(3): 132–137.
Eight patients with hemiparesis were fitted with a PRAFO® and analysed using 3D motion capture at the Center for Motion Analysis, Connecticut Children’s Medical Center. Of the five subjects who showed excessive equinus in swing during barefoot walking, the PRAFO® corrected ankle position into the normal range (p = 0.029), eliminated toe-first initial contact, and increased step length from 57±7 cm to 63±8 cm (p < 0.024). The study also found an unexpected benefit: increased peak knee flexion in swing, which improved foot clearance even in patients whose ankles were not the primary problem. The authors concluded that the PRAFO®, originally designed for recumbent heel protection, performs well enough to assist functional ambulation.
Plantarflexion Resistance of Selected Ankle-Foot Orthoses
DeToro WW
DeToro W. Journal of Prosthetics and Orthotics. 2001; 13: 39–44.
Eighteen ankle-foot orthoses — eight custom-made and ten prefabricated, including four PRAFO® variants — were tested on an instrumented model using a digital tensiometer. The devices fell into three distinct groups by static plantarflexion resistance at 10°: plantarflexion stop (≥20 lb), plantarflexion resistance (10–16 lb), and non-ambulatory (≤5 lb). The three standard PRAFO® models landed in the PFR group — enough resistance to decelerate foot slap at loading response and keep the toes clear during swing, without locking out the ankle. The heavy-duty PRAFO®-650HD provided stop-level resistance, appropriate when full limitation of plantarflexion is clinically indicated.
Clinical Experience of the Pressure Relief Ankle-Foot Orthosis (PRAFO) — Cases in Diabetic Foot Care
Munro W, Jones D
Munro W, Jones D. Allied Health Professions Clinical Effectiveness and Practice Development Conference, Scotland. First-prize poster, republished 2014.
This case series describes two patients with severe diabetic foot ulceration for whom amputation had been offered and declined. In Case A, a neuro-ischaemic heel ulcer with exposed calcaneum healed over 160 weeks of combined wound care and nightly PRAFO® use. In Case B, a septic ulcer following a trauma-related plaster cast healed over 56 weeks with PRAFO® day and night use, supported by dressings and antibiotics. In both cases the authors note the brace let wound dressings stay accessible and changeable while eliminating pressure and shear at the wound site, and that the orthotic cost was small relative to the overall care budget.
Frequently Asked Questions
What is a PRAFO® brace used for?
A PRAFO® brace is used to relieve heel pressure, maintain ankle alignment, and help prevent plantar flexion contractures. It is prescribed for patients who are bedridden, recovering from stroke, or managing diabetic foot complications, and its rubber sole also allows short periods of protected walking.
How does a PRAFO® prevent pressure ulcers?
It suspends the heel to reduce direct pressure and protect soft tissue. The brace minimises contact with the bony prominences of the ankle and foot so dressings at the wound site remain accessible and can be changed without removing the orthosis.
Can a PRAFO® be used for drop foot after a stroke?
Yes. In a three-dimensional gait analysis study (Lin 2009), the PRAFO® corrected excessive equinus in the swing phase for patients with hemiparesis, restored heel-first initial contact, and increased step length compared with barefoot walking.
What’s the difference between the standard PRAFO® and the 650HD?
The standard PRAFO® (650, 650APU, 650SS) provides plantarflexion resistance in the 10–16 lb range at neutral — enough to assist ambulation without locking out ankle motion. The 650HD (heavy duty) provides ≥20 lb and acts as a plantarflexion stop, appropriate when full limitation of ankle motion is clinically indicated.
Can the PRAFO® be worn with a diabetic foot ulcer dressing?
Yes. The PRAFO® is designed so the wound site is not enclosed, allowing exudate dressings to be monitored and changed without removing the brace. This was central to the two diabetic foot cases reported by Munro and Jones (2014), in which amputation was avoided.
Is the PRAFO® for bedrest only, or can patients walk in it?
Both. The PRAFO® was originally designed for heel protection in recumbent patients, but its posterior structural element and rubber plantar sole provide enough integrity for limited ambulation, including deceleration of foot slap at initial loading.
Related Products
- PRAFO® Ankle Foot Orthosis — product page
- Bariatric AFO
- APU Articulating AFO
- RAPO Ankle Foot Orthosis
Citations
- Lin RS, Ounpuu S, Oppedisano MJ, Kamienski K. Evaluation of the Pressure Relief Ankle Foot Orthosis in Individuals with Hemiparesis Using Three-Dimensional Gait Analysis. Journal of Prosthetics and Orthotics. 2009; 21(3): 132–137.
- DeToro W. Plantarflexion Resistance of Selected Ankle-Foot Orthoses: A Study of Commonly Prescribed Prefabricated and Custom-Molded Alternatives. Journal of Prosthetics and Orthotics. 2001; 13: 39–44.
- Munro W, Jones D. Clinical Experience of the Pressure Relief Ankle-Foot Orthosis (PRAFO). Allied Health Professions Clinical Effectiveness and Practice Development Conference, Scotland. First-prize poster.
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