Accessing GRAFOs at Orthotics Plus

GRAFO stands for Ground Reaction Ankle Foot Orthoses.

The GRAFO is a type of orthotic device that reaches around to the front of the knee extending down to the ankle. In contrast, a regular AFO extends at the rear of the lower limb.

The purpose of a GRAFO is to provide mechanically-induced stability to the lower limb. It is characterised by its design, where it aims to maintain the ground reaction force anterior to the knee joint centre, which prevents knee instability and collapse for a patient with quads and/or plantar flexor weakness

A GRAFO alters a person’s lower limb structure to displace load and impact appropriately, as well as minimising knee hyperextension.

Assessments, product fittings and ongoing support are available at both of our Melbourne clinics.

Who Would Benefit From a GRAFO?

A GRAFO is typically indicated when the patient exhibits mild to moderate knee instability.

In most cases, the patients will exhibit weakness in the quadriceps combined with suboptimal plantar flexion (the power to push off the ground).

Our prescription of GRAFOs is typically for people living with a physical or neurological condition such as:

  • Stroke
  • MS
  • Polio
  • MND
  • Hemiplegia
  • Guillain-Barre syndrome
  • Cerebral Palsy

GRAFOs are accessible by children, adults and older adults. A GRAFO could in some cases be considered a more user friendly option before a Knee Ankle Foot Orthoses (KAFO), however there are also patient groups where a KAFO may be a better prescription and a GRAFO isn’t suitable.

GRAFO Assessment & Fitting

The first stage of the process is to receive a full assessment from one of our Orthotists. An assessment should ensure that the prescription of a GRAFO is appropriate before custom-making one.

We offer in house devices which we can trial during your appointment to determine if the GRAFO design will assist you best, before considering if we pursue a custom made design.

If the patient is indicated to benefit from the orthosis, we would begin the process of custom fitting a GRAFO to their leg shape.

At the time of the initial consultation, we would take a cast of the leg with plaster, modify that cast then fabricate the brace from that. The creation process is entirely manual and made by hand.

We precisely locate the straps, the padding, materials, trimlines and other pieces to be conducive with our patient’s individual anatomy.

How Does a GRAFO Work?

Orthotics Plus Heidelberg reception

A GRAFO is a solid orthosis that serves as a strut between the ankle and knee longitudinally, leveraging the large tibia.

The primary objective of the Ground Reaction Ankle Foot Orthosis is improving knee control in a stance (weight bearing) phase.

Newtonian physics tells us that every action has an equal and opposite reaction, when you’re landing on the ground with your foot strike there is a direction of the force opposing that action.

A GRAFO is used to direct this force to create an extension moment at the knee, as opposed to a flexion moment which would be associated with knee collapse/flexion.

Additionally by keeping the ankle at approximately 90 degrees to the tibia and preventing excessive dorsiflexion, we prevent the knee from flexion/collapse when weight bearing. The design of the brace must be strong enough that the dorsiflexion moment at the ankle can be countered by the GRAFO, this will prevent knee flexion and allow a smooth rollover during stance phase.

Once the step is nearly complete the ground reaction force moves anteriorly along the foot and posterior to the knee joint centre, which allows the knee to bend in a controlled fashion and the step to be completed.

During the swing phase of gait, a GRAFO can maintain the ankle at 90 degrees and helps to clear the foot when walking.

Long-Term Benefits of a GRAFO

The usage of a GRAFO may assist people with:

  • Increased stability
  • Increased function
  • Lower falls risk
  • Pain relief
  • To improve the efficiency of gait
  • Improved overall safety
  • Lower injury risk

If you know someone that may benefit from a GRAFO, please contact Orthotics Plus.

Contact Us Call (03) 9077 6414


Approximately one hour or more.

The correct fitting of a GRAFO is a detailed process, we strive to optimise your comfort and satisfaction.

Orthotics Plus will provide written information about:

  • How to take it on and off
  • Relevant information for carers
  • List appropriate footwear to wear with the brace
  • Practical information such as how long to wear the brace, showing, swimming, etc
  • Scheduled reviews
  • Warranty and ongoing support information

Patients are also able to phone us to speak with the orthotists on duty if necessary.

A GRAFO is an umbrella term, meaning that various companies and orthotists can make variations of the design.

The term is not referencing a single product from a single manufacturer.

In the vast majority of cases, we are providing a custom solution made in-house by hand.

We do access GRAFO products from Orthotic and Prosthetic manufacturers who offer products in generic sizes, which you may trial during the assessment or over a short term to indicate viability.

The client is provided choice and control.

The defining factor of GRAFO design is support of the anterior/front section of the tibia.

The ways in which GRAFO design can be customised would be:

  • Material type (i.e. plastic vs carbon fibre)
  • Features (i.e. inclusive of a Posterior Dynamic Element strut)
  • Trimline (i.e. exact location of straps, thicknesses)

When working with Orthotics Plus, we’ll optimise the specifications for you, which is part of our holistic approach.