What is a contraindication for using a GRAFO?

A GRAFO, or Ground Reaction AFO (Ankle-Foot Orthosis), is commonly used for patients with conditions that affect their ability to bear weight adequately through the ankle and foot, while providing support and stability. When considering the contraindications for the use of a GRAFO, one key factor is the structural stability of the knee, particularly regarding ligamentous support.

Medial knee ligamentous insufficiency poses a significant contraindication for GRAFO use. The design of the GRAFO is conducive to offering stability and controlling foot position during movement, but if there is an insufficiency in the medial knee ligaments, this could lead to excessive lateral forces during weight-bearing activities. Such instability can increase the risk of further injury or complications as the GRAFO may not provide adequate support at the knee to prevent valgus or varus deviations, resulting in a lack of proper alignment and potentially worsening the patient's condition.

Other conditions, such as weakness in the quadriceps, fixed equinus deformity, and fluctuating muscle tone, though they present management challenges, may not inherently preclude the use of a GRAFO while adjustments or accommodations could be made to address these specific issues. For example, the GRAFO may still assist