Existing treatments for foot drop include ankle foot orthosis (AFO), functional electrical stimulation (FES), physiotherapy and in some cases, surgery (Mayo Clinic, 2017). 

In cases where tension in the plantar flexors due to shortening cannot be overcome despite some recovery of dorsiflexion, a surgical procedure can be done to release the tendon and resolve foot drop (Graham, 2010). In cases where dorsiflexion is inactive, surgery involves either transferring the insertion point of tibialis posterior so that it acts as a dorsiflexor, or transferring the superficial peroneal nerve so tibialis anterior is re-innnervated (Graham, 2010). 

For most stroke patients, foot drop is treated with an AFO or with FES, which provide comparable ambulatory improvements compared to no device at all (Sheffler et al., 2006). 

An AFO is the traditional treatment for foot drop. As shown in Figure 13, an AFO is a brace worn on the lower leg and holds the foot and ankle in a neutral position, preventing foot drop during the swing phase of gait (Kluding et al., 2013, Pilkar et al., 2014). Although AFOs have been found to increase gait speed and functional ambulation, several limitations exist (Kluding et al., 2013). Contractures may result from limited ankle mobility, people have difficulty standing up from a seated position, and it is said to be uncomfortable (Kluding et al., 2013). People have difficulty standing from a seated position because although incorrect movements are restricted, the ability to dorsiflex the ankle is still lost, which aids in the transition from sitting to standing (Contact, 2019).

The alternative treatment is FES. FES works by applying short bursts of current to the nerve of the hemiparetic muscles, facilitating muscle contraction (Duncan, 2016). As presented in Figure 14, for foot drop, a foot switch inserted in the shoe or a tilt sensor attached to the shank is used to detect the instant of heel rise (Van der Linden et al., 2017). When this moment of gait is detected, two electrodes which are either attached to the skin or incorporated into a cuff, stimulate the common peroneal nerve (Van der Linden et al., 2017). The common peroneal nerve innervates the muscles responsible for ankle dorsiflexion, allowing the individual to clear their foot during the swing phase (Pilkar et al., 2014). FES has been found to decrease plantar flexor spasticity, increase dorsiflexor strength, and increase voluntary dorsiflexion and lower extremity motor recovery (Yana et al., 2017). One major limitation with FES treatment is that it has a strict inclusion criteria, which will be shown later.


Overall
Despite similar short-term benefits, FES is found to be better in the long run as it facilitates neural reorganization (Steinle and Carbaley, 2011)