First, let’s discuss what an SMO is. SMO stands for supra malleolar orthosis – a brace designed for the foot and ankle that stop just above the malleoli or the prominent boney aspects on either side of the ankle. SMOs are designed to provide support to the foot and ankle for children with low muscle tone or whose feet/ankles collapse inwards. In this photo, you’ll notice there is a cut out behind the foot to allow room for the Achilles tendon to stretch and shorten while walking.
Toe walking SMOs are a modification of a general SMO designed to provide support to the feet/ankles and encourage a more typical gait pattern for those that walk on their toes. Toe walking SMOs do not physically block plantarflexion or the pointing down of the foot, but rather provide a kinesthetic reminder or tactile cue to keep the heels down at the posterior aspect of the ankle. In the photo, you’ll notice there is not a cut out behind the foot, but a higher extension of the brace where that kinesthetic reminder occurs.
So who is appropriate for toe-walking SMOs? Toe walking SMOs are designed for those that walk on their toes 30-60% of the time, but can obtain a flat foot when cued and can achieve at least a neutral ankle position or 0 degrees of dorsiflexion range of motion. Those with hypertonia, plantarflexion contractures, or spasticity are not appropriate for toe walking SMOs, however, other orthotics devices are available. For the best outcomes, toe-walking SMOs should be used in conjunction with physical therapy and/or sensory integration therapy to promote gait development.
For more information, contact your local orthotist or set up a consultation with a pediatric physical therapist.
Blog by: Katie S. DPT, PT
