Functional electrical stimulation of the peroneal nerve improves post-stroke gait speed when combined with physiotherapy. A systematic review and meta-analysis.

Foot drop after stroke, where the ankle can't lift properly during walking, is often treated with functional electrical stimulation (FES) applied to the peroneal nerve to help lift the foot during the swing phase of walking. This review pooled data from 14 trials to ask whether FES actually speeds up walking and improves related outcomes, and how it compares depending on what it's paired with. Overall, FES alone did not walk faster than standard care.

But when FES was added to supervised physiotherapy sessions, gait speed improved more than physiotherapy alone. Pairing FES with unsupervised home exercise showed no added benefit, and combining it with general home activity gave unclear results. FES did appear to improve ankle movement, balance, and functional mobility compared with standard care, though the evidence behind those last two outcomes was quite inconsistent across studies, and overall confidence in the gait speed finding was rated low.

If you or someone you know has foot drop after a stroke, meaning the front of the foot doesn't lift properly while walking, you may have heard about a treatment called functional electrical stimulation, which uses a small device to stimulate the nerve that lifts the foot. This review combined findings from 14 studies with over a thousand participants to see whether this stimulation helps people walk faster and move more easily. The results were mixed.

Using the stimulation on its own, without added therapy, didn't lead to walking faster than standard care. But when it was combined with physiotherapy sessions guided by a therapist, people did walk faster than with physiotherapy alone.

It didn't seem to add benefit when combined with exercises done without supervision. The stimulation was also linked to improvements in ankle movement, balance, and everyday mobility compared with standard treatments. That said, the researchers rated the evidence behind the walking speed improvement as low quality, and the findings on balance and mobility varied a lot between studies.

So while there are some encouraging signals here, these results should be viewed with caution rather than certainty.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis pooled 14 randomized or crossover trials (1115 participants) examining peroneal nerve FES for post-stroke foot drop. Comparing FES with conventional treatment overall, no gait speed benefit was detected.

Subgroup analysis by co-intervention showed that FES combined with supervised physiotherapy outperformed physiotherapy alone for gait speed, while FES combined with unsupervised exercise showed no added effect, and FES combined with regular home activity produced inconclusive results. Across the pooled comparisons against conventional treatment, FES was associated with improvements in active ankle dorsiflexion, balance, and functional mobility, but the balance and mobility outcomes carried high statistical heterogeneity (I2), limiting confidence in the pooled estimates. The authors explicitly rated the certainty of evidence for the gait speed finding as low. Clinically, this suggests any gait speed benefit from FES may be contingent on concurrent supervised therapy rather than a standalone effect, though the review does not establish the mechanism or dose-response relationship.

Given the low certainty grading and marked heterogeneity in secondary outcomes, these findings should be interpreted as hypothesis-generating rather than definitive, and do not establish FES as superior to supervised physiotherapy delivered without stimulation.