REVIEW PAPER
Effects of foot posture-related interventions on balance and fall risk in older adults: a systematic review
1
Department of Physiotherapy, Dr. Vithalrao Vikhe Patil Foundation’s (DVVPF’s) College of Physiotherapy, Ahilyanagar (Ahmednagar), Maharashtra, India
2
Department of Community Physiotherapy, Terna Physiotherapy College, Nerul, Navi Mumbai, Maharashtra, India
Submission date: 2025-09-08
Acceptance date: 2026-01-23
Online publication date: 2026-07-16
Corresponding author
Asawari Peter
Dr. Vithalrao Vikhe Patil Foundation’s (DVVPF’s) College of Physiotherapy, Ahilyanagar (Ahmednagar), Maharashtra, India; Department of Community Physiotherapy, Terna Physiotherapy College, Nerul, Navi Mumbai, Maharashtra, India
Dr. Vithalrao Vikhe Patil Foundation’s (DVVPF’s) College of Physiotherapy, Ahilyanagar (Ahmednagar), Maharashtra, India; Department of Community Physiotherapy, Terna Physiotherapy College, Nerul, Navi Mumbai, Maharashtra, India
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Falls represent a major public health issue among older adults, where balance impairment, exacerbated by age-related declines in the sensory, musculoskeletal, and neurological systems, and abnormal foot posture critically influence stability and fall risk. This systematic review aimed to analyse the effects of foot posture interventions in reducing fall risk.
Methods:
Electronic databases (ScienceDirect, PubMed, Google Scholar) were searched from January 2020 to December 2025. Studies were included as per the eligibility criteria. Primary outcomes were balance measures and fall risk indicators; secondary outcomes included gait parameters and mobility-related quality of life. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool for trials and the Newcastle-Ottawa Scale for observational studies. Due to heterogeneity, outcomes were synthesised narratively with descriptive statistics.
Results:
Twelve studies, which consisted of 5 observational and 7 randomised controlled trials (RCTs), involving 196 participants in the experimental groups and 131 in the control groups of the RCTs, met the eligibility criteria. Balance shoes/minimal footwear enhanced postural stability and sensory feedback. Exercises improved static/dynamic balance via strength/coordination. Foot care/TENS boosted control via mechanoreceptors; vibration showed limited effects. Ill-fitting footwear/soft insoles worsened instability. Heterogeneity limited comparisons, but individual effect sizes included standardised mean differences (SMD 0.85–1.04 for Baduanjin exercise on balance, SMD −0.35 for vibration on Timed Up and Go), and r = 0.42–0.58 for foot posture-balance correlations in observational studies.
Conclusions:
These findings suggest that tailored footwear, exercise, and sensory interventions can reduce fall risk, but larger, standardised trials are needed to optimise protocols and ensure generalisability.
Falls represent a major public health issue among older adults, where balance impairment, exacerbated by age-related declines in the sensory, musculoskeletal, and neurological systems, and abnormal foot posture critically influence stability and fall risk. This systematic review aimed to analyse the effects of foot posture interventions in reducing fall risk.
Methods:
Electronic databases (ScienceDirect, PubMed, Google Scholar) were searched from January 2020 to December 2025. Studies were included as per the eligibility criteria. Primary outcomes were balance measures and fall risk indicators; secondary outcomes included gait parameters and mobility-related quality of life. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool for trials and the Newcastle-Ottawa Scale for observational studies. Due to heterogeneity, outcomes were synthesised narratively with descriptive statistics.
Results:
Twelve studies, which consisted of 5 observational and 7 randomised controlled trials (RCTs), involving 196 participants in the experimental groups and 131 in the control groups of the RCTs, met the eligibility criteria. Balance shoes/minimal footwear enhanced postural stability and sensory feedback. Exercises improved static/dynamic balance via strength/coordination. Foot care/TENS boosted control via mechanoreceptors; vibration showed limited effects. Ill-fitting footwear/soft insoles worsened instability. Heterogeneity limited comparisons, but individual effect sizes included standardised mean differences (SMD 0.85–1.04 for Baduanjin exercise on balance, SMD −0.35 for vibration on Timed Up and Go), and r = 0.42–0.58 for foot posture-balance correlations in observational studies.
Conclusions:
These findings suggest that tailored footwear, exercise, and sensory interventions can reduce fall risk, but larger, standardised trials are needed to optimise protocols and ensure generalisability.
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