Functional Electrical Stimulation for Pediatric Foot Drop: A Clinical Brief

Hey colleague, let's talk about FES for our peds patients with foot drop. We all have kids on our caseload who struggle with AFOs, and it's always a question of what else is out there. The good news is, the evidence for FES is getting stronger and gives us a solid alternative to consider. A major 2018 meta-analysis from Prenton and colleagues looked at the existing RCTs and found that FES and AFOs have an equally positive therapeutic effect on walking speed. This is a big deal because it tells us FES isn't just a fancy gadget; it produces real, measurable results that are on par with our traditional gold standard. The analysis included 7 RCTs with over 450 participants, primarily stroke but with one cerebral palsy study, giving us a moderate level of confidence in this finding for the general CNS population. More recently, a 2024 randomized cross-over trial by Moll et al. dove specifically into the pediatric population. They studied 25 children (ages 4-18) with unilateral spastic CP (GMFCS I & II). Each child used FES for 12 weeks and their conventional treatment (usually an AFO) for 12 weeks. The results? FES was not significantly worse than the AFO in achieving patient-specific goals. While walking with FES, kids maintained a better ankle range of motion compared to their AFO. Interestingly, about half the families who completed the trial chose to continue with FES afterward. This highlights that while not superior, it's a highly viable alternative that comes down to individual patient factors. The protocol involved using a device like the WalkAide, with a 4-week ramp-up period to gradually increase stimulus intensity and wear time. This study reinforces that careful patient selection and a trial period are absolutely key.