Review of electrical stimulation, botulinum toxin, and their combination for spastic drop foot

Spastic drop foot is a functional impairment causing significant morbidity and mortality. Multiple treatments are available for this condition, but it is often not clear which treatment or combination of treatments is optimal for a given patient. One relatively recent therapy is the use of functional electrical stimulation to stimulate the peroneal nerve. Another is the use of botulinum toxin injections in the spastic ankle plantar flexors. While reasons exist to think these two treatments might work effectively in combination, there is no clear consensus in the literature. In this article, I review the background of the pathophysiology of spastic drop foot and its treatment options. I present some of the theoretical reasons why functional electrical stimulation and botulinum toxin injections could work synergistically and present a literature review on the topic. Recommendations for future research are discussed.