Pediatric AFOs vs SMOs - Which One Is Better for Your Child?

Does your child have some mobility issues and you’re considering investing in a brace, but don’t really know where to start or which one to choose? We’re here to help.
As a general rule, always consult with your orthotist before making decisions based on articles and blog posts. 
However, if you’re impatient and would like to explore your options before the orthotist appointment, we’ll give you a brief rundown of the two very popular brace types - AFO and SMO ankle and foot braces.
What Is an AFO Brace?
AFO stands for ankle foot orthoses and it is a type of brace that is quite tall and usually sits just below your knee. There are many different types and use cases for an ankle foot orthosis brace. For example, they are particularly useful for children who suffer from hypertonia.
AFO braces resemble regular snow boots, except that they’re made from plastic. Depending on your particular needs, you can choose between dozens of different types, such as:

• Hinged AFO - suitable for cases where the leg requires slightly more movement and freedom. It consists of two parts and a hinge which helps with mobilizing and stabilizing the foot.
• Static AFO - very hard and rigid AFO brace type that’s suitable for cases where the foot or ankle have to remain completely still and movement-free.
• Dynamic AFO - similar to static AFO, with the exception that it allows minimal movement of the foot. Also very strong and rigid.
• Low AFO - AFOs with a lower reach, only covering the leg up to the ankle.

How to Know If My Kid Needs an AFO Brace?
There are a couple of key indicators that show whether your child is a suitable candidate for this type of ankle orthosis. Those include:

• Hypertonia
• Hypotonia
• Foot, knee, and ankle instability
• Contractures
• Foot drop

General Tips for Using and Fitting an AFO Ankle Brace
If you’ve decided that an AFO foot ankle brace is a good fit for your child, then there are some things you should be aware of before you purchase a pair. Let’s go in-depth about important aspects of buying and wearing an AFO brace.
First, decide whether you’d like to buy an AFO brace directly from the store shelf, or if you’d like a customized pair. When you go in to buy AFO braces, the first thing to expect is customized fitting. The expert will make a cast of your kid’s ankle and foot to ensure that the fit is correct and comfortable. This part of the process lasts about 15 minutes per leg.
Most companies nowadays offer some sort of additional customization to make the brace more fun and interesting for your child. Who likes boring white braces anyways? You can add custom colors, elements, and patterns before the production process, or you can add stickers and stick-on jewels once the brace is ready.
Once it’s time for your kid to start wearing the brace, we recommend avoiding ribbed and short socks. They can cause irritation and damage the skin. Socks with seams can also cause friction issues and irritate the skin. Your best bet are plain seamless socks that reach up at least to their knees.
What Are SMO Foot Braces?
SMO ankle brace stands for supramalleolar orthoses and it is a type of brace that’s much shorter than traditional AFO braces. They are suitable for situations where your child may need a brace that allows more movement and freedom.
SMO design is very compact, but in a way that still stabilizes the foot and helps with its alignment. These braces are especially suitable for kids with pronation that is usually a consequence of lower muscle tones.
Good SMO braces shouldn’t only tackle ankle issues by propping it up. Instead, it should address other aspects like forefoot, heel, and the arch.
Because of their size, SMO braces are particularly suitable for cases where a child only has issues with their ankles and feet. If your child’s issues are more complex, you might want to consider other options or pairing the SMO brace with another device like AFO or derotation steps.
How to Know If My Kid Needs an SMO Brace?
There are a couple of key indicators that show whether your child is a suitable candidate for this type of leg support. Among others, some of them include:

• Foot instability
• Ankle instability
• Hypotonia
• Pronation 
• Hypermobility

Can I Use Both Pediatric AFO Braces and SMO Braces?
As a general rule, you shouldn’t combine multiple braces unless it’s absolutely necessary. Less bracing is usually better, as long as your child’s condition allows it. However, in more severe cases, a combination of braces might be your best bet for success.
So yes, you can also combine AFO and SMO braces. A large number of companies even offer a combined solution where you can use both of these braces simultaneously or individually, and adjust it to your child’s daily needs.
Where Can I Get Pediatric SMO and AFO Orthotics?
The world of orthotics does seem daunting at first. With so many different options and use cases, it’s understandable to be confused and unsure as to what is your best option. Because of that, we highly recommend working with a team of orthotists to ensure that your child is taken care of properly.
Our team at Align clinic is here to help with anything you might need. Book a free consultation call with one of our experts to see whether AFO or SMO is a better option for your child. We have offices all over the United States - drop us a visit.