Fast guide to orthotics: AFOs, inserts, and everything beyond.

I’ll start this with the caveat that I’m not an orthotist and I don’t make braces, but I’ve been so

fortunate to have some amazing orthotists work with me through the years, and in general I make what I think are pretty successful recommendations for families. This is meant to be a quick guide to the differences and indications of each brace (or for those PT students who just need a little help). Also, I’m not receiving commission for anything I mention on this site, this is just my personal experience with various brands.

Let’s start from the lowest profile and go from there.


These are your common “arch supports” that you can find in the drug store or can be custom made. There’s a lot of mixed research with these depending on goals. For little ones I really like the cascade chipmunks, and for older kids/adults I’ve had good success with the Superfeet brand.

When do you use them: Like I mentioned, research is mixed on these, some say there aren’t any indications for these, others say only with pain when kids are older. I personally find that I really like them for some of the more hypermobile kids that I work with (think “double jointed”) to reduce how much their ankles roll during walking.

SMOs (also known as supramalleolar orthotics).

These stick out just a little bit from shoes over the top and surround the entire ankle joint. They don’t stop anything such as walking up on tippy toes (except very specific types), or walking on your heels. They’re meant to give a little more stability around the ankle to prevent rolling over the ankles in either direction. I find them used most often in little kids that need a little extra support to stand/walk. They’re super common in the trisomy 21 (down syndrome) population or any kid classified as “low-tone”. Often kids wear them anywhere from 6 months-a few years. They’re much less commonly seen in the older populations.

Side note: There has been a recent toe-walking SMO on the market that seems to work best for sensory toe-walkers without range of motion limitations. They give a little pressure on the back of the foot, and discourage walking up on tippy toes. I’ve trialed them with some of my kiddos. Some instantly come down to a typical walking pattern- some could care less. Definitely something to keep in mind!


When people think of leg braces, this is generally their first image. AFO stands for Ankle foot orthotic. There are so many types of AFOs, but I figured I’d give a quick lowdown of the ones I personally use the most. They control the ankle joint much more than the SMOs and often limit going on toes or heels- depending on how they’re set

Solid: Just as it sounds, a solid piece where there is no split for movement in the ankle. These are often used for people who hyperextend or crouch in their walking patterns because although it does not control the knee, it puts the ankle at a set angle to reduce compensatory motions at the knee.

Articulating/hinged: Set to a certain angle, generally allows for dorsiflexion (lifting the toes off the ground such as with heel walking) and is set to a certain amount of plantar flexion (going on your toes). These are highly variable depending on the goals of the child/adult.

Carbon fiber AFOs: These are generally used for people who have something called a foot drop or at risk for falling. They don’t work very well for people who are high tone. It’s a lot less obvious to wear than other AFOs and can be easily hidden under clothing.

KAFOs and above

KAFOs or Knee ankle foot orthotics control motion at the knee and go up to the thigh. These are often used for people that need more stability to stand often in populations such as spina bifida where they may not have much or any muscular activation in their legs. There are also braces that help to control the hips, and allow people to stand and take steps after spinal cord injury, but these are always custom made and are highly variable from person to person and require an extremely skilled orthotist to ensure fit and prevent irritation or wounds as sensation is often compromised.

As always, this is meant to be a quick reference guide, it is SUPER basic and not a substitute for medical advice. If you think your child or someone in your life needs bracing options, feel free to contact me and I can help you directly or get you to someone that can! If you have any questions, feel free to leave a comment or send me a message directly!

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