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.
It is often debatable whether all is fair or unfair in love and war. When it comes to the latter, the costs of war often require technology developers like DARPA to help the military and those we love. DARPA was created nearly 60 years ago under President Eisenhower’s administration as a part of the USA Department of Defense. Many of the technologies you use today, from smartphones to GPS and voice-to-text capabilities probably came from ideas from DARPA.
Few might recall that many of the basic principles of the internet were founded by a government agency for sharing information. Defense Advanced Research Projects Agency or DARPA created the first computer-based web network to collect and share research from various centers under DARPA grants. One of their recent projects is Airlegs, that helps energize walking power for soldiers climbing extreme levels of terrain.
Many of the prosthetics and walking devices used by those with muscular dystrophy or multiple sclerosis, that are generally available today, may have been results of earlier DARPA research.
Ankle Foot Orthoses or AFO that are dynamic braces that assist those with weak ankle muscles may have originally been designed for use by veterans. Today, these are mechanical devices that help make walking easier for those that normally can’t. Without the use of AFO devices, many would only be using wheelchairs or mobility scooters. Those patients and health care professionals who are aware of AFO technologies may help some patients with ankle and lower leg muscular problems choose the option of walking at close-to-normal levels.
Of course DARPA primary focuses are catering to military excellence in the field and those that are casualties of war. Engagements in Iraq and Afghanistan have motivated the need to revolutionize upper-limb prosthetics for use by wounded veterans. The program, launched in 2006, has been designed to allow those with upper-leg and upper-arm problems to enjoy nearly normal mobilities and lives.
Mechanical lower extremity prosthetics have been available since World War II as shown in the movie Best Years of Our Lives. A Navy soldier was one of the actors and demonstrated his adroit capabilities with mechanical hands. Of course, those were bulky and heavy and required quite a bit of strength to wear. The dilemma with upper-limb prosthetics is facilitating weight balance and lower extremity control with a lightweight product.
The DEKA-3 is a result of DARPA development. This and other next step technologies are being commercially produced for use by patients in need.
DARPA pushes the leading edged of the sciences and often are society’s first encounter with the legal or ethical dilemmas that can be raised by new biological and engineering technologies. When considering these, the Department of Defense does need to integrate the necessities of USA interests along military usefulness.
Airlegs uses an exoskeletal backpack that generate air impulses that help normal soldiers walk faster, and better in rough conditions. As superheroes go, Harvard University (under a DARPA grant) developed an Exosuit that conforms to the body, allowing for natural joint movement while augmenting effectiveness in combat. Both these technologies may one day be beneficial to those suffering with incurable muscular-skeletal problems.
Somewhat lower in scale to Airlegs, there are numerous commercial devices available for neuromuscular disorders that use air to enhance mobility. People with foot injuries may benefit from AirCast that is a post-surgical cast that can be customized with air pockets for comfort and greater walk ability.
The WalkAide system uses electro-stimulation of nerves to help patients with nerve diseases like multiple sclerosis walk more naturally. It’s a fair and less cumbersome device to most AFO braces but does not influence those with muscular exclusive diseases.
DARPA is not exclusive in setting these trickle-down technologies from military to public use. The National University of Singapore has been studying robotics as an aid to improve gait and walking abilities of patients under care of physiotherapists.
While many of these independent research projects and DARPA projects offer exciting reads, some succeed and some fail.
DARPA is intended primarily for defense technologies and the resulting products are intended for use by skilled soldiers. Some products derived from DARPA research grants do manage to trickle down for use by medical professionals and the general public. The internet was one of those DARPA projects! The efficacy of applying some of those technologies on wider samples may be difficult, while many promising projects fail in production.
Some limitations may stem from health insurance coverage restrictions or professionals with no education of newer methods at handling certain problems. It becomes more economic than practical.
Physiatrists, Orthotists and Prosthetists often work jointly in accessing and finding ways to help mobilize immobile medical patients. Some of the hardware come from archival DARPA studies. Because conditions vary from one patient to another, experimentation and therapy are necessary for adaptation to different individuals. “The evolution of orthosis and prosthetics is very promising,” says David Zwicker, a New York specialist. He adds, “Customizing these for each patients use is a must for performance.” As advanced as these appliances are, they aren’t always 100% perfect. Benefits and consequences partner in each design.
Of course, there are exceptions. There are wounded soldiers and athletes using DARPA-sponsored prosthetics that are so exceptional that they manage to compete in Paralympic games. The Paralympic Games are organized in parallel with the Olympic Games, while the IOC-recognized Special Olympics World Games include athletes with physical, sensory, and intellectual disabilities.
Perhaps the most famous (or infamous) of these is Oscar Pistorius. Although both of Pistorius’ legs were amputated below the knee when he was 11 months old, he has competed in events for single below-knee amputees and for able-bodied athletes. He competed in the 2012 Olympics. At his unfortunate criminal trial in 2013, he discussed how prosthesis evolved at such great levels that he was able to compete and win many Paralympic awards.
Zwicker concedes, “These are more exceptions than the average patients.” As a Myotonic dystrophy patient, using the Toe-Off AFO braces Zwicker recommended, my dynamic brace is indispensable as a walking tool. Sometimes they are like a balancing act and they stretch walking shoes beyond limits. Nonetheless, these braces allow a smooth (if slow) walk for someone with my degree of uncurable muscular ailment. The basic mechanics of the dynamic orthosis may have been introduced in earlier DARPA-funded experiments for wounded veterans.
More people resort to more orthodox, less challenging methods like wheelchairs, scooters, and walkers. I notice very few that recommended or prescribe dynamic braces. Thankfully, more children with neuromuscular development diseases find new technological tools that help them through their lives. Some have been adopted from DARPA products targeted for military use. Unfortunately, at this point, they are exceptions. They are the few fortunate ones.
Mobility devices make up only a small portion of DARPA sponsored research. Most go to weaponry, targeting, and reconnaissance. People are fortunate to inherit the by-products of some of these as available apps in smartphones and tablets.
According to the US Department of Labor, training and employment of Orthotists and Prosthetists is projected to grow 36 percent from 2012 to 2022, much faster than the average for all occupations. The large, aging baby-boom population will create a need for orthotists and Prosthetists, since both diabetes and cardiovascular disease, which are the two leading causes of limb loss, are more common among older people. In addition, new methods are likely to challenge this growing field as more people suffer from incurable immobilizing diseases.
When you see what may seem as inordinate government spending toward the military, realize that some of that money fuels DARPA research. You inherit some of the DARPA outcomes indirectly. Any transaction requires weighing benefits and consequences, DARPA funding sponsors at-the-edge research at many universities and labs that work toward advances of all kinds. There may be consequences. Yet, the next time you use GPS, the Internet, or a form of prosthesis, remember benefits often outweigh the consequences that may result through personal needs and interactive abuse.
Perhaps nothing is fair in war but being triumphant may be a necessary good or evil. Reaping other benefits from war-based research may indirectly help many. DARPA helps balance the scale.
Street observations often show that quite a few people of all ages seem to drag their feet, gliding slowly on pavement. Some walk slowly, taking small steps, careful not to trip or fall. Are these people tired, weak, in pain or depressed? Sometimes all of these are in play. Emotion disorders for some may loosely involve motion disorders. This mode of walking is called Foot Drop. It is where the ankle does not elevate your foot to stride comfortably. The key to a normal and smooth gait is placed on what is called a dorsal muscle that, basically, works to get your toes off the ground. In some cases, a Toe-Off orthosis might help lift your toes off for better walking.
The ankle of each foot lies at the base of each leg as it meets the foot. It is often vulnerable to sports injuries or falls. How many kids complain about sprained ankles? How many game players have to sit through a season because of an ankle problem? Usually, these wounds heal. For others, there are diseases that chronically affect the foot. This makes walking difficult and painful. This makes walking alongside friends annoying. Most people adapt to it while others use orthotics, canes, walkers, and wheelchairs. These are entirely different perspectives than those that normally walk.
The joint at which the leg meets the foot is called a dorsal joint. This connecting joint consists of bone, ligaments, and muscles. There are four muscles involved – Tibialis anterior, extensor hallucis-longus, extensor digitorum longus and fibularis tertius. The largest and most evident of these muscles is the tibialis anterior, which can be seen superficially in the front of the lower leg. Dorsiflexion involves these muscles for just a couple functions, primarily lowering and lifting the foot for walking. It also aids left/right motion for smoothness and capability of coping with hills. Dorsiflexion helps establish the toes off and toes on movements that are necessary. When dorsiflexion doesn’t function, the foot remains in a dropped position. Getting your toes off for a normal gait is virtually impossible.
There are other muscles that help the dorsal muscles function. Nearby, Plantar flexion involves lifting the whole body. These go together because the world does not exist as a straight plane and body’s weight creates all sorts of subtle adaptations to the differences of weight, angles, and voluntary movement. Because the ground constantly has variables, human feet need to adapt to smoothly interface with it swiftly on contact. In normal function and anatomical position, the ankle joint has flexion (dorsiflexion) and extension (plantar flexion). Foot draggers have a lot to do to get their toes off the ground.
For many foot draggers, a trip to a physiatrist might help deal with the problem. Some may require physical therapy to help break old habits. Others may need a prescription orthosis. The latter occurs when certain diseases chronically influence the dysfunction of the dorsal muscles. One particular orthosis for helping people get their toes off the ground is a bracing device called Toe-Off.
Toe-Off is part of a group of products, called an Ankle Foot Orthosis (AFO), that help replace the action of the dorsal muscles, when the muscle group has been compromised. This is common in muscular dystrophies, myopathies that can waste these muscles to the point that your foot can longer raise on its own. Toe-OFF is a new generation AFO, covered by several patents. While most AFO get your toes off and up to facilitate a more natural walking gait, and share some similarities, Toe-Off is lighter and easier.
Toe-Off is known as a dynamic AFO. It is made of a lightweight moldable carbon fiber composite material and works with various shoe types. It employs a high activity design that enables freedom of motion and allows for simulated walking that functions and appears as if you aren’t using any form of brace, with the exception of a few chronic cases. Whether custom of off-the-rack, a dynamic AFO encourages range of motion, allowing children to learn movement by moving and providing minimal support, only where the patient needs it. Scientific research on dynamic AFO devices show improved performance, though studies must be further explored.
Many AFO allow use of your own shoes. You remove the insole of the shoe, slide Toe-Off inside and then replace the insole. Most shoes aren’t adequately sized to hold your foot and an AFO. Sometimes you may find greater comfort by shifting to a wider shoe. New Balance and Dr. Comfort are recommended brands. Do not anticipate normally long wear from your shoes. Typical daily wear might be around 6 months and leather shoes should be changed every 6 weeks or so to keep it supportive (as leather stretches).
Toe-Off uses a Swedish technology that uses a carbon fiber for support or action. When worn, it does take your toes off the ground. Your walking gait is more normal.
Toe-Off resembles an over-the-calf shin guard, set in place by adjustable Velcro straps. Shoes are ties normally. It provides leg support and foot support as it aids that toes off process.
To say that use of Toe-Off will let you run marathons or play basketball is a rare exception. It helps a foot dragger with foot drop walk virtually normal. That is remarkable.
The feel of the Toe-Off is like standing on a suspended rocking chair. It rocks your foot into the appropriate position. Depending on your condition, getting up from a chair or using stairs may be a little difficult. Toe-Off primarily focuses on replacing the simple dorsal inaction that results in foot drop. Maneuvering other than walking may still be difficult or impossible. For someone who can’t walk normally, Toe-Off is a necessary option for those who want mobility without resorting to a scooter or wheelchair device.
Because even smoothly paved roads have variable surface changes, use of a cane is helpful in those cases. Many times you may not need it or use it lightly. When the walkway has cracks, embedded rocks, or other surface irregularities, that cane could be the difference from walking to falling.
A physiatrist or sports physician usually must prescribe an AFO and Toe-Off requires a prescription. It’s an expensive technological tool but is covered by many health insurances. Usually, your doctor sends you to an orthosis specialist. Prothotic Labs is a New York based progressive Prosthetic and Orthotic facility. David Zwicker is one of their specialists. He is particularly attentive to patient’s comforts in using any of these devices. While Toe-Off, for example, is an excellent product, it may need to be fitted for comfort for individualized use, Zwicker specializes in this. Developing a cordial relationship with your orthosis specialist is necessary. Finding one is crucial. An AFO is a walking mobility device that replaces poor natural muscle control. You and it must act comfortably as one.
As for support, there are 3 Toe-Off models that cover children, moderately affected adults, and severely affected adults. Due to Myotonic dystrophy (one of the muscular dystrophies) I use the Toe-Off BlueRocker pair – their offering for severe cases. It is designed for helping Footdrop from disorders such as stroke, MS, post-polio, Myelomeningocele, Cerebral Palsy, Muscular dystrophy, CMT, and forms of Neuropathy. This is my second Toe-Off AFO and I find it to be very supportive. It does require the Comfort Link accessory for extra padding around the leg.
Braces have changed a lot since the days of President Franklin Roosevelt. They help easily mobilize the otherwise immobile. Getting your toes off the ground as a means of alleviating foot drop means you have many choices to explore from exercise to using an orthosis. A dynamic AFO, like the Toe-Off family of products, may just be a possible answer. So don’t drag your feet when walking. Get your toes off and seek professional help. Treatment is often easier than you might think.
Toe-Off is not a miraculous cure for the causes of dorsiflexion. You may or may not be comfortable using it, and may not restore your walking range before your ankle disorder. Depending on the severity of your condition, Toe-Off helps provide a sense of dignity at the challenges of achieving upright mobility when walking. Many people do regress to needing scooters. It’s an acquired, adaptive taste and a quiet idea of walking using your own two feet, albeit with an AFO brace like Toe-Off. A dynamic AFO, under advisement from your physician, may help you cope with walking challenges a little differently (at least for a while). Isn’t it time to get your toes off and walking?