AFOs vs. SMOs: What’s the Difference and Which One Does My Child Need?
If you’re a parent exploring orthotic options for your child for the first time, you’re not alone—and you’re in the right place. The world of pediatric orthotics can feel overwhelming, especially with all the acronyms and unfamiliar terms. Two of the most common types of braces used for kids are AFOs (Ankle-Foot Orthoses) and SMOs (Supramalleolar Orthoses). But what are they exactly, and how do you know which one is the right fit for your child?
Unsure if your child may need orthotics? Take our one-minute quiz for further guidance.
Related: Five Signs Your Child May Benefit From Orthotics
What Are AFOs?
AFO stands for Ankle-Foot Orthosis. These orthotics extend from just below the knee down to the foot, supporting the ankle and foot in a more comprehensive way.
AFOs are used for children who:
Have muscle weakness or tightness that affects how their foot or ankle moves
Walk on their toes or have excessive toe walking
Experience poor balance, frequent tripping, or falling
Have conditions such as cerebral palsy, muscular dystrophy, or hypotonia
Need help keeping their foot and ankle aligned while walking or standing
What AFOs Do:
Help stabilize the foot and ankle
Prevent or reduce toe-walking
Improve balance and walking patterns
Reduce fatigue and allow for more efficient movement
Support proper alignment to encourage safe mobility
What Are SMOs?
SMO stands for Supramalleolar Orthosis. These braces stop just above the ankle bones (the malleoli) and are smaller and less supportive than AFOs—but that’s by design. SMOs provide more flexibility and are intended for children who need moderate support at the ankle but do not need full leg bracing.
SMOs are used for children who:
Have low muscle tone (hypotonia)
Struggle with foot and ankle alignment (like pronation or flat feet)
Are late walkers or have poor balance
Collapse inward at the ankles or show rolling of the foot
Don’t need control at the knee or higher up the leg
What SMOs Do:
Provide stabilization at the ankle to prevent rolling in or out
Encourage proper foot alignment
Improve balance and confidence with walking
Support better posture and coordination in movement
Which One Does My Child Need?
The answer depends on your child’s unique needs, strengths, and movement patterns. An experienced orthotist will evaluate your child’s walking (gait), alignment, muscle tone, and strength to recommend the best orthotic option.
You might hear a recommendation for:
SMOs if your child is still learning to walk or needs help with balance and ankle alignment
AFOs if your child’s walking is significantly impacted or they need more structured support
In some cases, children may start in AFOs and transition to SMOs as they gain strength, or vice versa. Orthotics aren’t one-size-fits-all—and they’re not forever. They evolve as your child grows and develops new skills.
Related: From First Steps to Big Strides: How Orthotics Help Kids Reach Their Milestones
Final Thoughts
Orthotics like AFOs and SMOs are incredible tools that help children gain mobility, confidence, and independence. Understanding the differences between them is a big step in advocating for your child’s needs.
Still not sure which one is right? Our team is here to help. At Baby Bear Clinic, we specialize in evaluating your child’s movement and recommending the best support to help them thrive. Whether you're just beginning this journey or seeking a second opinion, we’re here for you every step of the way.
Schedule a consultation today and let’s take the next step—together.