To explore the effect of extracorporeal shock wave therapy on lower limb spasticity after stroke. Methods: A systematic literature review was conducted in PubMed, the Cochrane Library, Embase, CNKI, WanFang, and CBM databases to identify randomized controlled trials on extracorporeal shock wave therapy for lower limb spasticity after stroke. The search included all records from database inception until May 2023. The outcome measures included the modified Ashworth scale (MAS), Fugl-Meyer assessment (FMA) and range of motion (ROM). The risk of bias was assessed using the Cochrane Handbook and meta-analysis was performed using RevMan 5.4 statistical software. Results: A total of 11 articles with 508 patients were included. Compared with the control group, the intervention group showed significant improvements in MAS [MD=－0.32, 95% CI (－0.41, －0.23), P<0.05], FMA [MD=2.05, 95% CI (1.32, 2.78), P<0.05] and ROM [MD=1.69, 95% CI (0.52, 2.86), P<0.05]. Conclusion: Extracorporeal shock wave therapy has a positive effect on lower limb spasticity after stroke.