AFOs vs. SMOs – Help! Thoughts?
As many of you know, we have been struggling with our AFOs. They hinder Pooka’s crawling & standing. Because she lacks adductor muscles, the AFOs act like long rigid levers that cause her hips to swivel into unnatural positions.
But she can’t stand properly without them. Can’t live with them, can’t live without them! 😉
Without them, she stands on the tops of her feet/sides of her ankles. (Look Tracy, no pants!)
When we correct her foot positioning, making them flat, her feet instantly roll outward (supinating).
So I thought, maybe SMOs would be a better option for her. She is strong, has hip & knee flexors and is highly motivated. It seems like she would have more control over a smaller orthotic, like a SMO *and* it would allow for more natural movement. It seemed like a great choice all around.
But all the SMO websites list supination as contraindicated. And my question is WHY? If supination is just the opposite problem to pronation (that’s probably oversimplifying things), why would they not make a SMO for supination too? Does anyone know why?
Or even better, what functional/structural level/problem would make one need AFOs over SMOs?
Just so you know, when I asked my ortho about SMOs, he instantly rolled his eyes, made a scoffing noise and said, “No, she definitely needs AFOs!” Helpful, right?
I would really appreciate all of your insights.
Thanks so much.