Development of a muscle group around the ankle may determine whether your baby will be able to walk on his/her own. A Surestep SMO is one of many external devices that gently wrap around your baby’s lower leg. It is an orthosis that helps your baby take those first steps.
Babies usually stand on their own and walk between 12 and 18 months. If baby is too unstable to do either, a good pediatrician suggests a pediatric neurologist. An SMO may help your baby take first steps. An SMO stands for Supra Malleolar Orthosis. It is designed to help support weak dorsal muscles and associated areas so your baby can walk.
The basic SMO is similar in design to an Ankle Foot Orthosis (AFO) that adults wear. It is a reinforced plastic sleeve that attaches to the ankle and is fastened with Velcro.It does not cure a possible condition but adds support to help make walking possible for those who can not support themselves/ The Surestep SMO is usually the most recommended device for babies.
I use an AFO called ToeOff BlueRocker to help me walk with mt muscular dystrophy impairment. I can’t walk without it.
David Zwicker, a certified orthodist, at Prothotic Laboratory in New York. He suggested the ToeOff AFO as an alternative to the one my physiatrist prescribed. He was right. Upon trying one of these ultralight carbon graphite devices, I was able to walk smoother than I had in previous years.
An SMO and AFO are particularly helpful with foot drop when your foot moves abnormally due to weak dorsal muscles at the juncture of your leg and foot.
Consequently, an SMO and an AFO have certain inabilities based on a wearer’s condition. Walking stairs and doing simple to complex maneuvers are difficylt. Falling in these may cause considerable damage to the supported area that is “caged” in the brace support. SMO and AFO are braces, albeit products using modern technology.
Controlling consequences, Surestep SMO suggests seeking out a competent orthodist (such as David Zwicker) who can help adjust the Surestep SMO for maximum comfort, usability, and performance. Many pediatric neurologists aren’t aware of the nuances of these devices.
A pediatric neurologist focuses on development delay of your baby. The practitioner also considers hypotonia or poor muscle tone.
Many pediatric neurologists connect with rehabilitation specialists. The key specialist is a physiatrist, a medical doctor that deals with helping muscle and limb structure and movement.
Unlike an AFO, the basic Surestep SMO is designed to be least invasive for your baby, as an integral part of the shoe. As such, muscle tone may improve as the baby walks more.
A Surestep SMO targets babies with muscle and angular improprieties as a device that helps move development along. At 18 months, most babies overcome the need by age 3.
After age 3, your pediatric neurologist may advise exploration of advanced and genetic testing that may point to dystrophies of muscles or some neural conditions. At any rate,
Basically, the Surestep SMO is an ideal way to aid walking movement and improved muscle tone with gait for most babies that may require it. It is a rather common neuromuscular problem with a variety of solutions.
Braces have evolved in leaps and jumps since those bulky ones that Forest Gump wore as a child. Can it be a challenge? Among those children who have walking diffriculties, an SMO or AFO is a major boost for healthy walking and social development.
Whether the origin of “If the shoe fits, wear it” comes from Cinderella, the saying can be traced over two centuries. At those times, shoes were exclusively for feet. Today, thanks to certain medical technologies, people with mobile impairments can choose shoes that fit. Unfortunately, if you are wearing a brace for leg and ankle support, many shoes intended for feet alone do not fit. If they do initially, they wear out rapidly. There are new support braces for children and adults that benefit many incurable conditions. Finding a standard shoe to fit a foot with a brace is often very complicated. You don’t have to wait for a fairy. Knowledge, research, experience and a medical professional motion support team can help.
When the cobbler cobbled his first shoe, it was intended for one foot in each shoe. They may not have been comfortable but they were sturdy and protective from rough terrain. For years, any form of brace, prosthetic or orthotic placed in the shoe with a foot would stretch the leather and the shoe-last would not last.
Shoes and sneakers do not adapt or wear well with braces also inserted with your foot. In addition, many brace users can’t jump over puddles or maneuver easily around them. Walking on smooth surfaces is almost or more challenging than hiking in the woods. A recent class of more supportive hiking boots may help people who rely on braces for degrees of mobility. Low-cut models with flexible midsoles are excellent for day hiking. Materials impact a boot’s weight, breathability, durability and water resistance. These may offer stiffer but comfortable ankle support. They may be the comfort match for brace wearers or those seeking more support than ordinary shoes provide. Low-cut hiking shoes are available virtually everywhere shoes are sold. If the shoes fit, they will wear well with or without a brace.
Wearing a shoe with an AFO or Ankle Foot Orthosis, a new term for a supportive brace, means you’re using the shoe beyond its expected intent. Most shoes will not withstand this use.
An AFO is a form of brace that supports and aids a common joint action called dorsiflexion. Dorsiflexion of the foot is sometimes referred to as dorsiflexion of the ankle. Flexing the ankle joint so that the underside of the foot rotates upwards. That is, the upper surfaces of the toes (including the toe nails) move towards the shin bones at the front of the lower-leg. Many are born with diseases that disallow those muscles (or associated nerves) to function normally. An AFO is added to the foot and lower leg. Both are inserted in a shoe.
Can you necessarily go to any shoe store or order online for a pair of shoes to fit a brace or AFO? Many will find it a stupefying task. You might have to opt for orthopedic or custom shoes that, for many, are not insured and beyond affordability. Furthermore, these custom shoe designers are usually podiatrists or orthopedists. They are often ignorant of what AFO is and how it works.
Many AFO manufacturers recommend and warranty each AFO foot brace for use with sneakers. Most sneakers are soft and these can stretch rapidly to the point of instability. Yet there is more to this dynamic. Weight and foot-size are two significant variables that can quickly damage ordinary shoes. Few AFO manufacturers are aware or recommend low-cut hiking shoes.
Among the best patients for an AFO are children that are low in weight. Children want to be mobile and AFO is a form of brace that helps support ankle and lower leg muscles that are necessary.
The ToeOFF KiddieGAIT is among the more popular AFO braces that many pediatric therapists prescribe. This brace offers dynamic technologies that help children rise and move from wheelchairs and walk.
The Allard KiddieGATE is a dynamic AFO and is very different than the brace you might have seen, such as the ones Forest Gump wore in the movie. Those are static braces. Static AFOs are devices that hold joints in constant position and are made of rigid materials.
Dynamic AFOs have varying types including hinged, articulating, static progressive or inhibitory. The dynamic components may be based on materials, mechanical joints, exertion of forces on joints, freedom of joint motion, or inhibitory influences to properly guide foot motion to simulate a normal gait.
David Zwicker, New York orthotist with Prothotics labs, indicates that dynamic AFO devices are helping children find mobility in varying degrees, based on their conditions. There are many more to choose from. Zwicker, among many other caring orthotists, understand that mobility is very precious to people at any age. Orthotists strive to use and explore technologies that help find the best and most comfortable fit to deliver the best mobility possible. In some cases, physical therapy aids in using the AFO devices more effectively.
Lighter body weights do allow a brace and foot to fit more sturdily in shoes and sneakers. Low-cut hiking shoes may add a little more stability while allowing other muscles to stretch and perform properly.
Adults with an AFO, on the other hand, over 175 pounds, bear more pressure that compromises the fit and durability of most shoes and sneakers. As adults age, calf to ankle muscles become more limited across genders and more complaints rise of walking issues. Over the course of ages 40 through 80, compromised dorsiflexion increases although sometimes related to other joint muscular problems.
Then there are adult-onset nerve and muscle diseases that wear nerves and/or muscles more rapidly, such as multiple sclerosis and muscular dystrophy.
Passive adults over 60 experience normal muscle wear and require additional support from shoes. You find New Balance sneakers more prevalent on normal aging feet, without braces. Some wear over-the-counter orthotics for
There’s a drop-off of how aging people might treat drop-foot dorsiflexion. They use canes, walkers, and power scooters. Many are unaware of what an AFO brace is, Very few are stubborn enough to want to stand and walk. That may be why fewer elect a brace and fewer than that choose an AFO.
Heavier bodies, larger feet, heavier feet, and an AFO can stretch almost any ordinary shoe, including leather or synthetic New Balance sneakers.
Hiking shoes are more rigid but an AFO foot brace doesn’t comfortably fit in a boot. It can fit in hiking shoes just at the ankle, and not tied to the top.
Brands like Oboz Footwear, The North Face, and Merrell make low-cut hiking shoes that are more likely to properly support an adult foot with a dynamic AFO brace in a shoe, while allowing dynamic natural foot movement in accordance with the brace.
AFO users have very case specific support needs. Avoid shoes that offer special supports for normal people. Some offer 3–5mm thick inserts are sandwiched between a boot’s midsole and outsole to add load-bearing stiffness to the midsole. They vary in length; some cover the entire length of the midsole, while others only cover half. There are also Plate supports –
thin, semiflexible inserts are positioned between the midsole and the outsole, and below the shank (if included). They protect ordinary feet from getting bruised by roots or uneven rocks. Most AFO wearers are more likely to be concerned about walking smooth hills or slightly bumpy surfaces. This is why use of a cane is helpful to avoid accidents.
Hiking shoe brands are not on many AFO brace manufacturer recommended lists and, in some cases, may nullify a replacement warranty. Consult with your prescribing health practitioner.
If you are an adult who wants to retain upright mobility and a choose a brace for support, then a low-cut hiking shoe is a lightweight alternative to flimsy sneakers. Remember that NO SHOE was designed for a foot and a brace and, as an adult, using a brace places you in a minority. Do not use a shoe for more than 3 consecutive days and switch to another. None of these shoes will last long under daily use. All will be more dependable than sneakers.
Nothing is better than stable, healthy muscles. An AFO helps people who can’t move as a helping aid. Ask a physiatrist for a recommendation. Ask you user to customize it for your comfort, Competent, professional orthotists like David Zwicker, can help you adapt and optimize a new pseudo-active lifestyle.
If the brace and shoe fit then wear it with AFO but make sure your shoe provides the support you need. A foot, an AFO device and a shoe must work in concordance. People with neuromuscular mobility problems need the assurance that fit and support must coexist for better mobility degrees, when nerves, muscles, or both can’t do the job.
Orthopedic trauma is an unforeseen life-changing event. Sometimes it goes beyond fractures to nerves and muscles. Sometimes it’s genetic or a symptom of a disease. It may not be orthopedic at all. The results and the traumatic quality of life deviations may have psychological consequences but you don’t need a psychiatrist. You may need another medical specialist. Ever hear of a physiatrist?
Sometimes personal outcomes depend on the choices you make. Often, the menus are limited. In a reality of physical aches and pains that dishearten even the heartiest. There are often overlooked options. When it comes to bones, nerves, and muscle interactions, physiatry or PM&R are often overlooked as a therapeutic means for body aches, pains, and mobility issues.
In medicine, there are many specialists. Knowing the right specialist may mean a great deal as to how a problem is diagnosed and treated. For broken bones, you might seek out an orthopedist. For nerve pain, a neurologist may be fine. For foot aches, a podiatrist might have answers. Bones ache? Try a chiropractor. These are all disciplines for ache and pain therapy. The one specialty that is ignored is that of a physiatrist.
Physiatrist? You must mean psychiatrist! A Physiatrist is a physician who has trained in an accredited program in the specialty of Physical Medicine and Rehabilitation (PM&R), which established board certification in 1947. This specialty seeks to restore a person’s functional capacity to the fullest extent possible. The major divisions of the field are musculoskeletal medicine, inpatient rehabilitation, and electrodiagnosis (EMG).
One day I chanced upon meeting a veteran while waiting at a bus stop. Ironically, he returned home fine but was in a car accident that damaged his bones, muscles, and nerves in his ankle-foot joint, making it painful to stand and walk. He saw that I wore foot braces and I told him that they support my ankle and foot muscles to help me walk. He had been seeing a podiatrist routinely with no real help. I suggested he might be helped by a physiatrist and he thought I was talking about a psychiatrist. I advised that a physiatrist pays attention to the after-effects that deal with motion disorders.
Many people don’t realize that a physiatrist is very different from a psychiatrist. Most people do not know what a physiatrist is. A physiatrist is a medical doctor that specializes in movement disorders, often associated with diseases.
A physiatrist focuses and offers different perspectives on bones, nerves, and muscles than orthopedists, podiatrists, and chiropractors. Virtually unknown or not regarded by the other three, a physiatrist’s target of dealing with motion and interaction may deliver movement and freedom from pain to many of those people for whom movement can be insurmountable challenges.
Physiatrists focus on a personalized method of treatment to improve their patients’ quality of life — one that involves a comprehensive approach. The treatment is often a guided process. Using a physiatrist often points to multidisciplinary approaches in seeking to rehabilitate movement. Physiatrists are often associated with comprehensive rehabilitation team of professionals that may include physical therapists, occupational therapists, recreational therapists, rehabilitation nurses, orthotists and prosthetists, as well as psychologists and social workers.
Why are physiatrists generally confused with psychiatrists? Some people can’t read and more people don’t know. Many medical specialists do not recommend them. They are generally affiliated with hospitals that perform complex surgeries, such as the Hospital for Special Surgery, generally performing joint replacements. Keeping physiatrists a secret route of treatment by those medical specialists may disrupt proper healing and promote greater challenges for needy patients.
Physiatrists are generally found in hospitals but many have private practices. Simonetta Sambataro, MD, operates from a small office in Chelsea on West 23rd Street in New York. She is a physiatrist that specializes in recovery, and provides rehabilitation, physical therapy and other types of therapy that help patients learn to regain normal/near-normal function. Trained in Italy, she provides physiatry care to pediatric and adult patients.
Dr. Sambataro offers very practical guidance of a European style and has a stack of business cards for reference to supportive professionals. One of those, that fitted me with my leg and foot brace is David Zwicker, a rather experienced and understanding orthotist. He helps provide supportive devices for people from head-to-toe.
Many patients may benefit by seeing a physiatrist to alleviate many frustrating physical and motion challenges that other specialty doctors simply might ignore. When you have chronic pain and movement disorders, finding a physiatrist might be challenging. but there are about 8,000 practitioners in the United States. That’s half the number of podiatrists and about an eighth of the number of practicing orthopedists. A physiatrist is part of a very small group.
Going to a physiatrist usually means a non-operative, no-drug and no quick-fix solution. The methods used are process based. The patient must be self-motivated to get better. Sadly, such motivation is often brushed aside in this society and patients may be less inclined to pursue seeking a physiatrist. The results may be poor healing or lingering pains.
Those suffering with otherwise untreatable degenerative neuromuscular diseases, such as muscular dystrophy, multiple sclerosis, and some stroke cases, may gain a little improvement by seeking out a physiatric approach. It may not be a miracle cure but may improve your general lifestyle.
It seems that physiatry is a much maligned, ignored medical discipline in the USA. When it comes to helping support your physical and emotional struggles with mobility challenges, a physiatrist may deliver more help than the more common medical disciplines dealing with nerves, muscles, and bones. Yet, physiatry often is perceived among the lowest levels in the treatment process and is often overlooked. Physiatry is a demanding medical specialty and a good physiatrist can be extremely helpful in the recovery process.
Mobility disorders are more than breaks, pulls, and sprains. From small to large, any shift from what you normally do can be traumatic. In those cases, your physiatrist may offer resources for a trauma services network that aids the process of healing and habilitating. Sometimes sharing helps boost your outlook.
Physiatry is physical medicine and rehabilitation (PM&R). The patient’s physical, functional, emotional, and psychosocial well-being are all considered in treatment. It may require more effort than swallowing pills but the positive outcomes may elevate your general mood when coping with movement challenges that affect your life and lifestyle choices. Physiatrists as medical rehabilitation specialists may help optimize patient outcomes and qualities of life by participating in strategies to help you cope throughout the process of reaching a better degree of wellness.
So when your muscles chronically ache, you may want to choose the aid of a physiatrist.
While most evident with aging, foot drop is a condition when ankle muscles or nerve signals cause your foot to drop when walking. Foot drop makes it difficult to lift the front part of your foot, so it might drag on the floor when you walk. It can affect people of different ages as well. While some mild foot drop conditions respond to physical therapy, moderate to severe cases often require a brace that helps reposition your foot to a normal gait. The Allard Toe-off is one such brace and the best of its kind. There are others as foot drop is more common than most people think. Statistics are difficult to ascertain because so many people function with foot drop and don’t recognize the mobility challenge. Certain diseases, however, make it a clearly disabling symptom. Toe-Off makes that disability somewhat less disabling for young and old challenged walkers.
Foot drop can be associated with a variety of conditions such as flexor injuries, peripheral nerve injuries, stroke, neuropathies, drug toxicities, or diabetes. Basically, Foot drop can be defined as a significant weakness of ankle and toe dorsiflexion during movement as you walk and stand. You drag your foot while walking. Some compensate when approached by hills and steps by elevating the hip. The result is a Frankenstein-monster like foot drop that results in imbalance and consequences like frequent falls. On level ground, the feet drag on the surface. Carpets and walkway cracks can often be threatening as a foot fails to lift.
Allard ToeOFF is a leader among several manufacturers making devices known as Ankle Foot Orthoses for children and adults to help cope with chronic foot drop. These are braces that fit into shoes and create a rocking motion at the base of the foot. It helps the foot simulate a smooth walking gait by lifting the toes off the ground, as evident in foot drop cases.
Foot drop may also be evident in young babies who have difficulties toddling at toddling ages. They have difficulty standing and walking. Pediatricians may recommend a Supra Malleolar Orthosis (SMO) if the child is 18 months or older.
Up to age 3, the diagnosis is usually hypotonia. Hypotonia is the medical term for decreased muscle tone. Healthy muscles are never fully relaxed. They retain a certain amount of tension and stiffness (muscle tone) that can be felt as resistance to movement. When it comes to orthotic management of pediatric patients with hypotonia, the medical literature is only beginning to document the effectiveness that clinicians have been reporting anecdotally for years. There may be several reasons for hypotonia in babies, including nerve, muscle, and metabolic syndromes.
An SMO is shorter than an AFO and usually has a baby-friendly decoration. It will help babies stand. Walking may require physical therapies. Sometimes a pediatric physiatrist (medical specialist in rehabilitation medicine) may organize a team of multifaceted supporters. Small studies indicate that the SMO with phased rehabilitation may help children overcome foot drop and walking issues within a couple years. After that, genetic testing may be required to determine whether hypotonia is more of a symptom of another disease than a condition itself.
Hypotonia is not the same as muscle weakness, although it can still be difficult to use the affected muscles. Depending on the cause, weakness may sometimes develop in association with hypotonia. As people age, muscle weaknesses may develop along with normall loss of lean tissues. Hypotonia influences the movement, condition, and action of muscles.
Foot drop is very evident in diseases like Muscular Dystrophy, Cerebral Palsy, CMT, Stroke, and Multiple Sclerosis patients. An Ankle Foot Orthosis (AFO) helps relieve foot drop. It resembles a brace but it fits in most of your shoes. Worn beneath long pants or skirts, an AFO is practically invisible.
While an AFO may not directly repair dorsiflexor problems or neuro-muscular conditions, it helps deliver a near-normal gait when walking. The key is near-normal but that is a vast improvement. You may experience difficulty ascending and descending stairs. Your speed may be slow, but significantly faster than dragging. Your maneuverability may be somewhat compromised. Compared to foot drop, an AFO is a very significant mobilizer for the somewhat immobilized.
The Dorsi-strap is the least invasive AFO and also relatively inexpensive in the $150 range. While users should first consult a sports medicine doctor about using it, purchase does not require a prescription. The manufacturer seems to promote its use as a cure-all, even supportive for obese and big people, but the Dorsi-strap is really only effective for very mild foot-drop conditions.
For moderate and severe foot drop, dynamic braces are often prescribed. These are light, generally made of carbon fiber, a foot-length foundation is placed in your shoe and covered with shoe’s (or your) orthotic. A vertical support goes up and the brace attaches to your leg by one or two Velcro straps. A dynamic response Orthosis helps support a stable, balanced gait for walking and enable better posture while doing so. These are expensive but when you’re immobilized, they help you become (somewhat) mobile. They are covered by Medicare and most insurance providers.
Some people might say that, if you’re immobile, why not get a wheelchair or scooter? It’s a good question from an outsider’s view. There are classes of stubborn immobilized adults who want the illusion of mobility as a biped (not including cane support) in a world designed for most healthy people that can walk normally. There are fewer doctors and people aware of dynamic AFO devices so few are seen. They are used, though a minority compared to wheelchair devices.
Among dynamic AFO manufacturers, Allard’s Toe-Off family recognizes this for adults with varying degrees of disability. They also remember children who can suffer at many levels when confined to wheelchairs when they have foot drop as a main concern. Allard’s KiddieGAIT offers innovative options that have never been available for AFO management of these challenges. Functional environments can be created that supplement gait function instead of immobilizing and inhibiting that function.
Designed to provide dynamic toe-off assist with maximum control for the unstable ankle, Toe-Off is available in five sizes from X-Small to X-Large to fit children through adults. The unique, patented design features a lateral strut which “wraps” over the instep to provide maximum medial-lateral and rotational control of the foot and ankle complex, when none or little normally exist. Approximate weight variations are Size 01 (XS) weighs 3.6 oz., Size 02 (S) weighs 4 oz., Size 03 (M) weighs 4.9 oz., Size 04 (L) weighs 6.4 oz. & Size 05 (XL) weighs 6.7 oz. This permits an almost invisible sense of added weight. There is, however, a training period to get accustomed to the rocking support of these braces. Significantly advantageous, the Toe-off AFO fits into the shoe like an insole and accommodates most shoes without having to increase shoe size. New Balance sneakers are recommended for daily use.
Beyond the KiddieGAIT and the regular Toe-Off AFO, Allard has introduced the Toe-Off BlueRocker to their AFO family. BlueRocker is identical in shape and design as Toe-Off but offers more orthotic control. It is developed primarily for bilateral patients and those with more involved pathology. The extra stability will improve both balance and posture and give the wearer greater security, especially individuals with weak quadricep muscles.
It is also the most preferred orthosis to be used in conjunction with a socket and toe filler for management of partial foot amputations. Every BlueRocker should be padded on the inside towards the tibia crest. The SoftKIT padding system is designed specifically for use with BlueRocker for optimum patient comfort and product performance.
There are several other dynamic response AFO brands available for all degrees of foot drop. Helios (Helical Energy Loading Integrated Orthotic System) focuses on the category that the Toe-off BlueRocker targets. Helios is quite different as it does not use Velcro straps but requires a custom wrap-around shell for additional support. The double-helical construction is designed to correct skeletal structural deformities and provide an increase in walking function. This unique energy loading design offers the potential of normal walking. Because of its energy return in walking, the manufacturer claims there is less fatigue. Like the Toe-Off, it targets muscular dystrophy, peripheral neuropathy, CMT, Stroke, Cerebral Palsy, Polio, and many other neurological and muscular diseases that compromise function of the dorsiflexor.
If you find walking painful and your feet are consistently dragging, find a physiatrist or sports medicine doctor. These doctors study and serve patients with movement disorders. Orthopedists primarily deal with bones. A thorough exam will help form a diagnosis. Physical therapy may help most people. If it doesn’t, an AFO may be prescribed. Use a recommended practitioner.
I was advised to go to Prothotic Laboratory for my AFO orthosis. While there are hospitals and other providers, this place was highly recommended by my physiatrist. David Zwicker is their certified orthotist and was a pleasure to work with. He suggested the Toe-Off and considered the basic model as satisfactory. I must admit that, once I put the Toe-Off on, it seemed a radical improvement. As with a cane, I’d advise moving up to the Toe-Off BlueRocker for maximum strength and support, though it does require a suitable get-comfortable period. Zwicker offers seasoned experience and provides an intuitive, independent approach to help maximize comfort. When using an AFO device, your relationship with the orthotist is very important. Do not get an AFO unless you are certain that your orthotist is right for you. If you are in the New York City area, David Zwicker of Prothotics offers excellent service, although many pediatricians and physiatrists offer AFO and SMO devices.
There are varying degrees of foot drop and many reasons behind it. There’s no assurance that a dynamic AFO will get you running or even fast-walking. In cases of muscular dystrophy (and my Myotonic dystrophy), happiness comes from the ability to walk without foot drop, or the use of a wheeled scooter. The myotonia is still there and instability and weakness may dominate. Using the Toe-off offers significant help in walking from point-A to Point-B. Without the Toe-off AFO, trying to walk is a monstrous challenge. Be thankful that world technology is designing products to help the significant few sample the illusion of normalcy again.
Ultimately, an AFO or SMO is an aid to enhance mobility against foot drop due to weak muscles and nerves. Seeking medical or rehabilitation help may be advised to avoid accidents or falls is advisable.