Balance Problems & Falls Prevention | Foot & Ankle Health

When we think about staying strong, mobile and independent as we get older, we tend to think about our heart health, muscle strength, eyesight and keeping active.

But what about our feet?

Our feet are our connection with the ground. They help us stand, walk, change direction and respond to different surfaces, while constantly sending information to our brain about what is happening beneath us.

Yet from my clinical experience, they are often overlooked when we talk about balance and falls prevention.

I regularly see patients in clinic where we intervene from a falls-prevention perspective, as well as people who come to see us following a fall. One of the most important things we can do is understand why somebody has fallen, or why they are beginning to feel less steady, rather than simply treating an injury after it has happened.

Because you don't need to wait until you've fallen to think about your balance.

In fact, that's exactly when I would prefer us to intervene – before the fall happens.

How do our feet help us balance?

Our feet are doing far more than simply carrying us from A to B.

The soles of our feet contain sensory receptors that constantly feed information back to our brain about pressure, movement, position and the surface beneath us.

Think of it as a communication system between the ground, your feet and your brain.

At the same time, the muscles in our feet and ankles are continually making tiny adjustments to help keep us steady. We don't consciously notice it happening, but it is taking place whenever we stand, walk, change direction or encounter an unexpected change beneath our feet.

This becomes particularly important on grass, gravel, cobbles, steps and uneven terrain. Our feet need to recognise the change, communicate it to the brain and then respond quickly enough to help us remain stable.

I often describe our feet as the foundations of the body. Good balance isn't simply about having strong legs. Our feet need to be able to feel, move and react effectively too.

Why can our balance change as we get older?

Like the rest of our body, our feet naturally change as we age.

We can gradually lose muscle strength, our joints can become stiffer and the sensitivity in the soles of our feet may reduce. The smaller muscles within our feet can weaken, our toes may become hammered or less effective and our ankles can become less mobile.

Our activity levels often change too.

We may exercise less frequently, for a shorter duration or at a lower intensity than we did when we were younger. Illness, injury, pain, arthritis and changes in lifestyle can accelerate this.

If we're using our muscles and joints less, we can gradually lose some of the strength, flexibility and mobility that help keep us stable.

However, I don't believe we should simply accept becoming weaker, stiffer or less confident as an inevitable part of getting older.

There is a great deal we can do to maintain our function, mobility and independence.

And this is why prevention matters so much.

What is proprioception and why does it matter?

Proprioception is essentially our body's awareness of where it is and how it is moving without us having to consciously look at it.

If you walk onto an uneven surface, for example, your sensory system recognises the change and your body makes the necessary adjustments.

As we get older, this sensory feedback can become less sharp. Combine that with weaker muscles and stiffer joints and our body may not react as quickly or effectively when something changes beneath our feet.

The good news is that we can continue challenging these systems.

Walking regularly, maintaining foot and ankle strength and practising safe balance and proprioception exercises can all help keep our movement systems active.

I always advise people to find some form of physical activity they genuinely enjoy. Whether that's walking, Pilates, dancing, golf, swimming or something completely different, it needs to be something you're going to continue doing.

If you loathe it, it's unlikely to be sustainable. Find something you love that also challenges you physically and it's a win-win.

Don't underestimate your toes

Our toes are much more important to our balance than many of us realise.

They help stabilise us when we're standing and moving and contribute to the way we propel ourselves forwards when we walk. The big toe is particularly important during the push-off phase of gait.

The encouraging thing is that toe strength can be worked on.

Simple exercises such as spreading the toes or independently lifting the big toe and smaller toes can help maintain movement, control and strength within the feet.

I sometimes compare our toes with our fingers. If we stopped using our fingers independently and stopped asking them to perform different movements, we wouldn't be surprised if we gradually lost some strength and dexterity.

Our feet are no different.

Try this simple balance check at home

There is a very simple check you can do at home which can give you an indication of your balance and foot and ankle strength.

Stand next to a sturdy kitchen worktop so that you have something to hold onto immediately if needed.

Try standing on one foot.

Then compare sides. Is one side noticeably easier? Do you wobble significantly more on one leg?

If you feel completely safe and steady doing this, try rising onto your tiptoes on that one foot and then slowly controlling yourself as you lower your heel back down.

Again, compare one side with the other.

We need strength through the foot, ankle and calf to lift and control our body weight. If you can perform this relatively easily on one side but struggle significantly on the other, that asymmetry is something I would want to investigate.

This isn't a competition to see how long you can balance. Safety comes first. If you cannot comfortably stand on one foot, don't feel confident attempting it or notice a significant difference between your right and left sides, I would recommend having your balance and lower-limb function assessed.

From a preventative perspective, I wouldn't wait until you've fallen.

Five simple exercises for stronger feet and ankles

Looking after our feet doesn't need to be complicated. These are some simple exercises I regularly recommend to help maintain movement, strength and balance.

1. Big toe and smaller toe lifts

Place your whole foot on the floor and try lifting your big toe while keeping the other four toes down.

Then swap: keep your big toe down and try lifting the other four toes.

Aim for 10 repetitions, twice, around three to five days per week.

If you find it difficult, start seated. This is a surprisingly challenging exercise and is excellent for working on individual toe control and the smaller muscles within the foot.

2. Toe spreading

Keep your foot relaxed on the floor and gently spread your toes apart without curling them.

Hold for around five seconds, relax and repeat eight to ten times, three to five days per week.

If you struggle initially, gently use your fingers to separate your toes so that you become familiar with the movement.

3. Calf raises

Stand behind a sturdy chair or kitchen worktop and slowly rise onto the balls of both feet.

Pause briefly and then slowly lower yourself back down.

Start with two sets of ten, around three times per week.

Hold on with both hands if you need to. Calf raises help maintain calf and ankle strength and work the muscles we rely on when pushing ourselves forwards during walking.

4. Supported single-leg balance

Stand beside a sturdy kitchen worktop and lift one foot slightly from the floor.

Try to balance for 20 to 30 seconds before changing sides. Repeat twice on each leg, around three to five times per week.

If that's too difficult, keep the toes of the other foot lightly touching the floor.

If you already have significant balance problems or have experienced a fall, I would recommend being assessed before progressing balance exercises independently.

5. Knee-to-wall ankle mobility

Stand facing a wall with one foot forwards, keeping your heel firmly on the floor.

Slowly move your knee forwards over your toes towards the wall and then return to your starting position.

Try ten slow repetitions on each side once a day.

You should feel movement or a gentle stretch, but it shouldn't be painful.

Ankle mobility is incredibly important because we need our ankle to move as our body travels over the foot during walking. If the ankle becomes very stiff, the body will often find another way to compensate.

Why walking matters – particularly during winter

I think the phrase "use it or lose it" is particularly relevant when it comes to foot and ankle strength.

During winter, many of us naturally walk less. We spend more time sitting, drive rather than walk and understandably avoid going outside when the weather isn't particularly inviting.

Our joints then move through smaller ranges, our muscles are challenged less and we're exposed to fewer variations in terrain.

Over time, this can contribute to reduced strength, mobility and confidence.

If I could recommend one simple thing to do every day, it would be to walk.

It doesn't have to mean chasing an enormous step target. Regular, purposeful movement throughout the day is what matters.

I'm also a keen advocate of a good running shoe for everyday walking. You don't have to be a runner to benefit from wearing one.

For many people, a well-fitting running shoe provides an excellent combination of cushioning, comfort, grip and support. If your feet feel comfortable and supported, you're also more likely to want to keep moving.

What about walking on uneven ground?

We need to continue giving our bodies opportunities to experience different environments safely rather than avoiding every uneven surface.

Walking outdoors naturally challenges our feet and ankles differently from walking around the house on a perfectly flat floor.

Maintaining toe strength, calf strength, ankle mobility and general lower-limb strength can all help, alongside specific balance and proprioception exercises.

If you've started avoiding grass, gravel, steps or uneven paths because you no longer feel confident, I wouldn't simply dismiss that as getting older.

It's worth asking why your confidence has changed.

Falls prevention starts at home

I regularly see patients where we're intervening as part of falls prevention, and I also treat people following a fall.

One of the first things I want to establish is why that fall happened.

Very often, it isn't one single cause. It can be a combination of reduced strength, poorer balance, inappropriate footwear, eyesight, hearing or vestibular problems, medication, confidence and our environment.

And sometimes the simplest things make a difference.

Two things I commonly ask patients about are slippers and rugs.

Unsupported, loose, backless or well-worn slippers can make us less stable, while loose rugs and mats create unnecessary trip hazards.

If you're beginning to feel unsteady, think you're susceptible to falling or simply want to reduce your risk before a problem develops, take a look around your home.

Remove or securely fix loose rugs and mats, keep walkways clear and think carefully about what you're wearing on your feet.

I would choose comfortable, stable, well-fitting footwear indoors rather than relying on loose or badly worn slippers.

Falls prevention is often about identifying and addressing several small risk factors before they combine to cause a problem.

Balance isn't just about your feet

This is incredibly important.

We need to look at balance holistically. Our feet are part of the picture, but they certainly aren't the whole picture.

Vision plays an important role. We use our eyesight to understand our surroundings, judge changes in level and identify obstacles. If your eyesight has deteriorated, your ability to navigate your environment safely may be affected.

Our inner ear is also integral to balance, and hearing loss is associated with an increased risk of falls. If you're experiencing hearing changes, dizziness, vertigo or unexplained unsteadiness, I would want this investigated appropriately rather than assuming that the problem originates from your feet.

Medication, blood pressure, neurological conditions, muscle weakness and other medical factors can also affect balance.

Sometimes that means involving your GP, optometrist, audiologist, physiotherapist or another healthcare professional alongside your podiatrist.

We need to treat the person, not simply their feet.

How I assess balance, walking and falls risk in clinic

When somebody comes to see me because they're feeling unsteady, have experienced a fall or simply want to take a preventative approach, I start by understanding what has changed.

Have they actually fallen or are they experiencing near-falls? Are they catching their toes? Has their walking changed? Are there particular situations where they feel less confident?

Uneven ground, stairs, getting up from a chair or walking in low light can all provide useful clues.

I also look at footwear, including what they're wearing around the house, and consider other potential contributing factors such as changes in activity, eyesight, hearing, dizziness, medication and general health.

From a podiatry perspective, I assess foot posture, joint mobility, ankle range of movement, foot, ankle and lower-limb strength, toe function, balance and proprioception.

Importantly, I compare one side with the other.

Asymmetries can give us valuable information. One foot or leg may be weaker, stiffer or less stable than the other and sometimes the patient hasn't been aware of that difference.

I also want to see somebody moving.

Our biomechanical and gait analysis allows us to look at how the feet, ankles and lower limbs function together during walking. Using gait-analysis technology, we can objectively examine aspects of walking and identify differences between the right and left sides.

We can look at timing, how long each foot spends in contact with the ground, step and stride characteristics and how somebody moves through different phases of gait.

I can then combine this information with my clinical assessment and how pressure is being distributed beneath the feet.

It gives us a much fuller picture of how somebody is actually functioning rather than simply looking at where something hurts.

How can we treat balance problems?

There isn't a one-size-fits-all answer because treatment should be based on what we've identified during the assessment.

For one person, ankle stiffness may be particularly significant. Another may have good mobility but reduced strength. Somebody else may have a marked difference between their right and left sides or poor proprioception.

Often, it isn't one dramatic abnormality but several smaller factors occurring together.

Treatment may include foot and ankle strengthening, improving ankle mobility, specific balance and proprioception exercises, addressing painful foot conditions, changing footwear and gradually increasing appropriate physical activity.

Where clinically indicated, I may also prescribe custom foot orthotics.

Custom orthotics can influence how forces and plantar pressures are distributed underneath the feet and aspects of how the foot and lower limb function during walking.

I don't view orthotics as a standalone answer to balance problems or falls prevention. For the appropriate patient, however, they can form one part of a much wider treatment and prevention plan.

We can then reassess.

Is the person stronger? Has their ankle movement improved? Is there less difference between their two sides? Are they moving more confidently? Can they cope better with the activities and environments that matter to them?

Those functional improvements are what matter.

Don't underestimate the effect a fall can have on confidence

A fall isn't only physical.

I regularly see the psychological and emotional impact too.

Somebody who was previously very independent can become frightened of walking outside, using stairs or going somewhere alone. Even a near-fall can be enough to make somebody question their balance.

The problem is that fear of falling can make us move less.

We stop going for the walk, avoid uneven ground, hold onto furniture or stop doing activities we previously enjoyed.

The less we move, the more strength and confidence we can lose, potentially creating a cycle of fear, reduced activity, weakness and even less confidence.

Rebuilding confidence therefore needs to be part of falls prevention.

Start gradually. Short, achievable walks in a familiar environment, appropriate footwear, simple strengthening exercises and supported balance work can all help.

Exercising with somebody else, joining an appropriate strength and balance class or working with a physiotherapist may also provide reassurance. Many communities have falls-prevention, strength and healthy-ageing classes for older adults, and the social aspect can be just as valuable.

Most importantly, I don't want somebody to stop living their life because they're frightened of falling.

Getting the right help early can make an enormous difference physically and psychologically.

What are the warning signs that your balance may be changing?

Pay attention to changes in the way you move.

Regularly catching your toes, beginning to shuffle, becoming more stooped, walking with your feet further apart, feeling that you're not lifting your feet properly, repeatedly rolling an ankle or suddenly feeling less confident on uneven ground are all worth investigating.

Persistent foot or ankle pain, numbness, altered sensation or weakness should also be assessed.

Sometimes people start holding onto furniture around the house without really noticing they're doing it.

And pay attention to near-falls.

You don't need to hit the floor before asking for help.

If you're regularly stumbling, grabbing onto something to steady yourself or finding yourself thinking, "I nearly went then", your body is already giving you information that something may have changed.

Please don't ignore it.

Don't wait for the fall

For me, this is the most important message.

You do not have to wait until you've fallen to think about falls prevention, and you don't have to wait until your feet hurt to look after them.

If you cannot comfortably stand on one foot, there is a noticeable difference between your right and left sides, you're regularly catching your toes or stumbling, you've started holding onto furniture, or you've simply lost confidence in your ability to walk safely, these are changes worth investigating.

I would much rather assess somebody at that stage, identify where the weaknesses, restrictions or asymmetries are and put measures in place to help maintain their strength, mobility and confidence than meet them for the first time because they have fallen.

We spend a great deal of time thinking about keeping our hearts healthy, maintaining muscle strength and keeping our minds active as we get older.

Our feet deserve to be part of that conversation too.

At Callen Olive, that's central to the way I think about foot health. I don't simply want to treat today's problem. I want to understand why it has happened, identify the things we can change and help preserve movement and function for the future.

Healthy feet aren't simply feet that don't hurt.

They're part of keeping us active, confident, independent and doing the things we love for as long as possible.

Concerned about your balance or the way you walk?

If you've noticed a change in your balance, walking or confidence, have experienced a fall or near-fall, or simply want to take a preventative approach to your foot health, a biomechanical and gait assessment can help us understand how your feet and lower limbs are functioning.

At Callen Olive, we look beyond where it hurts. We assess how you move, identify areas of weakness, restriction or asymmetry and create an individual plan designed around maintaining your mobility, function and confidence.

Book a Biomechanical & Gait Analysis with the Callen Olive podiatry team.