AFOs vs. SMOs

Camilla,

In MrsK’s “Standing Up” post you said, “If you do decide to get afos/smos (I would tend toward smos). . . ”  Can you give me more information on why you tend toward SMOs.

We are scheduled to get our first set of AFOs in a few weeks.  When I mentioned SMOs to Dr. Doom he smiled, shook his head and said, “Oh no, she definitely needs AFOs,” in a condescending tone.

Why do you tend toward SMOs.  What would be the deciding factor between the two?  Dr. Gloom seemed to indicate that SMOs don’t provide any ankle support.

I would love everyone’s feedback on this.  We meet with Dr. Doom again on the 17th.

Thanks,

TSpar

9 comments

  • I am very interested too. Caroline is not yet braced, but likely will head that direction at next SB clinic on Wednesday. She dorsiflexes both ankles and can stand somewhat flat footed on the right, but stands on her heel (foot in dorsiflexion most of the time) on the left. She does not have clubbed feet or roll her ankles. She has been standing with help/holding onto something since about 6 mo old.
    TSpar – sorry, don’t mean to hijack your post, just wanting to learn 🙂

  • I welcome all hijackers! I’m a hijack-friendly poster! 🙂

  • I always tend toward the less bracing possible to allow the body to move the most naturally. That being said, Claire can not use only smos b/c they are not sufficient to keep feet unclubbed–to maintain the best position for clubbed feet, you would actually have to brace above the knee but I’m just not willing to do that. Also, she just needs more support. Her tendency is to bare weight on the side of her left foot (probably b/c she walked on it clubbed for so long and its still not in a perfect position) and the smos are just too easy for her to manipulate–she needs something stronger.

    On MrsK’s post I said smos because I know Z functions really well and at times they thought she may not need bracing at all.

    Traditional AFOS are actually similar to casts in the sense that they keep the foot in a rigid position and make it so that if there are active muscles below the knee, they atrophy. If I wore an AFO for six months, my muscles would be atrophied. So, if you have a young child (around a yr.) who appears to have some muscle below the knee, I would think that it would be best to try SMOs and to allow time to see how much they are able to use that area.

    But, if you are really not sure which AFOs/SMOs, the safer option is definitely to get AFOs–since most all kids with SB do need at least AFOs. However, you can order a pair of smos from Cascade–they are called leapfrogs–for about 150 and just try them out. And esp. during the time around 1 yr. you may want to try several options and just see what works.

    I will try to download that picture of Claire’s braces that I emailed you TSpar–but you know how I am with technology so you can post it too if you still have it. 🙂 But, you can see in the pictures that her new afos are shorter than her rigid ones. I think even having the afos a couple inches shorter, allows for more movement and I think allows the muscle the chance to work. So, you can always ask the orthotist for shorter afos. Since Claire’s new afos are thin, stop before the toes (SO important), cut back above the ankle, and shorter, they really seem like much less brace than her other pair (which she sleeps in to keep feet from reclubbing) even though they are both afos.

  • That was so helpful, thank you. I will post the pic for you next time I’m at my computer.

    Does anyone know if ped or PT can write scripts for orthotics?

    • Yes, both our P/T and Ped have taken turns writing the script for orthotics. Our orthotist actually tells our ped what is needed most of them time and he just writes it accordingly. Our Orthopedic surgeon is over an hour away at the children’s hospital, so we just use a local orthotist.

  • We see our doctor on the 12th, so I will let you know how it goes. Oddly, and fascinatingly, Z has gone from rolling her feet out, to a strange little pronation where her smaller three toes and part of the outer edge of her foot are off the floor. I suspect some of it may self correct with time, but still want her seen.

    And yes, I’m pretty confident that your pedi can write the script if they and you are comfortable with that. I know some won’t attach least without guidance from a PT, but won’t and can’t are not the same.

  • Tracy & MrsK have you looked at the Sure Step SMOs? They sound similar to what Camilla was describing — open toes, thin flexible plastic, allowing for muscle development and a more normal gait.

    http://surestep.net/smo.php

  • I have seen them and done some minimal reading. They certainly seems like a good possibility.

  • They do seem like a good possibility and something I will check into. We have SB clinic this Wednesday, so I will be asking PT for their opinion. I was originally told that AFOs would be needed in our case as her foot only dorsiflexes but does not plantarflex. However, we have been “walking” with her by holding her fingers and letting her move her legs in a walking fashion and I swear she is putting her feet flat on the ground most of the time. Wait and see, wait and see…that is the name of the game, yes? Oh…and always question everything and look for alternatives 🙂

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