Foot Drop Treatment: Nerve Stimulation

Foot drop is a condition where a patient is unable to fully lift the front part of their foot when walking. It can be caused by peripheral neuropathy, muscle disease, polio, stroke, ALS or MS. 

A variety of treatments are used to help correct foot drop, one of which is nerve stimulation. This post will introduce you to how nerve stimulation is used to treat foot drop, as well as where it fits in a broader treatment program that also encompasses other remedies.

There are multiple types of nerve stimulation used in the treatment of foot drop. But the basic process is to put electrodes on the muscles of the lower leg. These deliver electrical impulses which cause muscle contractions. This in turn helps the foot to flex upward (which is called “dorsiflexion”). 

While a patient is receiving nerve stimulation, the nervous system itself is re-learning how to move the foot through the degrees of motion required for a normal gait.

Let’s talk a little more about foot drop. When you walk with a regular, healthy gait, you are able to lift the front parts of your feet completely off the ground as you walk. But when you walk with foot drop, you cannot fully lift the front parts of your feet. That means that your toes drag along the ground.

Foot drop imposes a number of challenges that can have an adverse impact on the daily lives of people who experience it.

Lack of Mobility

For starters, it is simply harder to get around when you have foot drop. Not being able to lift your feet completely when you walk makes it difficult to walk. Something as simple as a trip to the grocery store may feel burdensome, much less a walk around the block for exercise. 

Other Challenges 

When it is difficult for you to walk, you may also be more injury-prone. Your toes dragging on the ground may prevent you from clearing obstacles, resulting in trips and falls.

In addition, walking with an unnatural gait may strain your body in unnatural ways, potentially leading to discomfort or pain over time.

While nerve stimulation is a technique that is becoming more widespread for treating foot drop, there are other traditional approaches which may also be used.

Nerve stimulation is not fully replacing these other methods; instead, treatments are often used in tandem with one another for more effective results. 

Physical therapy for foot drop consists of doing exercises to increase your strength and range of motion, with the focus being mainly on the ankle and knee. You will do simple stretches, as well as walk.

Your foot can end up in unnatural positions when you try to walk with foot drop. If you are unable to prevent this on your own, you can try wearing a splint or brace around your foot and ankle. This will hold your foot in the position it is supposed to be in while you are walking. 

Speaking of walking with foot drop, it is also helpful to choose therapeutic footwear. Shoes for foot drop are designed to make it safer, easier and more comfortable to walk with this condition.

The Original Men’s and Women’s Adaptive Shoes by Cadense use patented variable friction technology to enable you to “glide” over uneven surfaces when you walk. That way, even if you are not able to fully lift your feet, you can cross these surfaces with lower chances of tripping and falling.

While physical therapy and assistive devices can go a long way toward helping you recover from foot drop, they do not directly stimulate the nerves and encourage dorsiflexion in the way that nerve stimulation does. 

Nerve stimulation is a therapy where a mild electrical current is used to stimulate the nerves. 

Nerve stimulation is not painful. In fact, it can help to reduce pain for many patients with a wide range of conditions

There are several different types of nerve stimulation that are used in the treatment of foot drop. Let’s learn a bit about each of them.

Functional Electrical Stimulation (FES)

The first type of nerve stimulation used to treat foot drop is Functional Electrical Stimulation (FES). Doctors use FES when patients are experiencing stroke-induced paralysis. FES specifically targets motor nerves to induce deliberate contractions.

What can you expect? Electrodes will be placed at strategic points on your skin, with wires running to the FES device, which administers the current. It is completely non-invasive.

Transcutaneous Electrical Nerve Stimulation (TENS)

Transcutaneous Electrical Nerve Stimulation (TENS) is very similar to FES. The device appears similar and works the same basic way.

So, what is the difference between FES and TENS? This source from Cleveland Clinic explains that FES induces muscle contractions, but TENS does not.

It is more accurate to say that TENS at a higher setting can induce muscle contractions, but that they are mild. 

Speaking of settings, when you first start using a device for nerve stimulation, you should try it on a low setting. At higher settings, some patients find the sensation uncomfortable (and even a bit prickly)—at least at first. You can also overdo it with the muscle contractions if you start out too high.

Another thing that is helpful to know is that your body will get used to the level of sensation you feel after a few minutes. 

So, what felt like a high intensity five minutes ago may feel merely moderate or even mild after that time elapses.

This is mostly true on the lower settings. At higher settings, your mind will get used to what you feel, but the sensation will still seem strong.

So, here is a common way to start a nerve stimulation session:

1. Turn the device on at a low setting. Check how you feel.

2. If you find the sensation okay, you can increase it right away. If you find it intense, try waiting a few minutes.

3. At that point, you can either keep the setting, or raise it if it now feels too mild. Then, wait a few more minutes.

4. If the sensation now feels too mild, you can increase the setting again, and so on. 

The right setting to use for nerve stimulation depends on your individual condition(s), as well as your preferences. Discuss this with a therapy professional to find what is best for you.

An implanted nerve stimulation device is also called an “implantable neurostimulator” or “spinal cord stimulator.” It is about as large as a stopwatch. This is an invasive treatment, as the device will be surgically implanted in your body.

Your doctor may recommend this type of implanted device if a central nervous system lesion is causing your foot drop. Patients who receive this treatment report increased satisfaction with their performance.

At its core, electrical stimulation for foot drop works by delivering controlled electrical impulses to the tibialis anterior muscle and peripheral nerves responsible for ankle dorsiflexion (lifting the foot). These impulses essentially "remind" the nervous system how to activate these muscles properly during walking.

Nerve stimulation is used to promote dorsiflexion in patients with foot drop, as well as to help the patient’s body, nervous system and brain to re-learn proper movement of the foot. Patients who have pain may also experience some relief from nerve stimulation.

Studies show promising results in using nerve stimulation as part of foot drop rehabilitation. 

Some nerve stimulation interventions are only possible for patients who are able to walk. So, pairing nerve stimulation with physical therapy and suitable footwear such as Cadense Adaptive Shoes may be necessary to achieve the full benefits.