Drop foot treatment: Functional electrical stimulation

Background: The gait pattern after stroke can be disturbed by foot drop. The conventional approach to the treatment of drop foot gait is a splint, the ankle-foot orthosis (AFO). An active approach is functional electrical stimulation (FES). Functional electrical stimulation (FES) refers to electrical stimulation of muscles in order to improve the impaired motor function. This is achieved by activating skeletal muscles with constant frequency trains of stimulations. Objective: The objective of this paper is to compare the conventional treatment, the transcutaneous device and the implanted device of electrical stimulation to correct drop foot in stroke patients. Further, developments and improvements are discussed. Results: FES is divided in surface and implanted electrodes system, both improve the gait pattern and reduce spasticity. AFO is a passive treatment, which also improves the gait pattern of the ankle joint. Drop foot treatment with FES results in a more natural gait pattern. Different groups of patients with different lifestyles will also have different opinions in what treatment they prefere. The implantable FES has some advantages in comparison with the transcutaneous FES, but the surgery needed for this is the biggest disadvantage. Conclusion: FES is, in theory, a better technique for treating drop foot in stroke patients than AFO. It is however really the choice of the patient what the patient prefers. Transcutaneous FES yet remains the common approach of FES, since the disadvantages of surgery are too big. The new technology BION microstimulation looks very promising to overcome the risks of surgery and still have the advantages of implanted electrodes.