Responses to "AFO with SMO inside it".... volume 1

Responses to "AFO with SMO inside it".... volume 1

Bill Lifford, CP

4/12/2004

Hello everyone,

Here are the responses to my original post. Thank you to all of you who
responded! There were so many responses, I'll post them in at least two
parts. Here's the first set of responses.

MY ORIGINAL POST:

I recently inherited a bunch of patients from a practitioner who has left
our facility. One of these patients has an AFO with an SMO inside it....
supposedly the SMO is supposed to be made with a more flexible material, but
this is not the case with this set of braces. is this familiar to anyone?
what is the appropriate material for the SMO???


THE REPLIES:

The flexibility of the smo is determined by the secondary use of the
orthosis with the afo. If the afo is used witht the SMO for all ADL
activities except sitting in a chair or non ambulatory situations its one
type of control therefore softer material can be used. If the SMO is used
for ambulatory situations like training with a therapist mre rigid plastic
is used.
Some of the plastics used include TPE, COPOLY and HD polyethelene. The
thickness of so materials also dictates rigidity.
Speak to Orthomerica Central Fab, they do alot of SMO/AFO combos.

--------------------------

Usually the SMO is made of a thin flexible material like 1/16 polypro,
3/32 polyeth,flexilene or even 1/8 TPE. The idea is to aggressively grasp
the foot with an almost total contact design that does not cause skin
breakdown because there is no rigidity. The stability is provided by the
outside AFO. It works quite well despite the bulk. Good luck.

--------------------------

In my experience, the proper material for an SMO is 1/16th inch
polyethylene, possibly 3/32nds inch if the person is heavy and requires more
support (usually that is the job of the AFO though).

--------------------------

He was trying to duplicate a Cascade DAFO. I can not remember the #. You
can look it up on their chart. The SMO should be flexable-maybe
polyethelene.

----------------------------

I have fabricated those types of AFO's using 1/8 co-poly for the SMO and
3/16 co-poly for the AFO. It is very similar to Cascades DAFO Two-Step.

----------------------------

The SMO is usually made of a more flexible material, like Modified
Polyethylene; It can also be made from thin Copoly or Polypro stretched to
be very thin - especially over the dorsum. The AFO section is typically
Polypro - much like a standard AFO. We use this design all the time and are
very familiar with it. If you have any questions, I'd be more than happy to
help you.

----------------------------

I've seen a lot of these. One way to do it is the Cascade Turbo design
(dafo.com) but others make them like this also. The thinner SMO part gets
some subtalar and and metatarsal control (may be needed to correct
compensatory forefoot supination for example) and is a lot easier to put on
than if it was built in ot the AFO outer shell. Sometimes they work very
well. Sorry I have no more detailed expertise on the material, my guess is
the ones I have seen are just a thinner gauge polpropylene.

-------------------------------

I think the first to do that was a company in the Washington St. area. The
inner is made from very thin PP.
Here is a website for more info. <URL Redacted>

-------------------------------

When I have used the SMO inside the AFO I have used a 1/16 or 1/8
polyethylene for the SMO. It is molded first to the cast. Cut out the SMO .
This is the difficult part because you do not usually firt the SMO first,
you go by eye as to the trim lines. Put the SMO back on the cast and use a
seperator (2 nylon stockings with baby powder) to allow you to peel the SMO
from the AFO section.Glue the joints, if you are using Tamarack or
Oklahomas, directly to the SMO before you pull the seperator on. Drape the
3/16 polepro AFO section. Cut out the AFO large around the SMO to get it off
Peel the SMO section out and and then trim it back behind the trim lines of
the SMO if need be.
The SMO is used to control calcaneal movement when there is a lot of laxaity
 or you need a lot of corection.. When going directly into the AFO wouild
be too stressfull on the skin. It is also good to help don the AFO when an
intimate fit is needed and the SMO acts to slip the foot into the AFO.






12/4/2004
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