Supra-Malleolar Orthosis (SMO)

How to put on your SMOs:

  1. Place socks on feet.
  2. SMOs may have a left or right foot sticker on the bottom of the device. The sticker indicates the correct foot the device goes on, even if they appear to be wrong.
  3. Open brace behind and underneath the foot and then slide foot into brace. Bend knee to 90º to make sure heel is all the way to the back of the SMOs.
  4. Pull up on the toes to make sure the heel and the rest of the foot is fully seated in the brace.
  5. Apply tension to the Velcro shin straps and pull for snugness. The buckles should be on the outside of the braces.
  6. Use a shoehorn if SMOs are difficult to slide into shoe. This will also prevent breakdown of the back of the shoe.
  7. Fasten shoes.

Wearing Schedule:

Just like a new pair of shoes, SMOs have a breaking in period. Use the following wearing guidelines to allow the body to adapt to the use of the brace gradually.

Day 1: Only use the SMOs for one hour.

Day 2: Use the SMOs for two hours. One hour in the morning and one hour in the afternoon.

Day 3: Use the SMOs for four hours. Two hours in the morning and two hours in the afternoon.

Day 4: Use the SMOs for six hours. Three hours in the morning and three hours in the afternoon.

Day 5: Use the SMOs for eight hours. Four hours in the morning and four hours in the afternoon.

Continue to use the SMOs as prescribed by your Orthotist for full day use.

There may be some slight redness on the instep, under the ball of the foot or the on the sides of the little toe or big toe. If redness does not disappear within 20 minutes, discontinue the use of the SMOs and please contact your ABLE Orthotist to schedule an appointment for an adjustment.

If child goes up two shoe sizes, contact your ABLE Orthotist because the SMOs maybe too small now.

The importance of good foot wear

  • Remember that shoes are an integral part of using your SMOs. Never use them without shoes.
  • Tennis shoes are the best type of footwear.
  • Try to limit the amount of time spend in sandals, slip on shoes and rubber made shoes. These shoes will NOT give your foot the amount of support it needs.

Cleaning and Maintenance:

  • The best way to clean the SMOs are to spray rubbing alcohol on the inside and out and wipe down with a dry cloth. This will remove any body oils and residue.
    • If SMOs have foam padding, it is recommended to clean once a week to prevent sweat, dirt and grime build up. This can also help to eliminate smells.
  • If the Velcro is not sticking well on the brace, check for lint build-up on the Velcro and remove it.

Trouble Shooting:

  • If brace does not fit into shoe –
    • Check to see if the heel is all the way to the back of the SMO.
    • Check if the back of the shoe is crushed, causing the SMO to hang up.
    • Check if the insole of the shoe has been removed to accommodate for the SMO.


  • Never wear brace without shoes. It is slick plastic and the risk of falling is high.
  • Do not over use brace during the initial wearing phase. This can cause skin irritation.
  • Do NOT ever sleep in the SMOs.