Anatomical Concepts (UK)
Masters of Rehabilitation Engineering
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Opinions, Ideas & News from Anatomical Concepts (UK) Ltd

Posts in Diabetic Foot
The PRAFO and preventing pressure sores

The PRAFO designs of ankle foot orthoses are an effective way of (ideally) preventing or healing pressure sores at the heel. So why are these designs successful in achieving this in both immobile and ambulant patients? The answer to the PRAFO’s effectiveness is very simple - even if understanding how pressure ulcers can develop is complex. In this article we touch on the biomechanics of pressure ulcers.

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Which PRAFO design should I choose?

The original PRAFO design, designated the 650SKG, is the choice to consider when you wish to prevent heel ulcers in a recumbent patient or a patient with compromised mobility. When additional adjustment is required to accomodate contractures and other anomalies around the foot and ankle, the 652SKG and 653SKG provide easy adjustment without the need for special tools. Useful adjustments without compromising heel and ankle protection.

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Preventing heel ulceration with a PRAFO ankle foot orthosis

When we brought the PRAFO ankle foot orthosis to the UK in the 1990’s, heel pressure sores and diabetic foot ulcers were a huge problem for the NHS. Actually they are still a massive problem for the NHS. A major key to prevention is to relieve or ideally eliminate pressure and shear effects. The biomechanics of tissue are complex and this means that it is easier to aim to eliminate pressure and shear rather than use a method which assumes that a particular level of pressure is “safe”. The reason the PRAFO range is so effective for prevention and treatment of heel ulcers is that it cradles and positions the foot and ankle so that there is no possibility of pressure or shear force at the heel.

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Saving the NHS money by preventing pressure ulcers

For decades now pressure sores have been recognised as a serious yet preventable world-wide problem.  Here we are in 2017 and we still are not doing enough to prevent these even though we know who is at risk and we know what factors elevate the risk.  In Scotland, the Diabetic Foot Action Group has been working hard to both raise the quality of care and consistency across Scotland.  As we described in our last article on CPR for the Diabetic Foot, a Scottish system audit identified potential savings of £15 million per year if even 75% of diabetic foot ulcers could be prevented. 

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CPR for diabetic feet?

The NHS in Scotland could save £15m a year by implementing "CPR" for the diabetic foot. An audit organised by the Scottish Foot Action Group has shown the potential impact of taking the prevention of hospital-acquired diabetic foot ulcers seriously. By checking patients feet on admission, protecting the foot if at risk and referring for treatment if necessary. So often pressure relief devices like the PRAFO are looked on as a "cost" when this study clearly shows that using these devices can produce a massive saving both in money and distress when used thoughtfully and appropriately.

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What use is a PRAFO Ankle Foot Orthosis?

Lack of mobility tends to increase the risk of pressure sores and the heel is particularly vulnerable to ulceration. The PRAFO® range is perfect for all patients with compromised mobility and at risk of developing pressure sores at the heel.  It is not the only device on the market now but it still offers the best spread of functionality. When thinking about pressure relief it is important to remember some broader clinical objectives that can shape your choice of device.

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Dealing with pressure ulcers - then and now

The costs of dealing with pressure and diabetic foot ulcers are staggering. Pressure relief orthotic interventions should be more widely understood and used.  We started Anatomical Concepts more than 20 years ago after I saw a great product (The PRAFO Ankle Foot Orthosis) which we still deal with today.  It's not quite as "sexy" as some of the products we deal with, but in terms of it's clinical signficance and impact it is by far the best product range we have.

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