Purpose: About twenty percent of stroke patients suffer from equinovarus deformity of the foot during stance and/or swing phase of walking. Although multiple treatment alternatives are available, treatment recommendation is hindered by poor scientific evidence.The choice for treatment of ankle foot deformities in stroke in daily practice is preference rather than evidence based. The aim of this study is to increase the transparency of the choice of treatment in equinovarus deformity in stroke. Methods The analytical hierarchical process (AHP) is used as a structured methodology to study the subjective rationale behind choice of treatment in a panel of ten health professionals from different backgrounds. A case description of a patient with moderate equinovarus deformity was presented to the panel for reference purposes. The health professionals judged the performance of the applicable treatments on outcome, treatment impact, comfort, cosmetics, daily effort and risks and side-effects of treatment as well as the relative importance of criteria in the choice of treatment. Results According to the model soft tissue surgery (0.413) is the first ranked treatment followed by orthopedic footwear (0.181), ankle-foot orthosis (0.147), surface electro stimulation (0.137) and finally implanted electro stimulations (0.123). Outcome was found most influential on treatment choice (0,509) followed by Risk (0,194), comfort (0,104), ease of use(0,098), cosmetics (0,065) and impact of treatment (0,030). Conclusion Soft tissue surgery is judged best on clinical outcome, daily effort, comfortable shoe wear and it has the best cosmetically acceptable result and is thereby preferred as a treatment alternative by the panel in this study. Electrical stimulation is dominated as a treatment by the other alternatives, and orthosis and orthopedic footwear are preferred in daily practice. The AHP method was found to be suitable methodology to elicit subjective opinions as well as to quantitatively compare treatments in the absence of scientific evidence.