Drop Foot After Stroke: Causes, Treatments, Costs, and Everyday Solutions

Drop foot (also called foot drop) is a common problem after a stroke. It happens when the muscles that lift the front of your foot are weak or when the nerves that control them are not working properly. As a result, the front part of the foot drags when you walk. Many people describe it as feeling like their foot is “slapping” the ground or catching on rugs, curbs, or stairs.

Why Does It Happen After Stroke?

A stroke can damage the parts of the brain or spinal cord that control movement in the leg and ankle. This makes it hard for the ankle dorsiflexors—the muscles that lift the toes and foot—to function normally. Drop foot may appear right after a stroke or develop over time as you try to walk more. It can lead to trips, falls, and fatigue because you have to lift your leg higher than normal just to clear the ground.

How Drop Foot Affects Daily Life

• Walking feels slower, uneven, or unsafe

• It may be difficult to walk outdoors or on uneven ground

• Confidence can drop, making some people avoid social or community activities

• Risk of falls increases, which can delay recovery

  
  

Recovery Timelines: What to Expect

Recovery from drop foot after stroke varies greatly, but some general patterns can help set expectations:

• First 3 months: Most rapid neurological recovery. Weakness and nerve control may improve with intensive therapy.

  
  

• 3–6 months: Gains may slow but can continue, especially with consistent rehab. Drop foot may become less severe or more manageable with a brace or device.

  
  

• 6–12 months: Progress is steadier. Therapy and devices can improve walking confidence and independence.

  
  

• Beyond 1 year: Some people still see improvements, particularly if they stay active. For many, drop foot remains a long-term issue requiring ongoing management.

  
  

Exercises to Help Drop Foot

These exercises, often taught in therapy, can also be practiced at home if approved by your provider:

• Ankle dorsiflexion with resistance band: Sit with your leg straight, wrap a band around your foot, and pull your toes toward you against resistance.

  
  

• Toe taps: While seated, keep your heel on the floor and repeatedly lift and lower your toes.

  
  

• Heel raises: Stand holding a chair, lift your heels off the ground, then slowly lower.

  
  

• Balance practice: Stand on your affected leg (with support nearby), gently shift weight side to side.

  
  

Even short, daily sessions help maintain mobility and prevent stiffness.

Treatment and Management Options

1. Physical Therapy. Strengthening, gait training, and balance exercises form the foundation of recovery. Early, consistent therapy leads to the best outcomes.

2. Ankle-Foot Orthosis (AFO). A lightweight brace that fits in your shoe and holds your ankle in a safe position.

3. Functional Electrical Stimulation (FES). A device worn around the leg that sends small electrical signals to stimulate the muscles, lifting the foot during walking.

4. Surgery (for select cases). Procedures like tendon transfer or implantable stimulators may be considered when other treatments fail.

AFO vs FES: Pros and Cons

Feature	AFO (Ankle-Foot Orthosis)	FES (Functional Electrical Stimulation)
Cost	$60–$2,000+ depending on type	$2,000–$4,000+ plus ongoing supplies
Insurance Coverage	Widely covered (Medicare & private)	Medicare rarely covers for stroke; private insurers vary
Ease of Use	Simple, no batteries	Requires setup, electrodes, battery charging
Appearance	Can be bulky, but carbon-fiber is discreet	More natural walking pattern, but requires wearing a cuff
Comfort	May rub or cause heat; better if custom	Tingling sensation, possible skin irritation
Effect on Walking	Provides stability and prevents tripping	Promotes natural movement, may help strengthen muscles
Best For	Most survivors, especially early recovery	Those who can afford it, appeal insurance, or need dynamic movement

Everyday Tips for Living With Drop Foot

• Choose safe footwear: Firm, supportive soles reduce tripping. Avoid slippers or flip-flops.

  
  

• Make your home safer: Remove loose rugs, add non-slip mats, and ensure good lighting.

  
  

• Use walking aids when needed: A cane or walker helps during early recovery.

  
  

• Check devices regularly: Adjust or refit as your recovery changes.

  
  

• Track progress: Keep a log of falls, fatigue, or walking changes. Share with your rehab team.

  
  

U.S. Costs & Insurance Coverage

(2025 Estimates)

Ankle-Foot Orthosis (AFOs)

• Basic off-the-shelf: $60–$300

• Mid-range: $300–$1,200

• Custom-made: $1,000–$2,000+

• Usually covered by Medicare and private insurance with a doctor’s prescription. Under Medicare Part B, expect ~20% coinsurance after the deductible.

  
  

Functional Electrical Stimulation (FES) Devices

• Typical cost: $2,000–$4,000+

• Extra costs: Electrodes, batteries, training, and follow-ups.

• Medicare: Rarely covers FES for stroke-related foot drop (restricted mostly to spinal cord injury).

• Private insurers: Mixed. Some cover with strong documentation, many deny as “experimental.” Appeals can sometimes succeed.

  
  

Coverage Tips:

• Ensure prescriptions state “medical necessity.”

• Provide therapy notes showing falls and failed AFO trials.

• Use manufacturer-supplied appeal templates.

• Explore nonprofit grants or payment plans.

  
  

FAQ: Common Questions

Q: Can drop foot improve without devices?

Yes, especially in the first 6–12 months post-stroke, with therapy and exercise. Devices, however, improve safety and speed up recovery.

Q: Is FES painful?

Most people feel tingling or mild buzzing. It should not be painful if electrodes are placed correctly and intensity is set appropriately.

Q: Can I use both FES and an AFO?

Yes. Some people alternate between them depending on the situation.

Q: When will I notice improvements with FES?

Some changes in walking may be seen in a few weeks. More measurable progress typically requires 8–12 weeks of consistent use and therapy.

Q: Are there risks with FES?

Yes. Possible issues include skin irritation, mild soreness, or fatigue. It is not suitable for everyone (for example, people with pacemakers or certain heart conditions).

Is FES FDA Approved for Drop Foot After Stroke?

Yes. Several FES systems are FDA-cleared for foot drop caused by upper motor neuron injuries, including stroke.

• L300 Go System (Bioness): FDA-cleared for adults and children with foot drop due to stroke and other neurological conditions.

  
  

• EvoWalk 1.0 System: Recently FDA 510(k)-cleared for adults with foot drop or weakness due to upper motor neuron injury (e.g., stroke).

  
  

“FDA-cleared” means the devices meet safety and effectiveness standards, but coverage by insurance is not guaranteed.

Key Takeaway

Drop foot is a common but manageable complication of stroke. With early therapy, practical exercises, and devices like AFOs or FES, survivors can walk more safely and confidently. While U.S. insurance coverage is uneven, persistence, appeals, and community support can make a difference.

We’d love to hear from you: If you have drop foot after stroke, how much have you spent on braces, FES devices, or therapy? What worked for you? Share your experience in the comments below to help other survivors understand the real-world costs and options.

Disclaimer: This article is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, physical therapist, or other qualified health provider with any questions you may have regarding a medical condition or device. Never disregard professional medical advice or delay seeking it because of something you have read here. Mention of specific devices, products, or services (such as AFOs or FES systems) does not imply endorsement by RebuildAfterStroke.org. Costs and insurance information are estimates and may vary widely based on your health plan, location, and medical needs. Use of any device or therapy should be guided by a licensed healthcare professional, and individual outcomes will vary.