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A Pediatric PT’s Guide for Recommending SMOs

Hey PTs! Wanna know my guidelines for recommending SMOs? Here is a little cheat sheet I use!

Step 1

Look for indications of foot/ankle instability. This can be flat arch, calcaneal eversion, toe curling, wide base of support, etc. NOTE: just because they have any of these does not mean they NEED SMOs. There is a fine line between overprescribing foot support and not providing enough. However, if you do see some of these signs, go through your next checklist.

Step 2

Answer these questions: ✔️Has the child been standing a considerable amount of time with no change in foot position? it is very common for the feet to do these things when babies first start standing. However, as babies weightbear more and gear up for walking, the foot position may change and become more stable. If it doesn’t, this may be an indication that SMOs will help.

✔️ Is the babe making progress towards walking or have they been doing the same thing for a while now? If the child has not made progress from standing to cruising to walking, this may be another indication that SMOs will help.

✔️Does the child seem to be in pain when weightbearing? If the flat arch or instability is causing pain, DEFINITELY an indication to add more stability with an SMO.

✔️ Will it affect them in the future? This is a tough one. Depending on severity, foot instability can affect bony alignment in the future. Remember, our bones form based on the forces that are placed on them. Also remember that our feet are our BASE of support. Meaning that if we don’t have an aligned and stable base, it could affect the knees, hip, spine, etc. So if there is any risk for bony alignment malformation as they grow, I recommend SMOs.

Step 3

One more piece of advice: do not “wait and see”. SMOs can take a couple months by the time they get measured, sent out for fabrication, and delivery. The earlier we intervene, the earlier we can get closer to walking in a better alignment!

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