AFO vs. SMO: Orthotic Treatment Options for Pediatric Patients

Posted by Anatomical Concepts on Jun 20, 2022 4:59:51 PM


Most children, especially younger ones, love to run around and play. But for some, this mobility comes with a price – pain. That’s because a myriad of injuries and diseases cause pain or fear of injury for some children. 

As the physician of your pediatric patients, you’ve undoubtedly seen a variety of diagnoses where mobility is compromised. Treatment options can vary by condition, patient, and other unique factors. 

While surgery can be an effective option for some of your patients, it’s certainly not the only one — especially when treating young patients who are anxious to get up and move quickly.  

One non-invasive and non-surgical treatment option for your pediatric patients is the use of orthotics. Many options can help your patients improve mobility, manage pain, and achieve a favorable outcome. 

Two common brace types used to treat children are SMO and AFO ankle and foot braces. Each has its advantages and applications that will meet your patients’ needs. This blog will discuss both options, including some frequently asked questions.


What Are SMO Foot Braces?

SMO ankle brace stands for Supramalleolar Orthosis and is a type of brace that’s significantly shorter than traditional AFO braces. They are ideal for a child needing a brace that allows more movement and freedom. 

SMO design is very compact but still stabilizes the foot and helps with alignment. These braces are beneficial for children with pronation because of low muscle tone. 

Effective SMO braces shouldn’t tackle ankle issues only by propping them up. Instead, they should also address the forefoot, heel, and arch. Because of their size, SMO braces are mainly prescribed for cases where a child only has issues with their ankles and feet.  

For children with more complex issues, you should work with an orthotist to discuss other options like AFO.  


How to Know If a Child Needs an SMO Brace?

Several key indicators signal whether a pediatric patient needs this type of leg support. Among others, some of them include: 

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


 What Is an AFO Brace? 

AFO stands for Ankle Foot Orthosis and is a taller brace that usually sits just below the knee. There are many different types and use cases for an AFO. For example, they are particularly useful for children who suffer from hypertonia. 

What is hypertonia? It’s a condition where too much muscle tone causes the arms or legs to become stiff and difficult to move. Muscle tone is regulated by signals from the brain to the nerves and tells the muscle to contract. Hypertonia happens when the brain or spinal cord regions that control these signals are damaged.  

Hypertonia limits how easily the joints can move. If it affects the legs, walking becomes stiff, and children may fall because it is difficult for the body to react to regain balance.  

AFOs are also sometimes used to treat children suffering from hypotonia, which is essentially the opposite of hypertonia. Hypotonia is a medical term for decreased muscle tone.  

Typically, muscles have a small amount of contraction that gives them a springy feel and provides some resistance to passive movement even when relaxed. It is not the same as muscle weakness, but the two conditions can co-exist. Muscle tone is regulated by signals from the brain to the nerves and tells the muscles to contract.  

Hypotonia can be caused by damage to the brain, spinal cord, nerves, or muscles. The damage can result from trauma, environmental factors or central nervous system disorders. It can be seen in conditions such as Down syndrome, muscular dystrophy, cerebral palsy, Prader-Willi syndrome or myotonic dystrophy.  


Are There Different Types of AFOs? 

AFO braces are like regular snow boots, except that they’re made from plastic. Depending on your patient’s particular needs, an orthotist could recommend dozens of different types like: 

  • Hinged AFOs – These are applicable for cases where the leg requires slightly more movement and freedom. These consist of two parts and a hinge that helps mobilize and stabilize the foot. 
  • Static AFOs – These are hard and rigid AFO braces suitable for cases where the foot or ankle must remain completely stationary. 
  • Dynamic AFOs – These are similar to static AFOs, except they allow minimal foot movement of the foot. 
  • Low AFOs – These AFOs have a lower reach and only cover the leg up to the ankle. 


How Do I Know If a Child Needs an AFO Brace?

A couple of conditions could indicate that the child is a potential candidate for an AFO. Those include: 

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


Can I Prescribe Both Pediatric AFO Braces and SMO Braces?

Generally, we do not recommend that pediatric patients combine multiple braces unless necessary. As a rule, less bracing is usually better if the patient’s condition allows it. However, in some severe cases, a combination of braces may be the best course of treatment.  



Anatomical Concepts specializes in orthotic solutions for treating both upper and lower extremity conditions. Specifically, we offer a group of devices designed specifically for helping physicians and therapists treat pediatric patients.   

Here’s a look at two of our non-surgical treatment options physicians use as part of their comprehensive treatment plans for pediatric patients.  


EV Orthosis 

The EV™ (Equino-Varus) Orthosis offers positive heel suspension for children during their recovery. It accommodates and helps control varus/valgus conditions of the ankle/foot complex (+ or - 30º). The calibrated settings on the bar allow for a more accurate documentation of the patient's progress. The adjustable anti-rotation bar helps to control unwanted extremity rotation that could cause pain or additional damage. 

The EV™ Orthosis bar works in tandem with our standard AFOs and is extremely useful when used as the distal segment (PKA™ Orthosis) in our custom-made KAFO's or with our prefabricated knee or KAFO systems. 


PRAFO® Ankle Foot Orthosis 


Our flagship product is the PRAFO® Orthosis, which is a fully adjustable, custom fitted AFO that can help manage many of the ankle/foot anomalies your pediatric patients present. 

We have accommodated this line with optional accessories that help complement secondary needs. Our practitioners and designers guide physicians and therapists in choosing the most appropriate AFO system based on patient etiologies, cost and applications.  


Product Features  

  • Clinically proven for effective ambulation*  
  • Controls dorsi-plantar flexion  
  • Infinite measurable adjustments  
  • Custom-contoured, malleable aluminum heel connector  
  • Malleable aluminum anti-rotation bar  
  • Compatible with all liner variations that we offer, if applicable  
  • Proven superior integrity of the superstructure 
  • Available in Adult standard Kodel liner #650SKT, Pediatric standard #550SKG and Infant standard #450RKG  
  • Specific options to enhance alignment and support of the ankle and foot (e.g. VCA™, Plastic stabilizing shell) 


To learn more about all our pediatric patient device options, click here