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Background: The integration of advanced 3D scanning and additive manufacturing technologies in stroke rehabilitation offers promising advancements in the design and production of ankle-foot orthoses. These technological innovations are progressively recognized for their potential to provide more precise and customized orthotic solutions for individuals with stroke-related impairments. Objectives: The primary aim of this study was to biomechanically test and validate the effectiveness of custom ankle-foot orthoses produced through additive manufacturing technology using data captured by a novel photogrammetric scanning system. The customized orthosis was compared with a standard prefabricated orthosis to assess their relative effectiveness in improving gait dynamics and patient satisfaction in stroke rehabilitation. Methods: Participants with equinovarus deformity, a common consequence of stroke, were fitted with custom ankle-foot orthoses, alongside conventional prefabricated orthoses. The study utilized the Qualisys® motion analysis system for comprehensive biomechanical gait analysis, and the QUEST questionnaire was employed to capture participant feedback on both types of orthoses. Detailed comparisons of gait dynamics were conducted using Statistical Parametric Mapping with each orthosis. Results: The study revealed notable kinematic and kinetic differences between the custom and prefabricated orthoses. The custom orthoses demonstrated superior performance in enhancing gait efficiency, symmetry, and safety. Patient feedback favored the customized orthoses over the prefabricated variants, with higher scores in comfort, fit, and overall effectiveness. Conclusions: This research underscores the effectiveness of custom orthoses produced through additive manufacturing technology for stroke rehabilitation. By offering a comprehensive evaluation of orthotic interventions and establishing a comparative framework, the study serves as a reference point for future research, advocating for a more personalized and evidence-based approach in orthotic design for improving the quality of life of stroke survivors.