• SMO Order Form v5.3

    SMO Order Form v5.3

    Standard Fabrication 4 Business Days
    • Account Information 
    • Order Information 
    • Today's Date
       - -
    • Requested Due Date*
       - -
    • May we proceed with fabrication or is the Job on HOLD?
    • Device 
    • Mirror Negative*
    • Modifcation*

    • Edema Present

    • Minimum Modifications Include:

      • Squaring and leveling the plantar surface of the cast
      • Adding 3 mm (1/8") build-ups to the medial and lateral malleoli. This will increase the overall ML by 6 mm (1/4")
      • Adding 3 mm build-ups to the navicular and calcaneal tuberosity
      • Arches at the plantar surface are NOT modified
      • If the order calls for a raised forefoot trimline, 3 mm will be added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups will be added to any marked bony areas

    • Standard Modifications Include:

      • Squaring and leveling the plantar surface of the cast
      • Adding 5 mm (3/16") build-ups to the medial and lateral malleoli. This will increase the overall ML by 10 mm (3/8")
      • Adding 3 mm build-ups to the navicular and calcaneal tuberosity
      • Modifying the plantar surface of the cast to a depth of 6 mm (1/4")
      • If the order calls for a raised forefoot trimline, 3 mm will be added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups will be added to any marked bony areas

    • Tone Reduction Modifications Include:

      • Squaring and leveling the plantar surface of the cast
      • Adding 5 mm (3/16") build-ups to the medial and lateral malleoli. This will increase the overall ML by 10 mm (3/8")
      • Adding 3 mm (1/8") build-ups to the navicular and calcaneal tuberosity
      • Modifying the plantar surface of the cast to a depth of 10 mm
      • If the order calls for a raised forefoot trimline, 3 mm will be added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups will be added to any marked bony areas

    • Clubfoot Modifications Include:

      • Squaring and leveling the plantar surface of the cast
      • Adding 2 mm (1/16") build-up to the medial malleolus and 8 mm (5/16") to the lateral malleolus. This will increase the overall ML by 10 mm
      • Add 3 mm (1/8") build-ups to the calcaneal tuberosity
      • The medial side of the 1st MTP joint will be moved laterally, to align it with a mid-calcaneal line. The amount of material removed from the medial forefoot to bring the forefoot into proper alignment will be added to the lateral forefoot to restore the proper ML
      • If the order calls for a raised forefoot trimline, 3 mm will be added to the MTP joint that is being covered by plastic
      • Adding 3 mm build-ups to any marked bony areas
    • Set Ankle To*

    • Heel Height


    • Hindfoot Correction*

    • Forefoot Correction*

    • Design 

    • Foot Plate Length*
    • Midfoot Coverage*

    • Forefoot Coverage*

    • Image field 50
    • Image field 51
    • Proximal Flare*
    • Dorsal Flaps
    • Molded Inner Boot
    • Boot Material*

    • Heel Flare
    • Heel Flare Location*
    • Heel Flare Profile*

    • Lining/Padding Locations

    • When to Pad*
    • Padding Material*

    • Padding Color (Plastazote)*
    • Padding Color (Multi-Density)*
    • Padding Color (Spenco)*
    • Padding Thickness (Aliplast)*

    • Padding Thickness (P-Cell)*

    • Padding Thickness (Pelite)*

    • Padding Thickness (Plastazote)*

    • Padding Thickness (Multi-Density)*


    • Thermoforming 
    • Plastic Type*

    • Thickness*

    • Finishing 
    • Straps*

    • Slot Location*
    • Strap Material*

    • Strap Color*
    • Pad Straps*
    • Slider Material*

    • Padding Thickness*

    • Non-Skid Surface
    • Non-Skid Surface Color*
    • Additional Instructions 
    • Guidelines
    • Anatomical Measurements 
    • If a Discrepancy Exists, Go By*
    • Units of Measure*
    • Show Additional Measurements
    • AOPS Billing 
    • Should be Empty: