Foot Problems and Falls: The Hidden Connection
The feet are the foundation of balance and mobility, yet foot problems are frequently overlooked in falls prevention. Research shows that foot pain, deformity, and weakness are independent risk factors for falls in older adults. Addressing foot health can significantly reduce fall risk.
Common foot problems in older adults include: bunions (bony deformities at the base of the big toe), hammer toes (toes that curl abnormally), calluses and corns (thickened skin causing pain and pressure), toenail problems (thickened, ingrown, or fungal nails), flat feet or fallen arches (reducing shock absorption), and neuropathy (reduced sensation, common in diabetes). Any of these can alter gait pattern, reduce balance, and increase fall risk.
The mechanisms are several. Pain causes compensatory gait changes — limping or altered weight distribution — that destabilise balance. Reduced sensation in the feet (neuropathy) removes important proprioceptive information that the brain uses for balance. Foot deformities change the biomechanics of walking and standing. And inappropriate footwear, often chosen to accommodate painful or deformed feet, may itself contribute to falls.
Management involves several approaches. Regular podiatry care addresses nail problems, calluses, and corns — simple treatment can significantly reduce pain and improve mobility. Appropriate footwear is essential: shoes should have a firm, non-slip sole, adequate support, sufficient width and depth to accommodate any deformities, and a secure fastening. Custom insoles or orthotics can address biomechanical problems and improve comfort and balance.
Foot and ankle exercises are also beneficial: toe curls (picking up marbles or a towel with the toes), ankle circles and alphabet writing (improving mobility), heel raises (strengthening calves), and towel stretches (improving calf and Achilles flexibility). These exercises strengthen the intrinsic foot muscles and improve ankle mobility and proprioception.
Our falls prevention service includes foot and footwear assessment as part of comprehensive falls risk evaluation. Our elderly physiotherapy service incorporates foot and ankle exercises into rehabilitation programmes. For patients with diabetic neuropathy, our neurological physiotherapy service addresses the balance impairment associated with sensory loss.