A drop foot occurs in up to 20% of stroke patients and leads to an increased risk of falls. Until recently, only a foot orthosis or surface stimulation was able to improve the gait of these patients. Recent studies have shown that direct peroneal nerve stimulation with an implantable 4-channel peroneal nerve stimulator (ActiGait) allows independent electrode adjustment and leads to better functional results and an improved quality of life. The application of this therapeutic option is restricted to patients with a drop foot attributable to a lesion of the first motor neuron caused by stroke, multiple sclerosis, or tumors. In this paper, we present the first technical note with possible pitfalls of the surgical procedure and the perioperative care after implantation of ActiGait drop foot stimulators in 50 patients.