Supra-Malleoar (typically meaning just “above the true ankle joint or malleoli”).

The acronym “SMO” has been used for quite a number of years and typically referring to a UCBL-like orthosis but with above ankle medial-lateral uprights / supports.

The Foundation of any SMO remains a well contoured, accurate capturing of the plantar-lateral aspect of the foot similar to most all functionally beneficial orthoses.

Healthcare practitioners become obsessed and intent while trying to “push” this bone or that bone back up against gravity and the rotations of the entire lower limb; based on anecdotal belief only. 

It’s simply not going to happen without creating pain or skin pressure sufficient to cause skin breakdown.  

The is no reason what-so-ever to attempt to push the medial malleous laterally or the talar head (as an extension of the lower leg) into an abducted position.  Yes, we see that these bones appear to ‘enlarge’ when some children shift from off to on weight bearing.  The larger appearing bony  prominence are just that –    Appearances;  Not a problem.

Yes.  That means will SMOs or for that matter any orthosis custom designed for a child one has to find and realize the ‘true problem’ and not attempt to manage the ‘appearances.’