Supramalleolar Orthosis (SMO)


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An SMO (Supramalleolar Orthosis) supports the foot just above the ankle bone or malleolus.  SMOs are prescribed for patients who have soft, flexible, flat feet (pes planovalgus).  They are mostly worn by children.  The SMO is designed to maintain a vertical, or neutral, heel while also supporting the arches of the foot.  The SMO can help improve standing balance and walking.


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ApplicationSMO (Supramalleolar Orthosis)

  • Apply a cotton sock.
  • Loosen the Velcro straps on device.
  • Spread the plastic which wraps around the top of the foot (dorsal flaps).
  • Slide the foot into the SMO by “scooping” it from behind.
  • Ensure that the foot is properly positioned and the heel is fully seated in the bottom of SMO. It may be easiest to bend the knee to help place foot in SMO.
  • Fasten the instep strap snuggly to hold the foot inside the brace.
  • Put on shoe.

A special shoe is not needed to accommodate the SMO.  However, remove the insert in the shoe to reduce any pressure.  A shoe that is one size larger or wider may be needed.

Wearing Schedule

On the first day, have your child begin by wearing the orthosis for one (1) hour.  After one hour, remove the orthosis and check your child’s skin.  Some slight red marks may be observed on the skin.  These should fade and/or go away completely within 20-30 minutes.  Slight redness is common at the arch, instep, and bony areas of the foot/ankle. If redness does not go away within 20-30 minutes, or if you notice any blistering or bruising do not put the orthosis back on.  Call your child’s Orthotist and schedule an appointment.

On the second day, put the orthosis on for two (2) hours.  Check skin, once again.  Increase amount of wear time an hour each day.  It typically takes 7-10 days to break in the SMO to be able to wear it all day.  Continue to check the skin for any areas of concern.  Have your child wear the SMOs daily to experience the best results.

Cleaning & Maintenance

The SMO may be cleaned by wiping it with a damp cloth.  You may also use rubbing alcohol on the plastic to remove any body oils and residue.  Do not submerge in water as it may harm the metal fasteners and straps.  Also, keep the brace away from excessive heat to prevent damage to the plastic.

If you experience any problems, please contact your Orthotist.