Custom Pediatric AFOs, SMOs, and Orthotic Bracing: A Parent's Guide From Falk Prosthetics & Orthotics
By Justin Kuntze, CPO/LPO
Justin Kuntze, CPO/LPO, is a certified and licensed prosthetist orthotist at Falk Prosthetics & Orthotics, with offices in Delray Beach, Jupiter, and Hollywood, Florida. He is certified by the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) and licensed in the State of Florida. Before entering the field, Justin gained clinical experience working with children as a volunteer at Shriners Hospital, and pediatric bracing has been a focus of his work ever since. A child’s diagnosis tells us where to start, but their gait, strength, range of motion, daily activities, and goals help determine what we build.
If you are reading this, there is a good chance that a pediatrician or physical therapist recently told you that your child needs a brace. Maybe you heard the term AFO or SMO for the first time this week. Maybe your child has worn braces for years, and you are looking for a team that will take the time to understand what has worked, what hasn’t and what needs to change. Either way, I want you to know two things before we get into any of the technical details. First, kids in braces do amazing things. Every day I watch children walk, run, climb, and keep up with their siblings in devices we built for them. Second, the brace itself is only half the story. The other half is the relationship. Some of the children we fit as toddlers are teenagers now, or even adults, and we have had the privilege of adjusting, rebuilding, and redesigning their braces through every growth spurt along the way. Watching those kids grow up is honestly the best part of this job, and it shapes how we treat every family that walks through our doors. We want Falk to be a safe place for every child and every family, no matter what they are going through. This guide covers the custom pediatric bracing we provide, how we decide what is right for your child, and what the process looks like from the first visit on.
What Is an AFO and Why Would My Child Need One?
An AFO, or ankle foot orthosis, is a custom brace that supports the foot and ankle and extends up the lower leg. Its job is to position the foot correctly, provide stability, and make walking safer, easier, and less tiring. Children are prescribed AFOs for many reasons, including cerebral palsy, toe walking, muscular dystrophy, spina bifida, foot drop, low muscle tone, and other neurologic or orthopedic conditions. Here is the most important thing I can tell you: an AFO should never be something pulled off a shelf. Every child’s diagnosis, anatomy, strength, range of motion, gait pattern, and goals are different, and the brace must reflect all of it. That is why everything we make is custom, designed and fabricated in house by our own team.
The Custom AFO Family: Which Type Is Right for Your Child?
Parents are often surprised to learn how many kinds of AFOs exist. We fabricate the full range, and the differences matter. Rather than list twenty technical names and leave you to sort them out, here is how I think about the different types of AFOs and when each one tends to help. The goal is never to put a child in the most supportive brace possible. The goal is to provide exactly the amount of support they need while preserving as much useful movement as possible.
Maximum support and stability
Some children need the ankle held firmly in place, so they have a stable, reliable base for standing and walking. This group includes solid AFOs, anterior-shell AFOs, and ground-reaction AFOs (also called GRAFOs or floor-reaction AFOs), which use the forces of walking itself to help straighten the knee for children who tend to walk in a crouched position.
Help lifting the foot
Other children have trouble picking the foot up as they step, which leads to tripping and dragging toes. For them we build posterior leaf spring (PLS) AFOs, dorsiflexion-assist AFOs, dynamic-response and carbon-composite AFOs, and complete custom foot-drop systems. These designs store and return energy with each step, giving the foot a lift at just the right
moment.
Controlled, natural movement
When a child has some active control and we want to allow motion in certain directions while blocking it in others, we use articulated or hinged AFOs, free-motion AFOs, and designs with plantarflexion stops or dorsiflexion stops. These let us fine tune exactly how much the ankle moves, which often produces a smoother, more natural walking pattern.
Tone management and positioning
For children whose muscle tone pulls the foot into poor positions, we fabricate tone-management AFOs, spiral and hemispiral AFOs, and night-stretch AFOs that maintain a gentle stretch while a child sleeps so that daytime function improves.
Comfort-focused designs
Fit is everything, especially for sensitive feet. We build custom gauntlet-style AFOs and AFOs with molded inner boots or SMO-style inner boots, which cradle the foot in a soft, precisely shaped inner layer inside the structural brace.
SMOs and Custom Foot Orthoses: Support for Littler Legs
Not every child needs a full AFO, and one of the devices we make most often for young children is the SMO, or supramalleolar orthosis. An SMO is a low brace that stops just above the ankle bones. It is ideal for children with low muscle tone whose feet flatten or roll inward, giving them a stable foundation without restricting more movement than necessary. For a lot of toddlers, an SMO is the difference between wobbly, cautious steps and confident running. Below the SMO, we also provide a complete range of custom foot orthoses, including UCBL orthoses, functional and accommodative foot orthoses, custom molded inserts, heel lifts and wedges, and posting and alignment modifications. Sometimes the right answer for a child is not a brace at all but a precisely built insert that corrects alignment from the ground up.
When a Child Needs More: Custom KAFOs and HKAFOs
Some children need support above the knee. For them we design and fabricate knee-ankle-foot orthoses (KAFOs) in thermoplastic, carbon-composite, and conventional metal-and-leather constructions, including locked-knee and stance-control designs that stabilize the leg during standing while allowing the knee to bend for sitting or swinging through a step. We also build custom knee orthoses, ligament-support braces, and post-operative knee braces. For children who need support at the hip as well, we fabricate hip-knee-ankle-foot orthoses (HKAFOs) and reciprocating gait orthoses, along with fully custom pediatric and neurologic lower-extremity bracing systems. If your child needs it, we can build it. Families should never have to be sent somewhere else because a device is too complex.
How We Customize Every Brace: Materials, Trimlines, and Design
Two children with the same diagnosis can need very different braces, and the customization goes far deeper than size. Depending on the flexibility, support, and control your child needs, we fabricate with polypropylene, copolymer polypropylene, polyethylene, flexible thermoplastics, and carbon-composite materials. From there, we tailor the plastic thickness, trimlines, joint selection, straps, padding, and inner boots to your child. This is where in-house fabrication really matters. Every adjustment we make is based on what we saw during your child’s evaluation, not just measurements on an order form. Because our lab is under our own roof, the orthotist who evaluated your child is directly involved in how the brace is built, and every one of those design decisions reflects your child’s unique needs. Our typical turnaround is about two weeks from casting to fitting, and when adjustments are needed, we make them on site rather than shipping the brace away and asking your family to wait.
Growing Up With Falk: Why the Relationship Matters
A brace is not a one-time purchase for a growing child. Most kids need a new AFO every 12 to 18 months, sometimes sooner during growth spurts, and their needs change as they change. The child who needed maximum support at three may be ready for a design that allows more freedom at six. This is the part of my work I love most. We see many of our pediatric patients through their entire childhood. We watch a toddler who was afraid to let go of the couch become a kid who has to be told to stop running in the hallway. We celebrate the milestones with the parents, because after years of visits, they are not just patients to us. Those connections are the heart of this practice, and they make us better clinicians too. Nobody knows a child’s history, gait, and preferences like the team that has been building their braces since the beginning.
What This Looks Like in Real Life
A few examples from the kinds of families we see every day. Details have been generalized to protect privacy.
A toddler with low muscle tone comes in barely walking, ankles rolling inward, tiring after a few steps. We cast her for a pair of custom SMOs with a pattern she picks out herself. At her follow-up a few weeks later, her mother’s first words are that she cannot get her to sit still anymore. That is the outcome we are after.
A school-age boy with cerebral palsy has been walking in a crouch that gets worse as he fatigues, and his physical therapist is concerned about his knees. We design a pair of ground-reaction AFOs, tuned with the trimlines and stiffness his gait pattern calls for, and work alongside his PT at the fitting. Over the following months his posture straightens, his endurance grows, and he keeps up on the playground in a way he never could before.
A teenager we have seen since preschool comes in for what may be his last pediatric brace, a low-profile carbon-composite AFO that fits under his uniform for school sports. His parents remind us of the day he took his first steps in our office. Visits like that are why we do this.
Why South Florida Families Choose Falk Prosthetics & Orthotics
Everything custom, everything in house.
We do not order braces from a catalog or ship casts to a factory. Every device is designed, fabricated, and adjusted by our own team, with a typical two-week turnaround. When we see something during the evaluation, such as a specific pressure concern, irregular foot shape, gait deviation, or sensitivity issue, we carry that information directly into our fabrication process.
The full range of pediatric bracing.
From SMOs and foot orthoses to every style of AFO, KAFO, and HKAFO, your child’s care never has to be referred out because a device is too specialized.
Team-based care.
Team-based care. We regularly see children alongside their physical therapists in clinics across South Florida, so the brace and the therapy work together.
Insurance handled.
We work with most insurance plans and handle the documentation, and we will walk you through your coverage before fabrication begins.
A relationship that grows with your child.
Many of our families have been with us for years. We are here for the first fitting, the growth spurts, and everything in between.
Frequently Asked Questions About Pediatric AFOs and Orthotic Bracing
How long does it take to get a custom AFO or SMO?
Our typical turnaround is about two weeks from casting to fitting. Because we fabricate everything in house, adjustments after the fitting can usually be made on site, often the same day.
What is the difference between an AFO and an SMO?
An AFO extends up the lower leg and controls the ankle and foot, while an SMO is a shorter brace that stops just above the ankle bones. SMOs are often used for young children with low muscle tone whose feet flatten or roll inward but who do not need full-length support.
How do you decide which type of AFO my child needs?
We evaluate your child’s diagnosis, anatomy, strength, range of motion, and gait pattern, and
we review the goals set by their physician and physical therapist. The design, materials,
trimlines, joints, and straps are all chosen to match your child, never picked from a standard
template.
Will the brace be uncomfortable for my child?
A properly fitted brace should not be painful. There is a normal adjustment period, but persistent redness, blisters, or complaints of pain mean the brace needs attention. Since we build and adjust every brace on site, resolving fit issues is fast.
How often will my child need a new brace?
Most children outgrow or wear out a brace every 12 to 18 months, and growth spurts can
shorten that. We monitor fit at follow-up visits and plan replacements before the old brace
causes problems.
Does insurance cover custom pediatric braces?
Custom orthoses prescribed by a physician are covered by most insurance plans. Our office handles the documentation and works directly with your insurer, and we will walk you through your coverage before we begin.
Can my child choose the color or design?
Absolutely. Kids choose from a wide range of colors, patterns, and strap options. A brace a child is proud of is a brace they will actually wear, and consistent wear is what gets results.
Schedule an Evaluation for Your Child
If your child has been prescribed an AFO, SMO, or any other brace, or you simply have concerns about how your child stands or walks, we would be glad to meet you. We serve families throughout Palm Beach and Broward counties from our offices in Delray Beach, Jupiter, and Hollywood. To get started, reach out to our team to schedule an evaluation. Bring your questions. We will take all the time you need.