By Gene Shenker, DPT, Founder & CEO, RehabStride™ AFO
Foot drop can make everyday activities—from walking across the room to climbing stairs—difficult and frustrating. Two of the most widely used solutions are ankle-foot orthosis (AFO) braces and functional electrical stimulation (FES) devices. Both approaches help lift the foot during walking, but they do so in very different ways. If you’ve been diagnosed with foot drop, you may be wondering: Which option is right for me?
This guide breaks down the pros and cons of AFO braces vs. FES devices, with a spotlight on how modern braces like the RehabStride™ AFO are redefining patient comfort and independence.
What Is an AFO Brace?
An ankle-foot orthosis (AFO) is a lightweight brace worn around the ankle and foot. Its main purpose is to hold the foot in a neutral position, preventing it from dragging during walking.
How it works: An AFO provides mechanical support. By holding the ankle at a set angle, it stops the toes from dropping and reduces tripping risk.
Types of AFOs:
Rigid or solid AFOs (fixed position, maximum support)
Hinged/articulated AFOs (allow some ankle motion)
Dynamic or adjustable AFOs (like the RehabStride™ AFO, which uses a tension-controlled cable system for customized lift)
AFOs are often prescribed after stroke, multiple sclerosis (MS), peripheral nerve injury, or spinal cord conditions. Patients who need immediate and reliable support often find braces like the RehabStride™ AFO to be a practical, non-invasive solution.
What Is Functional Electrical Stimulation (FES)?
Functional electrical stimulation (FES) devices use low-level electrical impulses to stimulate the nerves and muscles that lift the foot (mainly the tibialis anterior).
How it works: Small electrodes placed on the skin (or sometimes implanted) send pulses that activate the muscles when you take a step. This causes the foot to lift naturally.
Common systems: Portable units worn just below the knee, often paired with sensors that detect gait.
FES is frequently used in patients with neurological conditions such as stroke, MS, or brain/spinal cord injury—especially when the nerves and muscles still respond to stimulation.
Pros and Cons of AFO Braces
Pros
✔ Immediate effect: Works as soon as you put it on—no training required.
✔ Reliable: Provides consistent support regardless of nerve or muscle function.
✔ Widely available: Can be fitted by orthotists or purchased directly (like RehabStride™ AFO).
✔ Durable: With proper care, can last months to years.
✔ Modern comfort: Dynamic braces such as the RehabStride™ AFO offer adjustable tension and slimmer designs that fit more easily into footwear.
Cons
✘ Less natural gait: Some traditional AFOs restrict ankle movement.
✘ Footwear limitations: Shoes need enough depth and width to fit the brace.
✘ Muscle inactivity: Because the brace does the work, ankle muscles may remain weak.
✘ Appearance/self-image: Some patients feel self-conscious wearing a visible brace.
Pros and Cons of FES Devices
Pros
✔ Promotes natural movement: Activates your own muscles, which may help maintain strength.
✔ Dynamic gait: Often improves stride length, symmetry, and walking speed.
✔ Discreet: Most devices can be worn under clothing.
✔ Potential long-term benefit: May encourage neuroplasticity (the brain’s ability to adapt).
Cons
✘ Not for everyone: Requires intact nerves; won’t work if nerve damage is severe.
✘ Setup and training: Electrodes must be positioned correctly, and devices require programming.
✘ Higher cost: More expensive than most braces; coverage is inconsistent.
✘ Maintenance: Requires charging and replacement of electrodes.
✘ Skin irritation: Electrodes can cause redness or discomfort.
FES vs. AFO Braces for Foot Drop
Side-by-side look at how Functional Electrical Stimulation compares with an AFO (e.g., RehabStride™ AFO).
| Feature | AFO Brace (e.g., RehabStride™ AFO) | FES Device |
|---|---|---|
| How it works | Provides mechanical support; RehabStride adds adjustable cable tension for a customized lift. | Applies electrical pulses to stimulate nerves/muscles to lift the foot. |
| Best for | Weak or paralyzed dorsiflexors; immediate, reliable support needs. | Residual nerve/muscle function that can respond to stimulation. |
| Ease of use | Simple: strap on and walk. | Requires setup, electrode placement, and device training. |
| Cost | Moderate; RehabStride available direct-to-patient, often less than FES. | Higher; coverage varies and may need pre-authorization. |
| Effect on muscles | Passive support; may reduce active dorsiflexor use. | Active stimulation; helps preserve muscle strength and timing. |
| Appearance | Visible brace; low-profile options like RehabStride are discreet. | Usually worn under clothing; low visual footprint. |
| Maintenance | Minimal: routine cleaning and strap checks. | Ongoing: charging, electrode replacement, skin checks. |
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How to Choose Between FES and an AFO
Deciding between an AFO brace and FES isn’t about which is “better”—it’s about what fits your condition, lifestyle, and goals.
Talk to your healthcare provider: They can assess your muscle activity, walking pattern, and overall safety.
Consider your diagnosis:
Severe weakness or nerve damage → AFO may be the most dependable choice.
Partial nerve function and good rehab potential → FES could be more beneficial.
Think about daily life: If you want simplicity and immediate results, a brace like RehabStride™ AFO might be ideal. If you’re willing to invest time in training with technology, FES may suit you.
Factor in budget and insurance: Braces are often covered, while FES can require appeals or out-of-pocket expenses.
Some patients even combine the two: using an AFO for longer outings and FES for therapy sessions or shorter daily mobility.
Final Thoughts
Both AFO braces and FES devices have transformed the lives of people with foot drop. AFOs offer immediate, reliable support, while FES provides the potential for more natural muscle activation.
For patients seeking a modern AFO option, the RehabStride™ AFO stands out. With its adjustable tension system, it bridges the gap between rigid support and natural movement, offering flexibility that many traditional braces lack.
Ultimately, the best solution is the one that helps you walk with confidence, safety, and independence. Explore both options with your healthcare provider—and remember, innovation in mobility support continues to grow.
FAQs
1) Can I try FES and an AFO before committing?
Often yes. Many clinics offer in-office FES demos and temporary AFO trials or loaners. Ask your provider about a brief gait assessment using both so you can compare comfort, gait quality, and ease of use.
2) Will an AFO work with my regular shoes?
Usually—choose shoes with removable insoles, a wide opening, and extra depth. Athletic styles with laces or adjustable straps tend to accommodate braces best.
3) Who is not a good candidate for FES?
People with significant peripheral nerve damage, uncontrolled epilepsy, or certain implanted electronics (e.g., some pacemakers) may be advised against FES. Your clinician will screen for medical contraindications and skin tolerance.
4) Is insurance coverage different for FES vs. AFOs?
Typically, bracing has more predictable coverage, while FES can require pre-authorization or appeals. Collect a prescription, letter of medical necessity, and trial notes—they strengthen any claim.
5) Can I switch between FES and an AFO during the day?
Yes. Many patients use an AFO for long outings (reliable support) and FES for therapy or shorter walks (muscle activation). The mix can be tailored to fatigue, terrain, and your goals.
Sources:
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- Sheffler, L., & Chae, J. (2020). Neuromuscular electrical stimulation in neurorehabilitation. NeuroRehabilitation, 46(3).
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