NMES Parameters for Foot Drop

Neuromuscular Electrical Stimulation for Anterior Tibialis Weakness

If you have a drop foot, your physical therapist may use neuromuscular electrical stimulation, or NMES, to improve the way your muscle contracts. Foot drop is a condition that is caused by anterior tibialis muscle weakness or paralysis. There many causes of foot drop including, but not limited to:

  • Stroke
  • Sciatica
  • Spinal cord injury
  • Peripheral nerve entrapment or injury
An electrical stimulation and ultrasound unit in PT
Eliza Snow / Getty Images

If you have foot drop, visit your practitioner right away for a full assessment of your condition and to get an accurate diagnosis and treatment. Your healthcare provider may refer you to a physical therapist to help treat your foot drop.

Your physical therapist will likely prescribe various exercises and treatments for your foot drop. He or she may use a resistance band to help pull your toes off the ground while walking to retrain your anterior tibialis muscles to function properly. Strengthening exercises may be performed for your foot drop as well.

One type of electrical stimulation that is often used to treat foot drop is called neuromuscular electrical stimulation (NMES). It is a type of electric stimulation that helps to artificially contract your muscle to retrain it to function properly.

This can improve the way your muscle contracts, leading to strength gains in your anterior tibialis muscle. If your PT decides to use NMES in the clinic to treat your foot drop, be sure to ask a lot of questions about the treatment so you know what to expect.

Application of NMES in Physical Therapy

When using NMES, your PT will likely follow some basic steps. Here is the basic protocol.

  1. Expose your anterior tibialis muscle in the front of your shin.
  2. Your PT will apply small adhesive electrodes to the front of your shin
  3. The electrodes will then be connected to an electrical stimulation unit.
  4. Your PT will then turn on the machine and increase the intensity of the stimulation.
  5. You will likely feel a tingling sensation over the front of your shin.
  6. The intensity should be raised until a visible muscle contraction occurs in your anterior tibialis muscle. Your ankle will involuntarily flex up.
  7. While the NMES unit is flexing your ankle, work with it and try to pull your toes and ankle up further.

Your physical therapist will set the NMES unit to cycle on and off. Typically it will be on for 15 to 20 seconds, and then it will shut off for 15 to 20 seconds. While the machine is on and flexing your foot, you should be flexing your foot as well; when the unit shuts off, you should rest your anterior tibialis muscle.

Typically NMES for foot drop is applied for 15 to 20 minutes in the physical therapy clinic. After the treatment, the electrodes will be removed. Once the electrodes are removed, you should continue to exercise your anterior tibialis muscle by performing specific strengthening exercises.

If your physical therapist determines that the NMES has been beneficial in improving your anterior tibialis muscle function, he or she may continue it in the clinic several times per week. 

Home NMES units are also available for you to use on a daily basis if needed. These units are expensive, and your health insurance company may not cover the cost of the unit, so speak with your healthcare provider or physical therapist about home NMES.

Foot drop can be a difficult condition to manage, and it may cause functional limitations with walking and standing. Using NMES for foot drop is one way that you may benefit from physical therapy to help treat your foot drop.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  6. Fortier LM, Markel M, Thomas BG, Sherman WF, Thomas BH, Kaye AD. An update on peroneal nerve entrapment and neuropathy.Orthopedic Reviews. 2021;13(2):24937. doi: 10.52965/001c.24937

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By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.