Skip to content

SMOs: What’s Good to Know!


You probably already know what AFOs are, but what about the AFO’s lesser known little brother, the SMO? Let’s give the SMO a little love today because they are so often overlooked. It has been incredibly difficult for me to find any accurate recommendations for shoes or even other kiddos who wear SMOs. So we are going to break that now and put the spotlight on the SMO. SMO is the acronym for Supra-Malleolar Orthosis. This orthotic supports the leg just above the anklebones or malleoli. The SMO is considered the shortest of the Ankle Foot Orthoses or AFO’s. The SMO is prescribed for patients who have soft, flexible, flat feet. Jack jack got his SMOs almost a year ago now. You may or may not have noticed; SMOs are slightly more incognito than AFOs. His physical therapist recommended the SMOs for these issues: Pronation, Hypotonia, Developmental Delay, and Poor coordination and balance. While these are all still struggles for Jack, his SMOs have truly helped him SOAR! img-9636
I didn’t really know what to expect with the SMOs. How would Jack react to them?    What about shoes? He was almost 20 months-old and still not walking or standing independently. I was excited about an option to help him get on his feet. We had our consult, got Jack’s chubby little feet measured, chose a pattern (sports bc he loves to watch hockey with his daddy), and then waited for weeks. When we finally got to pick them up, I had a few shoe options with me because I was so confused. At first glance, the SMOs are intimidating…like how the heck am I going to get that bulky thing in a shoe? I was told to buy shoes one size up to fit with the SMOs and that has worked pretty well for me since then too. I had three different pairs of tennis shoes with us when Jack tried on his SMOs for the first time. The ONLY pair that even remotely worked that first time was the standard grey New Balance shoes my mom had bought just in case. One we got Jack in his SMOs and shoes, he was not the least bit interested in trying to stand (hard eye roll–typical Jack). However, once he was ready to stand, he was so much more steady! I was worried he would hate them because he doesn’t like socks/shoes or anything that touches his feet, but Jack’s PT told me she thought Jack would love the SMOs as soon as he realized he was more steady and could do more with them. She was absolutely correct!

There was no learning curve, the SMOs were easy peasy! However, it did take a few weeks for Jack to work up to wearing them for several hours at a time. We found some really wonderful seamless socks and everything seemed great. I was a little bummed over the summer because there were no sandal options that would also allow for Jack to use his SMOs. I love shoes and I loathed that there weren’t any CUTE or even sort of okay shoes for my little man. But, his success and confidence is so much more important. I can’t reiterate how badly he needs the SMOs on to be able to walk, even now. There are many times at home where I have to put his SMOs and shoes on just so he can move around and play safely. The whole family will be in pajamas, but Jack also has his shoes on. Watch out because he’s truly a toe crusher! Sometimes putting Jack’s SMOs on is a quick process, but other times it takes a full 15 minutes because he fights the entire time. Depends on the day and I’m sure many mamas can feel me on that. So basically the SMOs have been wonderful for Jack. Our biggest struggle with SMOs have been SHOES! Not only were there not any cute options, there just weren’t any options. None of the AFO recommended shoes worked for Jack. I spent so much money on shoes just trying to find something that would work for Jack’s chubby little foot and those bulky SMOs. We started with those plain ‘ol new balances and had a few other pairs with laces as well. Not bad, until…*insert terrible choking noise here* WHAT THE HECK? I had to frantically pull over to the side of the road on the way to therapy one day because it sounded like Jack was choking. Oh he’s not actually choking choking, just has some SHOE STRING stuck in the back of his throat and it’s gagging him. This began the shoelace chewing fiasco. You would think that one choking experience would have been unpleasant enough for him after he actually threw up, but ohhhhh no! This happened on repeat to the point that I never wanted him to wear shoes. That is, until I found Ikiki shoes!!!

I was scrolling through instagram one day and saw that the company that makes Jack’s SMOs, Surestep, posted a photo of puppy print SMOs and puppy Ikiki shoes. I asked if they REALLLLY fit with those shoes or if that was just a cute photo. When Surestep said the shoes fit their brand of SMOs, I immediately jumped over to the Ikiki website to purchase because not only were they adorable, but also NO LACES so they were also safe. I ordered Otto Sanchez, all the shoes have cute little names, and both Jack and I immediately fell in love when they arrived. To make any shoes fit with SMOs, you have to take out that bottom padding piece (not sure if it has a name or not, but see photo at bottom if you’re confused). It was the ultimate Cinderella moment as I slipped the shoe over Jack’s SMO. FIT LIKE A GLOVE! Jack extra approves of the Ikiki shoes because they squeak. The squeakers can be turned on and off easily, but Jack finds the “squeak! squeak!” extra motivating! We are currently the proud owners of two pairs of Ikiki shoes, both Otto Sanchez and Sascha the Narwhal. This is not an ad, but a note from a mama who spent so much time looking a shoe that would be transformative for my son with SMOs. These shoes were just that! Ikiki shoes are durable and affordable as well, which is amazing because decent toddler shoes are super pricey usually. I was sure there would be some terrible flaw once they finally came, but there was not. They really work for Jack and my life a whole lot easier! We are pretty sure the Ikiki shoes will make you smile too and I hope our anecdotes can help another kiddo or struggling mama in a similar situation. Please feel free to message me if you have any questions about SMOs or otherwise! You are not alone and your kiddo can still wear cute shoes! 🙂


The soft piece in the very bottom is what you have to pull out for the SMO to fill well! It looks weird, but that cute plastic orthotic is going in so it doesn’t matter!
Every detail of the Ikiki shoes is adorable, especially the animal tails in the back! This is Sascha the Narwhal!


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: