J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://jmc.elmerpub.com

Case Report

Volume 17, Number 9, September 2026, pages 470-481

Combined Functional Electrical and Transcranial Direct Current Stimulation for Foot Drop: A Case Series

↓ Figure 2. Plot of the toe clearance for participants 1 to 4 (baseline) using the tip virtual marker or digit 5 for participant 1, who was barefoot. The black line represents the mean of the toe clearance pattern from a sample of 10 gait trials of data, out of the 25 collected for each participant. The toe clearance graphs were normalized to 100% of the swing phase.

↓ Figure 3. Plot of change in minimal toe clearance subjects 1–4 from baseline through mid-test point to post test.

↓ **Table 1.** Patient Characteristics
Subject Number	Year of stroke	Affected side (L/R)	Ethnicity	Age (years)	Sex (M/F)	Weight (kg)	Height (m)	Past medical history
L: left; R: right; M: male; F: female; m: meters; kg: kilograms.
1	2010	L	Black/African American	58	F	68.04	1.75	Bowel and bladder irregularities, allergies, vascular clots
2	2007	L	Black/African American	66	M	105.91	1.69	Hypertension, diabetes
3	2020	L	Black/African American	36	M	68.49	1.69	Nerve disease/disorder, speech/communication deficits, paresthesia
4	2022	R	Black/African American	42	M	92.99	1.68

↓ Table 1. Patient Characteristics

Subject Number

Year of stroke

Affected side (L/R)

Ethnicity

Age (years)

Sex (M/F)

Weight (kg)

Height (m)

Past medical history

L: left; R: right; M: male; F: female; m: meters; kg: kilograms.

2010

Black/African American

68.04

1.75

Bowel and bladder irregularities, allergies, vascular clots

2007

Black/African American

105.91

1.69

Hypertension, diabetes

2020

Black/African American

68.49

1.69

Nerve disease/disorder, speech/communication deficits, paresthesia

2022

Black/African American

92.99

1.68

↓ **Table 2.** Minimum or Maximum Toe Clearance and Joint Angle Data at Minimum Toe Clearance for All Four Participants Across All Three Testing Periods
Subject	MTC/MAX L1 (cm) SD	MTC/MAX L2 (cm) SD	MTC/MAX M1 (cm) SD	MTC/MAX M2 (cm) SD	MTC/MAX tip (cm) SD	Mean of lowest MTC values across trials (cm) SD	Percentage of non-MTC for lowest MTC/MAX trials (%)	Ankle joint angle at lowest MTC/MAX (°) SD	Knee joint angle at lowest MTC/MAX (°) SD	Hip joint angle at lowest MTC/MAX (°) SD	Stance hip joint angle at lowest MTC/MAX (°) SD
Only the point with the lowest mean value is reported when all toe clearances are maximums, and other points are reported as non-MTC. Negative joint angles at the ankle = plantarflexion; knee = flexion; swing hip = extension; and stance hip = abduction. SD: standard deviation; non-MTC: when the toe clearance graph does not have a minimum in the mid-swing phase of the gait cycle; NA: not applicable.
Baseline
1	1.68 (0.59)	Non-MTC	Non-MTC	Non-MTC	Non-MTC	1.68 (0.59)	100	−14.72 (1.54)	−28.84 (2.34)	22.75 (1.99)	−6.02 (1.38)
2	−0.26 (0.22)	0.47 (0.43)	Non-MTC	−0.57 (0.28)	Non-MTC	−0.36 (0.63)	14	5.73 (1.35)	−23.15 (1.31)	20.17 (2.25)	5.91 (1.22)
3	0.48 (0.56)	1.86 (0.69)	0.78 (0.060)	1.68 (0.59)	0.04 (0.68)	0.05 (0.67)	1.8	−12.15 (5.51)	−29.24 (3.49)	5.91 (2.36)	−6.80 (1.31)
4	Non-MTC	10.52 (1.68)	Non-MTC	Non-MTC	Non-MTC	10.52 (1.68)	100	−14.34 (1.76)	−19.95 (3.06)	31.45 (2.14)	−1.67 (3.88)
Mid-test (week 4)
1	1.44 (0.67)	Non-MTC	Non-MTC	Non-MTC	Non-MTC	1.44 (0.67)	100	−14.51 (1.60)	−27.83 (2.23)	20.61 (1.60)	−7.00 (1.67)
2	0.13 (0.66)	1.56 (0.85)	0.07 (0.64)	0.29 (0.62)	−0.25 (0.58)	0.21 (1.04)	46.3	0.65 (2.25)	−51.98 (6.67)	26.07 (4.53)	2.38 (2.83)
3	1.09 (0.70)	1.35 (0.78)	0.67 (0.69)	1.92 (0.70)	1.39 (0.71)	0.68 (0.69)	1.4	−9.88 (4.86)	−28.41 (4.11)	7.94 (2.77)	−3.56 (1.84)
4	Non-MTC	8.30 (1.47)	Non-MTC	Non-MTC	Non-MTC	8.30 (1.47)	100	−16.96 (1.60)	−16.44 (1.90)	25.36 (2.02)	−2.12 (0.96)
Post-test (week 8)
1	1.84 (0.68)	NON-MTC	Non-MTC	Non-MTC	Non-MTC	1.84 (0.68)	100	−11.42 (1.44)	−27.97 (2.10)	22.39 (2.42)	−0.95 (2.38)
2	0.21 (0.57)	1.42 (0.68)	−0.11 (0.56)	0.11 (0.53)	−0.55 (0.47)	0.12 (0.91)	59.4	0.07 (2.18)	−48.41 (5.80)	26.12 (4.46)	−2.92 (3.48)
3	0.77 (0.77)	1.47 (0.72)	0.98 (0.78)	1.54 (0.73)	0.89 (0.87)	0.82 (0.88)	1.3	−11.38 (6.23)	−29.41 (4.48)	7.81 (2.99)	−5.31 (1.08)
4	Non-MTC	8.65 (1.42)	Non-MTC	Non-MTC	Non-MTC	8.65 (1.42)	100	−14.55 (2.21)	−12.39 (2.24)	20.33 (2.12)	−6.33 (1.38)

↓ Table 2. Minimum or Maximum Toe Clearance and Joint Angle Data at Minimum Toe Clearance for All Four Participants Across All Three Testing Periods

Subject

MTC/MAX L1 (cm) SD

MTC/MAX L2 (cm) SD

MTC/MAX M1 (cm) SD

MTC/MAX M2 (cm) SD

MTC/MAX tip (cm) SD

Mean of lowest MTC values across trials (cm) SD

Percentage of non-MTC for lowest MTC/MAX trials (%)

Ankle joint angle at lowest MTC/MAX (°) SD

Knee joint angle at lowest MTC/MAX (°) SD

Hip joint angle at lowest MTC/MAX (°) SD

Stance hip joint angle at lowest MTC/MAX (°) SD

Only the point with the lowest mean value is reported when all toe clearances are maximums, and other points are reported as non-MTC. Negative joint angles at the ankle = plantarflexion; knee = flexion; swing hip = extension; and stance hip = abduction. SD: standard deviation; non-MTC: when the toe clearance graph does not have a minimum in the mid-swing phase of the gait cycle; NA: not applicable.

Baseline

1.68 (0.59)

Non-MTC

1.68 (0.59)

100

−14.72 (1.54)

−28.84 (2.34)

22.75 (1.99)

−6.02 (1.38)

−0.26 (0.22)

0.47 (0.43)

Non-MTC

−0.57 (0.28)

Non-MTC

−0.36 (0.63)

5.73 (1.35)

−23.15 (1.31)

20.17 (2.25)

5.91 (1.22)

0.48 (0.56)

1.86 (0.69)

0.78 (0.060)

1.68 (0.59)

0.04 (0.68)

0.05 (0.67)

1.8

−12.15 (5.51)

−29.24 (3.49)

5.91 (2.36)

−6.80 (1.31)

Non-MTC

10.52 (1.68)

Non-MTC

10.52 (1.68)

100

−14.34 (1.76)

−19.95 (3.06)

31.45 (2.14)

−1.67 (3.88)

Mid-test (week 4)

1.44 (0.67)

Non-MTC

1.44 (0.67)

100

−14.51 (1.60)

−27.83 (2.23)

20.61 (1.60)

−7.00 (1.67)

0.13 (0.66)

1.56 (0.85)

0.07 (0.64)

0.29 (0.62)

−0.25 (0.58)

0.21 (1.04)

46.3

0.65 (2.25)

−51.98 (6.67)

26.07 (4.53)

2.38 (2.83)

1.09 (0.70)

1.35 (0.78)

0.67 (0.69)

1.92 (0.70)

1.39 (0.71)

0.68 (0.69)

1.4

−9.88 (4.86)

−28.41 (4.11)

7.94 (2.77)

−3.56 (1.84)

Non-MTC

8.30 (1.47)

Non-MTC

8.30 (1.47)

100

−16.96 (1.60)

−16.44 (1.90)

25.36 (2.02)

−2.12 (0.96)

Post-test (week 8)

1.84 (0.68)

NON-MTC

Non-MTC

1.84 (0.68)

100

−11.42 (1.44)

−27.97 (2.10)

22.39 (2.42)

−0.95 (2.38)

0.21 (0.57)

1.42 (0.68)

−0.11 (0.56)

0.11 (0.53)

−0.55 (0.47)

0.12 (0.91)

59.4

0.07 (2.18)

−48.41 (5.80)

26.12 (4.46)

−2.92 (3.48)

0.77 (0.77)

1.47 (0.72)

0.98 (0.78)

1.54 (0.73)

0.89 (0.87)

0.82 (0.88)

1.3

−11.38 (6.23)

−29.41 (4.48)

7.81 (2.99)

−5.31 (1.08)

Non-MTC

8.65 (1.42)

Non-MTC

8.65 (1.42)

100

−14.55 (2.21)

−12.39 (2.24)

20.33 (2.12)

−6.33 (1.38)

↓ **Table 3.** Functional Outcome and Gait Measures
Subject	FGA	Walk-12	Stroke Impact Scale version 3	ABC scale	Gait speed (m/s) SD	Step length (m) SD
**Missing data. Walk-12 formula = Transformed Walk-12 score = [(Raw Walk-12 score − 12)/48] × 100. Stroke Impact Scale subdomains [(Mean item score − 1)/4] × 100. FGA: functional gait assessment; ABC scale: Activities-Specific Balance Confidence Scale.
Baseline
1	17	60.42	86.1	62.5	75	73.1	0.30 (0.04)	0.28 (0.05)	0.14 (0.05)
2	11	47.92	80.6	68.8	50	65.6	0.75 (0.04)	0.57 (0.03)	0.45 (0.03)
3	24	10.42	**	**	70	95	0.74 (0.05)	0.57 (0.03)	0.57 (0.03)
4	10	31.25	83.3	50	40	34.5	0.18 (0.02)	0.13 (0.02)	0.27 (0.02)
Mid-test (week 4)
1	16	58.33	86.1	78.1	65	68.1	0.33 (0.04)	0.29 (0.04)	0.18 (0.05)
2	15	29.17	94.4	96.9	55	69.5	0.76 (0.04)	0.59 (0.04)	0.49 (0.04)
3	19	52.08	77.8	34.4	70	76.9	0.67 (0.05)	0.55 (0.03)	0.52 (0.03
4	11	81.25	66.7	56.3	80	56.3	0.21 (0.02)	0.15 (0.03)	0.30 (0.03)
Post-test (week 8)
1	15	64.58	80.6	71.9	75	68.8	0.30 (0.05)	0.30 (0.06)	0.12 (0.05)
2	17	10.42	94.4	96.9	**	81.3	0.76 (0.05)	0.57 (0.04)	0.50 (0.03)
3	24	45.83	88.9	37.5	75	85	0.73 (0.04)	0.62 (0.03)	0.54 (0.03)
4	13	56.25	72.2	28.1	35	50	0.26 (0.02)	0.17 (0.03)	0.34 (0.02)

↓ Table 3. Functional Outcome and Gait Measures

Subject

FGA

Walk-12

Stroke Impact Scale version 3

ABC scale

Gait speed (m/s) SD

Step length (m) SD

Mobility

Participation

Perceived recovery

Left

Right

**Missing data. Walk-12 formula = Transformed Walk-12 score = [(Raw Walk-12 score − 12)/48] × 100. Stroke Impact Scale subdomains [(Mean item score − 1)/4] × 100. FGA: functional gait assessment; ABC scale: Activities-Specific Balance Confidence Scale.

Baseline

60.42

86.1

62.5

73.1

0.30 (0.04)

0.28 (0.05)

0.14 (0.05)

47.92

80.6

68.8

65.6

0.75 (0.04)

0.57 (0.03)

0.45 (0.03)

10.42

0.74 (0.05)

0.57 (0.03)

31.25

83.3

34.5

0.18 (0.02)

0.13 (0.02)

0.27 (0.02)

Mid-test (week 4)

58.33

86.1

78.1

68.1

0.33 (0.04)

0.29 (0.04)

0.18 (0.05)

29.17

94.4

96.9

69.5

0.76 (0.04)

0.59 (0.04)

0.49 (0.04)

52.08

77.8

34.4

76.9

0.67 (0.05)

0.55 (0.03)

0.52 (0.03

81.25

66.7

56.3

0.21 (0.02)

0.15 (0.03)

0.30 (0.03)

Post-test (week 8)

64.58

80.6

71.9

68.8

0.30 (0.05)

0.30 (0.06)

0.12 (0.05)

10.42

94.4

96.9

81.3

0.76 (0.05)

0.57 (0.04)

0.50 (0.03)

45.83

88.9

37.5

0.73 (0.04)

0.62 (0.03)

0.54 (0.03)

56.25

72.2

28.1

0.26 (0.02)

0.17 (0.03)

0.34 (0.02)