Top 10 Evidence Based Foot Drop Strategies
Amy Bean
Wednesday, October 29th, 2025
#dropfoot#electricalstimulation#footdrop#nmesAFOMirror TherapyStroke rehabilitation
1. Orthotic
What are these?
Often call an AFO or Ankle Foot Orthosis, these are splints that are worn to help lift the foot when walking. They can either be custom made or off the shelf.
Custom made orthotics are typically for those that need a lot of support due to severe spasticity, unstable ankle, or loss of range of calf muscle preventing the foot going flat on the floor. An orthotist would assess and make a custom made splint which may require adjustments over time.
Our SaeboStep is an example of an off the shelf orthotic. These help by holding your foot in a lifted position so your toes don’t drag. The SaeboStep has an ankle cuff that wraps around your ankle with an adjustable cord attaching to eyelets that are secured in the shoe. The orthotic lifts the front of your foot when you walk, helping you take more natural steps, reducing effort and the risk of tripping.
There are many different styles of orthotics available so when selecting the right one for you ensure it is user friendly for you (e.g. can you get it on and off independently?), comfortable for all day wear, robust, and provides the lift and support that you need.
2. FES
What is this?
FES or Functional Electrical Stimulation uses electrical stimulation to stimulate the muscle activity required to lift the foot when walking. To help the timing of the stimulation to coordinate with your stride, devices typically have a motion sensor or heel switch to trigger the stimulation. The motion sensor is often built into a cuff that is positioned just below the knee; it detects specific movement of the leg to initiate stimulation for lifting the foot. A heel switch inside the shoe triggers the stimulation when pressure is taken off it i.e. your heel lifts as you start to swing your leg forwards.
A therapist will be involved to assess and set up an FES device for you.
You can also use FES as a training or rehabilitation tool if you are not yet mobile. It can be used to build strength and help start practicing taking steps. Our SaeboStim Pro can be used for this through its built in manual trigger button to control timing of the stimulation. Note that the SaeboStim Pro would not be a suitable device for everyday walking, but ideal for gait rehabilitation.
Orthotic VS FES – What does the evidence say?
Both have high quality evidence to support their use for managing foot drop during walking with neither being superior (Prenton et al 2016). Both are supported by the National Clinical Guidelines for Stroke for foot drop. It really comes down to user choice, access and affordability. The “best” option isn’t always the most advanced or popular—it’s the one that fits your unique situation.
🧠 Decision Factors to consider:
- Neurological status: If nerve-muscle pathways are intact, FES can be used to stimulate activity rather than provide a passive support with an AFO.
- Lifestyle and terrain: FES may be better for active users as it most closely matches a natural walking pattern; AFOs are better suited for those needing consistent support.
- Cost and access: AFOs are more accessible and lower cost; FES may require funding or specialist referral with long wait times if through the NHS.
- Personal goals: Consider whether the aim is rehabilitation (FES) or support/stability (AFO).
If choosing an AFO, why not add in NMES as a strengthening and rehabilitation tool to get benefits of both?
3. NMES
NMES (Neuromuscular Electrical Stimulation) is electrical stimulation not used in the context of a task. With drop foot you can use NMES to help strengthen the muscle that lifts that foot (tibialis anterior) in sitting or lying. You will get the additional benefit of moving your ankle through range, and stretching your calf when the stimulation is on. This will help reduce ankle stiffness in addition to increasing muscle strength in preparation for walking.
In addition to the SaeboStim Pro, you can also use our SaeboStim One for this :
4. Task Orientated Gait Training
Instead of just doing general leg exercises, task-oriented gait training focuses on practicing specific walking activities that you would do in everyday life, e.g. walking on different surfaces, stepping over objects, turning corners, or climbing stairs.
Key Features:
- Real-world practice: You rehearse walking tasks that you actually need in daily life.
- Goal-focused: Each session is designed around a specific goal, like walking to the kitchen or getting up from a chair and walking across the room.
- Repetition and feedback: You repeat tasks many times with guidance and corrections to help your brain and muscles relearn the right movements.
- Adaptability: The training is adjusted to your current ability and gradually becomes more challenging.
It’s like training your body and brain together to walk better by doing the kinds of walking you actually need to do.
5. Strengthening
Why Strengthening Matters:
Foot drop is often caused by nerve damage, stroke, or muscle disorders. While specific treatment depends on the cause of the foot drop and what movement you have, strengthening the muscles around your ankle and lower leg can help you regain better control, improve walking ability and reduce the risk of tripping or falling.
Key Muscles to Target:
Calf muscles – support balance and push-off strength. Pointing the ankle downwards, or raising up on to tip toes is an activity for the calf muscles
Tibialis anterior – lifts the foot upward, important when swinging the leg forward during walking.
Peroneal muscles – help with foot stability and side-to-side movement, and help turn the foot outwards (eversion) during walking.
Your own muscle activity is always preferred when working on movement and strength but if this is limited, NMES can be a helpful tool to help increase repetitions and generate muscle activity if there is very little.
6. Treadmill Training
There is high quality research supporting the use of treadmills for gait training. The motorised walking platform allows high repetition of steps in a very controlled manner that can be adjusted to the users ability e.g. speed, incline, assistance through body weight harness etc. It also provides immediate data that you can use to help track your progress.
You can use treadmills with AFO’s or FES to help reduce effort and promote a more efficient walking pattern when you have foot drop.
Treadmills can very from more expensive devices with body weight harness (available in some NHS trusts and private clinics), to gym treadmills to cheaper home office style treadmills :
7. Repetition
As with all rehabilitation, repetition is key. The number of reps will be dependent on each person, their endurance, strength and also what can fit into your daily schedule.
This may be counting the steps you take throughout the course of the day, the number of repetitions you do with an NMES device, or your own active exercises.
8. Mirror Therapy
Although most commonly used for arm rehabilitation after a stroke, mirror therapy can also be used for the leg. There is good evidence to show benefit in the subacute and chronic stroke population (about 3-6 months and longer post stroke), it can help with motor activity including foot drop, walking and balance.
Consider using it for 30 min per day, 5 days a week for a minimum of 4 weeks, but you certainly continue longer. It can be used on its own or as an adjunct with electric stimulation to see beneficial effects.
Our SaeboMirror Box can be positioned on the floor when you are in sitting with your affected foot inside and your non affected foot outside. Try to position the mirror box so that you can’t see your unaffected foot inside the box.
9. Spasticity Management
If foot drop is a result of a neurological injury such as Stroke or Head Injury, spasticity may be an additional factor in its management. Spasticity in the calf muscle will typically add to the pull down of the foot which will further exacerbate the difficulty in lifting the foot.
This can in turn lead to shortening of the calf muscle over time further adding to the problem if not addressed (see point no.10 below).
The National Clinical Guidelines for Stroke 2023 recommend that :
“People with persistent or progressive focal spasticity after stroke affecting one or two areas for whom a therapeutic goal can be identified (e.g. ease of care, pain) should be offered intramuscular botulinum toxin. This should be within a specialist multidisciplinary team and be accompanied by rehabilitation therapy and/or splinting or casting for up to 12 weeks after the injections”
10. Passive Range / Muscle Length Management
Any joint that does not move frequently is at risk of developing shortening of surrounding tissues leading to restricted movement. This is referred to as a contracture when the change becomes permanent, and is not uncommon when spasticity is present. Regular stretching and positioning are key to prevent these changes when there is minimal or no movement.
In the video below you can view a sample calf stretch. Depending on your ability, you can also stretch your calf by standing on a step with both heels overhanging and slowly lower yourself until you feel a gentle stretch.
NMES to move the ankle joint through range can also help prevent loss of range over time.
Clinical Evidence
National Clinical Guideline for Stroke for UK and Ireland
Australian and NZ Clinical Guidelines for Stroke Management
Spasticity Management with Botox
Suitability for each of the Interventions listed above are dependent on the cause of your foot drop. If you are not sure what may be suitable for you please seek medical advice. If you would like advice on the suitability of the Saebo products mentioned please contact our Clinical team for guidance.
Top 10 Evidence Based Arm Recovery Strategies After Stroke With Saebo
Amy Bean
Wednesday, August 20th, 2025
Arm RehabilitationEvidence-based therapyNeurorehabilitationOccupational therapyPhysical therapyPhysiotherapySaebo toolsStroke careStroke RecoveryUpper limb exercises
This handy user guide of the Top 10 interventions for Stroke rehabilitation are supported by the latest UK and Ireland National Clinical Guidelines for Stroke, the Australian and New Zealand Stroke guidelines and Canadian Stroke Recommendations for Best Practice. A full reference can be found at the bottom of this post.
All dosage recommendations (“How much/How often”) comes from the best evidence available. For some interventions this is very concrete e.g. NMES for shoulder subluxation, and for others such as Mirror Therapy we know it works but exact guidance on dosage is not as well known so we have provided the best summary information available.
1. Electrical Stimulation : “NMES” or “FES
What Is it ?
An electrical current stimulates nerve activity in a targeted muscle to ellicit a muscle contraction. This can help build strength, enhance motor recovery and enable task practice when weak or no movement. If the movement generated is used to help practice a task this would FES (Functional Electrical Stimulation) and if used in isolation with no task it is NMES (Neuromuscular Electrical Stimulation).
How NMES Can Help Relieve Arthritis Symptoms and Improve Mobility
Amy Bean
Tuesday, April 15th, 2025
Arthritis reliefArthritis supportChronic pain solutionsJoint pain managementNeuromuscular electrical stimulationNMES therapyNon-invasive arthritis treatmentSaebo rehabilitation
Arthritis is a musculoskeletal condition in which the body’s joints wear over time leading to pain, stiffness, reduced function and mobility. The severity of the condition varies person to person, and symptoms can be intermittent. With over 10 million people suffering from Osteoarthritis in the UK, or 1 in 6 people, there are many people having their every day life impacted by this condition.
The most common joints affected are the knee, (approximately 5.4 million people), and the hip (approximately 3.2 million people).
Cartilage wears, joint space is reduced, and bony spurs develop on the joint surface , all leading to a joint that is painful to move and weight bear on.
Long term management can include surgery (e.g. joint replacements) and /or pharmaceutical management for pain. Non invasive management can include therapeutic exercise, education and weight loss where relevant, with the goal to improve pain and function for this long term, disabling condition.
Peripheral Nerve Injury
Amy Bean
Tuesday, August 13th, 2024
#dropfoot#electricalstimulation#footdrop#pain#painrelief#peripheralnerveinjury#TENS
Our peripheral nervous system is a network of nerves that deliver motor, sensory and autonomic information (regulates body functions such as heart rate and digestion) from our brain and spinal cord to the rest of our body. Think of it like our telephone system sending messages and calls along telegraph lines to the end receiver and back again.
If any of the nerves are injured e.g. trauma, compression from bulging spinal disc, broken bones pushing on them etc., this disrupts the signals being sent. This can lead to weakness or absence of movement depending on the severity of the nerve damage, loss or altered sensation and for some people pain.
The injury can be partial meaning there is still some connection to send the electrical signals but movement is weaker, there is reduced sensation or altered pain; or it can be a complete severance of the nerve fibre resulting in no movement and sensation.
Treatment and management will be dependent on the extent of the nerve damage.
2024 : Celebrating 20 Years of Saebo UK and our SaeboFlex
Glyn Blakey
Monday, January 8th, 2024
Saebo UK and our SaeboFlex celebrate 20 years in the UK this year. This is our story of how it all started and the journey that the Saebo UK team have made…..
When we started in 2004, Constraint Induced Movement Therapy (CIMT) was the go to treatment for chronic stroke survivors, (i.e. at least 6 months post stroke). Saebo clinics were run based on the CIMT protocols with one to one supervision/assistance, but adapted for those unable to grasp and release by incorporating our SaeboFlex. The SaeboFlex was used for at least 3 hours a day, with the SaeboStretch as a night time resting splint and a session of electrical stimulation thrown in. After every SaeboFlex session, the stroke survivor was asked to attempt every day activities without the splint. This was 20 years ago and revolutionary at the time. Today, the literature is full of modified CIMT protocols to enable more people to follow this outside of the original very strict protocol.
TENS : Using Electrical stimulation for Pain Relief
Amy Bean
Tuesday, October 17th, 2023
#electricalstimulation#pain#painrelief#TENS
What is it?
Transcutaneous Electrical Nerve Stimulation, or TENS as it commonly referred to, is the use of electrical stimulation for pain relief.
In simple terms this type of electrical stimulation blocks the pain signals being sent to the brain and spinal cord to provide pain relief. It therefore doesn’t combat the cause of the problem but can provide much needed temporary relief for some users and is a potential alternative to medication.
Depending on the cause of the pain, the relief may provide relaxation to muscles that are in spasm because of the pain which will allow more freedom in movement. TENS can also stimulate the production of endorphins, our bodies natural pain killers.
Saebo Product Top Tips
Amy Bean
Monday, August 7th, 2023
At Saebo we strive to empower our customers with as much knowledge as possible to ensure our devices our used to their optimum.
To do this, in addition to the comprehensive manuals that come with each product, we have a number of different ways in which we provide additional product support.
Our Clinical Team, with over 45 years experience between them in Neurological Rehabilitation, are available to assist with any queries or support required. They can be contacted by email, phone, video calls, WhatsApp, and across our social media platforms.
Electrical Stimulation Contraindications: Facts and Myth Busting
Amy Bean
Tuesday, June 27th, 2023
#electricalstimulation#nmes#TENS
Before considering using neuro muscular electrical stimulation (NMES), users need to be aware of the contraindications and whether this treatment is safe to use.
A contraindication in medicine is a reason not to use something as it may cause harm.
It would be understandable to presume that there is an agreed set list of contraindications that apply internationally for everyone. Unfortunately this is not the case so in this blog we are going to go through the most commonly agreed contraindications in the UK and discuss each one. By having some knowledge of the reasons behind each one, and any research behind them, it will hopefully help more users to use this evidence based treatment as part of their rehab.
National Stroke Guidelines 2023
Amy Bean
Friday, April 14th, 2023
#strokerecovery#strokerehab#strokerehabilitation
On 4th April the new UK and Ireland National Stroke Guidelines 2023 were published. The last published guidelines were the 5th edition in 2016, and 7 years is a long time in medicine.
These Guidelines bring the biggest changes to Stroke Care and Rehabilitation that we have ever seen.
Almost 300 recommendations were reviewed and updated, 62 key questions searched, 676 papers reviewed and the Guidelines were drafted by a group of over 170 topic experts from the UK and ROI, and they are NICE (National Institute for Clinical Excellent) accredited.
Here at Saebo we have pored over the Guidelines and thought it would be helpful to highlight some key rehabilitation recommendations that stood out for us that are new to these Guidelines.
Sensory Electrical Stimulation for Pain Management
Amy Bean
Wednesday, March 1st, 2023
#electricalstimulation#pain#painrelief#TENS
The International Association for the Study of Pain defines pain as “An unpleasant sensory or emotional
experience associated with actual or potential tissue damage, or described in terms of such damage.” And this can be from many different causes ranging from arthritis in a joint, to muscle damage from a sports injury to “post stroke pain” which might be from a shoulder subluxation, spasticity or joint stiffness from lack of movement.
We have previously discussed the use of TENS for pain relief in a previous blog but in this blog we are going to go more in depth into the use of Sensory Electrical Stimulation to manage pain.
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