Fall Prevention in Older Adults: New Research Highlights Footwear, Foot Strength, and Exercise Strategies
Emerging research underscores the important role podiatrists can play in reducing fall risk among older adults. Three recent studies highlight how evidence-based footwear recommendations, intrinsic foot muscle strengthening, and targeted exercise programs may improve stability, confidence, and mobility in patients aged 65 years and older.
Key Takeaways
- Proper footwear matters. Shoes with wide soles, low heels, slip-resistant outsoles, secure fastenings, and moderately firm insoles can improve stability and reduce fall risk in older adults.
- Foot muscle strengthening offers benefits. While a 12-week intrinsic foot muscle strengthening program did not improve gait speed, it increased foot strength and reduced participants' concerns about falling.
- Exercise remains a cornerstone of fall prevention. A new meta-analysis found the Falls Management Exercise Programme (FaME) was the most effective exercise intervention for reducing falls, followed by the Otago Exercise Program, aquatic exercise, tai chi, and balance training.
Falls are the leading cause of injury for adults ages 65 and older, with about one-quarter of adults, or 14 million, reporting falls annually.1,2 Research has shown lower extremity problems, including inappropriate footwear, can increase the risk of falls, and that podiatric intervention can have a positive effect.3 Three recent studies take a look at the effect of proper footwear and different exercise programs in preventing falls.
A recent review confirms the importance of wearing proper shoes to prevent falls in elderly patients. The topic review, published in the Journal of the American Geriatric Society, synthesized recommendations from more than 45 years of clinical experience in physical therapy.4 The evidence identified in the study focused on effective shoe features such as sole stiffness, tread patterns, heel elevation, and orthotic modifications to reduce fall risk, as well as improve function and lessen pain.
The review found that shoes with wide soles, medium-firm materials, low heels, and high collars improved stability and reduced postural sway.4 Researchers noted insoles that are cupped and rigid insoles enhanced dynamic control, and treaded rubber outsoles minimized slipping. The review generally recommended improving safety and function with properly fitted comfortable shoes with moderately firm insoles, slip-resistant outsoles, and secure fastening mechanisms.
Another study looked at the effect of strengthening plantar intrinsic foot muscles (PIFM) to improve gait and balance in older patients and prevent falls.
The randomized controlled trial (RCT), published in Gait and Posture, recruited 33 adults over 65 with potentially higher fall risk at functional exercise classes.5 Participants were randomized to an intervention group (12-week supervised and progressive PIFM strengthening program) or a control group.
Researchers noted no difference between intervention and control groups as far as change in maximum gait speed.5 However, the study found the intervention group showed decreased concerns about falling as well as an increased capacity and strength of foot muscles, although authors noted this was not related to other findings.
A recent meta-analysis identified the relative effectiveness of different exercise interventions on fall rates and fall risk in older people.
The meta-analysis, published Ageing Research Reviews, included 21 RCTs including 3387 participants.6 Researchers noted the Falls Management Exercise Programme (FaME) was the most effective adjunctive intervention, followed by Otago Exercise Program (OEP), aquatic exercise, tai chi, and balance training.
The meta-analysis noted that providing the most effective exercise strategies may enhance fall prevention in older adults, even when the exercise dose falls below the thresholds that World Health Organization guidelines recommend.6
References
1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. [online]. Accessed August 6, 2026. https://wisqars.cdc.gov/
2. Kakara R, Bergen G, Burns E, Stevens M. Nonfatal and fatal falls among adults aged ≥65 years—United States, 2020–2021. MMWR Morb Mortal Wkly Rep. 2023;72(35):938–943. DOI: 10.15585/mmwr.mm7235a1.
3. Spink MJ, Fotoohabadi MR, Wee E, et al. Efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people: a randomised trial. J Foot Ankle Res. 2011;4(Suppl 1):O47. Published 2011 May 20. doi:10.1186/1757-1146-4-S1-O47
4. Cheever CR, Sim H, Ahmidouch MY, et al. Evidence-based footwear recommendations for older adults: enhancing mobility, comfort, and fall prevention. J Am Geriatr Soc. 2026;74(2):556-565. doi:10.1111/jgs.70111
5. Willemse L, Wouters EJM, Pisters MF, Vanwanseele B. Effects of a 12-week intrinsic foot muscle strengthening program (STIFF) on gait, balance and concerns about falling in physically active older adults: An assessor-blinded randomized-controlled trial. Gait Posture. 2026;123:110018. doi:10.1016/j.gaitpost.2025.110018
6. Cheng M, Ni J, Liu F, Wang S. Optimal type and dose of exercise to improve fall behavior in older adults: A systematic evaluation and network meta-analysis. Ageing Res Rev. 2026;113:102924. doi:10.1016/j.arr.2025.102924
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