SMO Brace: Overview, Indications and More

Being told that your child needs an orthosis is difficult to hear for any parent. But learning about the brace, how it works and what it helps with can ease the transition to accepting the diagnosis. 
The SMO brace is safe for kids to use. It’s small enough to go inside the shoe and comfortable enough for your kid to walk, run and play in the jungle gym with it. 
At our clinic, we regularly meet with patients who need the SMO brace. And we also educate the parents on everything they need to know about this orthosis. 
If you’re new to this term then keep reading for valuable information on Supramalleolar orthosis that caregivers should know! 
What Is the SMO Brace? 
SMO or the Supramalleolar orthosis are braces that support the foot and ankle region. We’ve talked about AFOs before and the SMO is very similar to that, but this brace is much smaller than the Ankle Foot Orthosis and ends just above the ankle. 
1. The Structure of the SMO brace 
The Supramalleolar orthosis is made of a mixture of different materials, same as the AFO and other orthotic braces. 
Thermoplastic, acrylic and carbon fiber are the most commonly used materials. 
Although the SMO braces are available off the shelf, most Orthotists customize them to each patient for best results. Since these are prescribed early on in life, you might have to get the SMO brace refitted a few times as your child grows. 
2. Who Should Wear the SMO Brace? 
Children with a poor muscle tone often pronate [turn inwards] their feet when walking and crawling. Supramalleolar orthosis is prescribed for them to improve their walking and to help increase their tone. 
Babies and toddlers with Downs Syndrome, Cerebral Palsy, gross motor delay and such conditions which result in hypotonia often need to wear the SMO brace. 
The duration they’ve to wear the brace for varies according to the level of recovery the Orthotist is going for and the stage of your child’s crawling or walking.
3. What’s the Best Age for Wearing the SMO Brace? 
Often, there’s no specific age to start wearing the Supramalleolar orthosis. But the general rule of thumb is; the earlier the better. 
Your Orthotist will prescribe the brace once your kid begins to bear weight either in standing or walking. Kids can comfortably wear and benefit from it up to the age of 2 or 3 years.  
4. What Structures Does the SMO Brace Stabilize? 
The SMO brace is similar to the AFO. The difference being that the Supramalleolar orthosis only stabilizes the ankle and the foot instead of also the region above the ankle. 
That’s why it’s prescribed for toddlers with a deformity located specifically in or around the foot and the ankle region. 
5. Benefits of Wearing the SMO Brace
Wearing the SMO braces increases your kids’ confidence in walking and balancing themselves. The SMO brace adds to the stability of the ankle and improves the foot muscle tone. 
It aligns the heel in the neutral position which helps develop the arch of the foot.
Indications for Wearing the SMO Brace 
The primary indication for wearing the SMO brace is foot pronation [flat feet] which is due to hypotonia in toddlers. 
Although all toddlers naturally have flat feet because their arches are not yet developed, the kids with pathological flat feet need the Supramalleolar orthosis to compensate for the missing arch. 
If the flat feet condition is not addressed early on, it can lead to several secondary conditions such as knock knees, hip issues and an increase in the spinal curves.  
Here’re the foot conditions SMO bracing is used to correct: 
1. Hyper Pronation or Flat Feet 
Flatfeet in kids is due to the three issues; lack of an arch, heel eversion and toes pointed outwards. 
SMO brace applies pressure on all three regions to bring them towards the midline. Your child has to wear the brace until the ligaments and the arch are strong enough to maintain the correct alignment without the orthosis. 
2. Hypermobile Ankle or Foot 
Hypermobility is due to a laxity of the ligaments that stabilize the ankle. That increased range of movement also contributes to instability in walking. 
The SMO brace controls the range of motion at the ankle and provides external stability to prevent dislocation. Toddlers can balance themselves much better while standing and walking with the help of the SMO brace. 
3. Decreased Muscle Tone (Hypotonia)
The decreased muscle tone in kids prevents them from mastering balance and gait patterns. Using the SMO early on in life helps them develop the muscle strength necessary for walking. 
Proper weight-bearing positions also tend to increase the tone enough to allow your kids to catch up with their milestones and peers. 
4. Congenital Clubfoot Deformity 
The infants’ foot is turned inwards or even upwards in the clubfoot deformity due to a shortening of the tendons. 
The Supramalleolar orthosis along with proper stretching is prescribed to correct the deformity and allow kids to stand and walk normally.  
How Can You Know If Your Child Needs the SMO Brace?
Some deformities are obvious enough for you to realise that your child needs additional help to develop normally. Other times, the signs are much subtle. 
If you notice developmental delays, toe walking or difficulty balancing then you should approach a professional and get a diagnosis. 
The paediatricians perform a full checkup of the babies during each visit. If there’s an issue, that’s when you’ll find out.  
A proper diagnosis should guide your next steps. You can contact an Orthotist to find out which device is best for your child and follow the guidelines s/he shares with you. 
Final Thoughts 
The world of orthosis is scary for most parents, but what helps is having a great Orthotist and a support system to get you through the difficult times. 
Supramalleolar orthosis is used by toddlers all over the world. Most kids grow out of it and live a healthy life with little or no trace of deformity. 
Contact us for a free consultation from our experienced Orthotists and learn more about the SMO brace. We’ve got branches all over the United States so book an appointment at any one of our clinics today. 
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