Are Children’s AFO’s (Ankle Foot Orthotics) /SMO’s (Supramalleolar Orthotics) Overprescribed?


Children’s AFO’sAs children’s foot types vary, so do the options of treating them with orthotics. Many conditions children suffer with are justifiably treated with some type of orthotic appliance.  However, are they being over treated with tall braces like AFO’s/ SMO’s or can some other type of orthotic suffice? In many cases, I have found the answer to be yes in both cases. Typically afo’s/smo’s typically require larger sized footwear. Not to mention the visual display of a disability the child has as seen by others as having, but they are cumbersome as well.

One reason for overprescribing may be solely due to financial reasons. That is, even though a foot orthotic may be very adequate and sufficient to treat/control the problem, the insurance company may only pay for an AFO or SMO (supramalleolar orthotic) and not for the foot orthotic. Therefore, the child is prescribed the former. This decision may be made by the parent but is it made by the fabricator? Obviously, the latter unethical but I’ve seen it happen.

Another reason for overprescribing may be a lack of knowledge on the complexity of controlling the foot with just a foot orthotic. Therefore, a complex foot orthotic is bypassed. I typically see this with examination of the child and their afo/smo. The device typically will have a flat bottom with very little medial or inside arch. This, in my opinion, places the child’s foot and leg in a boxed brace, neither repositioning the foot and leg but rather simply maintaining the deformity in its abnormal position, any pain may resolve but this is only due to the foot and leg not being able to move. Is this then placing more of a burden on other joints and muscle structures? I think so. This treatment does not ideally address the complex motions of the foot and leg. Moreover, I see this patient because they are complaining that their afo/smo is painful to wear. I find this is due to the foot and leg are trying to function but cannot due to the box it is placed in. With treatment thru applying TC3-DR technology (total contact three dimensional realignment) with a foot orthotic, the foot and leg are repositioned in their ideal functioning position and the pain resolves. They now have more functional mechanics of walking and running-without the cumbersome, visually impairing device that requires larger shoes.

Finally, prescriptions for these devices are usually required by a doctor or therapist. Unfortunately, the prescriber has little knowledge of the options of treatment, the pros and cons etc. of the devices needed.  This then is typically left to the fabricating practitioner, some whom even lack a college education!