A common assumption may be that fitting an ankle foot orthosis (AFO) is sufficient to address walking difficulty after neurologic impairment such as stroke, MS,  traumatic brain or spinal cord injury. However, patients fitted with an AFO to assist walking can, in many cases, benefit from a foot drop stimulator as this intervention can be successfully combined with an AFO  i.e. – an AFO does not have to be discontinued when foot drop stimulation is applied.  Both can be combined to maximize walking performance.

While an AFO provides passive assistance to clear the foot overground during walking –  a stimulator  provides activation of pre tibial and peronei muscles augmenting the effect of the AFO  to improve gait speed, safety and security. Stimulation additionally improves hip excursion to make walking easier.

While it may be contraindicated to initially discontinue use of an AFO with introduction of FES – it may however be possible, over time, to use an AFO and stimulator interchangeably,  particularly as patient experience and confidence is gained with stimulation.

The accompanying picture illustrates bilateral AFOs and FES for walking in MS.