Functional electrical stimulation versus ankle-foot orthoses in adults with foot drop: A systematic review and meta-analysis

This study aims to synthesize the available evidence regarding the effectiveness of functional electrical stimulation (FES) compared to ankle-foot orthoses (AFOs) for improving gait in adults with foot drop. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020–compliant systematic review was conducted. Databases were searched from inception to March 18, 2026. Eligibility criteria included studies evaluating adults with chronic foot drop (≥3 months) of neurological origin treated with FES. Studies comparing FES with AFO or other control conditions were included; however, only direct FES-versus-AFO comparisons were considered in the meta-analysis. Data were extracted concerning gait velocity, functional capacity, kinematic parameters, and quality of life. A random-effects meta-analysis was performed for gait velocity, expressed as the standardized mean difference (SMD). Sixteen studies were included in the qualitative synthesis. Most investigations reported significant improvements in gait velocity and endurance with both FES and AFO, with no consistent differences between the two devices. However, the meta-analysis (comprising four comparisons) demonstrated a significant improvement favoring FES in gait velocity (SMD = 0.29; 95% confidence interval: 0.07–0.52; p = 0.01), and no heterogeneity was observed (I 2 = 0%). In addition, FES was associated with improvements in kinematic parameters, gait adaptability, and some patient-reported outcomes. Both FES and AFO appear to improve gait performance in adults with neurological foot drop. The observed advantage of FES on gait velocity is small and supported by limited evidence. These findings should be interpreted cautiously. Treatment selection should be individualized according to patient characteristics, preferences, and clinical context. Further high-quality comparative studies are warranted.