AFO vs. SMO: Which Orthotic Brace Is Right for Your Child?

For children facing mobility challenges, orthotic support can make a huge difference in their development and daily comfort. Ankle foot orthoses (AFO) and supramalleolar orthoses (SMO) represent two distinct approaches to providing lower limb support, each offering specific benefits depending on a child's needs. Selecting between these two options involves careful consideration of the child's condition, developmental stage, and therapeutic goals.

At PrimeCare, we’re here to help. We craft custom orthotic solutions addressing specific mobility challenges. As pediatric orthotic specialists serving New Mexico and surrounding areas, we work closely with families to determine whether an AFO or SMO would best support your child's developmental journey.

An Explanation of Ankle Foot Orthosis (AFO)

An ankle foot orthosis is a type of orthosis that extends from below the knee to the foot, providing stability and alignment to both the ankle area and foot. AFO braces keep the foot in the correct position while supporting weakened muscles around the ankle joint. These devices are especially valuable for children with more pronounced mobility limitations who need substantial support throughout their lower leg.

The design of an AFO specifically addresses issues related to foot drop, ankle instability, and various neuromuscular disorders that affect proper foot positioning while standing and walking. These braces control motion at strategic points, creating more efficient movement patterns and reducing compensatory behaviors that could lead to long-term complications.

Types of AFO Braces

AFO braces come in several variations to address different clinical needs. Each type offers specific benefits depending on the child's condition:

• Solid AFO: Completely restricts ankle movement, ideal for children with severe muscle weakness or spasticity, and provides maximum stability for those with significant foot drop.
• Dynamic ankle foot orthosis (DAFO): Made from flexible, thin plastic that wraps closely around the foot and provides gentle support while allowing more natural movement. Particularly beneficial for children with low muscle tone, sensory issues, or mild instability.
• Hinged/articulated AFO: Features a mechanical joint at the ankle, allows for controlled dorsiflexion and plantar flexion, and benefits children who need stability but have some muscle function.
• Ground reaction AFO: Specifically designed to improve knee extension during the stance phase, transfers ground forces to help stabilize the knee joint, and works particularly well for children who hyperextend or collapse at the knee.
• Posterior leaf spring AFO: A more flexible design that allows plantar flexion, assists with dorsiflexion during the swing phase, and helps prevent foot drop while walking.

When Your Child Might Need an AFO

Children facing certain mobility challenges often benefit significantly from AFO braces. These devices offer targeted support when a child experiences:

• Pronounced drop foot caused by neuromuscular disorders.
• Significant ankle instability affecting walking ability.
• Cerebral palsy that impacts lower limb function.
• Muscular dystrophy requiring structural support.
• Need for substantial correction to maintain proper foot alignment.
• One leg appears significantly shorter than the other due to alignment issues.
• Limited independent mobility requiring more control of the lower limb.

An Explanation of Supramalleolar Orthosis (SMO)

SMO braces extend slightly above the ankle (hence "supramalleolar" or above the malleoli), making them shorter than AFOs. These braces primarily support the foot and ankle without restricting movement at the knee, offering a less invasive option for children who need moderate support.

Unlike AFOs, SMO braces focus primarily on controlling subtalar joint motion and providing medial-lateral stability to the ankle. SMOs allow for more natural ankle movement while guiding the foot into proper alignment. This design makes them particularly suitable for children with mild-to-moderate instability who don’t need as much bracing.

SMOs promote proprioception (awareness of body position) while providing structural support. This dual function helps children develop better motor control and balance as they grow. Many children who use SMOs can transition to less supportive devices over time as their strength and coordination improve.

Types of SMO Braces

There are several variations of SMO braces to address specific needs in pediatric patients:

• Standard SMO: Wraps around the foot and extends just above the ankle, provides moderate medial-lateral stability, and allows for natural ankle movement while supporting proper foot alignment.
• Dynamic SMO: Incorporates flexible materials that respond to movement, allows for more natural gait pattern development, and provides sensory feedback while supporting proper foot alignment.
• Tone-reducing SMO: Features specific pressure points to help reduce high muscle tone, may incorporate special padding or cutouts, and is designed specifically for children with hypertonia.

When Your Child Might Need an SMO

SMO braces are an excellent solution for children with milder stability issues or those who are beginning their orthotic journey. Consider an SMO brace if your child shows:

• Low muscle tone affecting foot position.
• Mild to moderate ankle instability.
• Pronation or supination of the foot.
• Early signs of gait abnormalities that don't involve the knee.
• Need for ankle support without restricting knee motion.
• Ability to walk but with alignment issues at the foot level.
• Developmental delays requiring less bracing but still needing support.

We know you still might have questions. To help clarify these distinctions, we've compiled a comparison table outlining the key features of AFOs and SMOs:

Can an AFO and SMO Be Used Simultaneously?

While most children use either an AFO or SMO exclusively, certain clinical situations warrant combining elements of both orthotic types. For children with complex mobility needs, orthotists may create hybrid solutions incorporating features from both designs.

For example, a ground reaction AFO might be modified with SMO-like features at the foot to address both knee instability and foot alignment simultaneously. This approach works well for conditions like cerebral palsy, where different levels of support are needed throughout the leg.

For children with one leg significantly shorter than the other, combined designs help normalize gait patterns by addressing both structural differences and foot alignment issues in a single custom device.

Making the Final Decision Between AFO and SMO

Choosing between an AFO, SMO, or other types of orthotics involves careful assessment. Consider your child’s needs and functional goals to help make your decision. You should also collaborate with healthcare professionals who can evaluate various factors affecting your child's mobility to ensure you find the right solution.

Evaluation Factors to Consider

Brace selection depends on several key factors that your orthotist will evaluate, including:

• Level of support required: AFOs provide more extensive support extending to the knee, while SMOs focus only on the foot and ankle areas.
• Growth and development stage: For a pediatric patient, considering future growth and motor development remains vital when selecting a brace.
• Daily activities: How active is your child? What activities do they participate in regularly? SMOs generally allow for greater freedom of movement.
• Compliance considerations: Less restrictive devices like SMOs may have better compliance rates with some children.
• Therapeutic goals: What are the specific rehabilitation objectives? Is the brace meant to reduce pain, improve mobility, or both?

Tips for Making the Right Decision

Finding the ideal orthotic solution involves more than just clinical assessments. Here are some practical considerations that can help guide your decision:

1. Consult with a multidisciplinary team: Work with physical therapists, orthopedic specialists, and orthotists to make an informed decision.
2. Consider a trial period: Sometimes, a temporary brace can help determine if a particular style works before investing in a custom device.
3. Prioritize comfort: No matter how therapeutic a brace might be, it won't be effective if your child refuses to wear it because it’s uncomfortable.
4. Think long-term: The best orthotic solution may change as your child grows and their condition evolves.
5. Balance function and cosmetics: Especially for older children, the appearance of the brace can affect their willingness to use it.

Finding Your Child's Perfect Fit

Finding the right orthotic solution for your child involves balancing immediate support needs with long-term developmental goals. AFOs and SMOs have their place in pediatric orthotic care, and many children transition between these devices as they grow and develop.

At PrimeCare, we create customized orthotic solutions that evolve with your child's development. We’re here to help determine whether an AFO or SMO would best serve your child's needs, ensuring they receive support for optimal mobility. We care for each patient like family, and we’re passionate about finding the right solution. Contact us today to schedule a consultation with our pediatric orthotic specialists and take the first step toward improved mobility for your child!