Fall Prevention for Seniors: How Foot Problems Increase Fall Risk and What Podiatry Can Do

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Falls Are the Leading Cause of Injury in Older Adults

Falls are the leading cause of injury-related death and disability in adults over 65. One in four seniors falls each year, and the consequences — hip fracture, traumatic brain injury, prolonged hospitalization — are often life-changing. What is less commonly known is that foot problems are among the most modifiable risk factors for falls. Addressing foot pain, deformity, neuropathy, and footwear through podiatric care directly reduces fall risk.

How Foot Problems Contribute to Falls

Foot Pain Alters Gait Mechanics

Any painful foot condition — plantar fasciitis, bunions, hammertoes, metatarsalgia — causes the patient to alter their walking pattern to avoid loading the painful area. These compensatory gait changes reduce balance, decrease stride length, and impair the ability to respond quickly to unexpected perturbations. Resolving the underlying foot pain restores normal gait mechanics and reduces fall risk.

Peripheral Neuropathy Impairs Balance Sensation

Peripheral neuropathy — most commonly caused by diabetes but also associated with chemotherapy, vitamin B12 deficiency, and other conditions — reduces the sensory information the feet send to the brain about ground surface and body position. Without accurate proprioceptive feedback, balance becomes dependent on vision and vestibular input alone. Falls are significantly more common in patients with peripheral neuropathy. Podiatric management of neuropathy, combined with balance training, reduces this risk.

Toenail and Skin Problems Affect Comfort and Footwear

Thick fungal toenails alter the fit of footwear. Corns and calluses create focal pressure that changes how patients place their feet. Painful skin conditions prompt patients to walk in loose, unsupportive footwear that dramatically increases fall risk. Regular podiatric nail and skin care maintains foot comfort and allows proper footwear use.

Deformity Impairs Shoe Fit

Bunions, hammertoes, and flat feet make it difficult to find shoes that fit properly. Seniors who cannot find comfortable regular footwear may resort to loose slippers or worn-out sneakers — two of the highest-risk footwear choices for fall prevention. A podiatrist can prescribe therapeutic footwear that accommodates deformity while providing the support and traction needed for safe ambulation.

Podiatric Interventions That Reduce Fall Risk

Foot Pain Treatment

Treating the underlying cause of foot pain — whether with orthotics, injection, physical therapy, or surgery — restores normal gait mechanics and eliminates the compensatory patterns that destabilize balance. Patients consistently report improved walking confidence after resolution of chronic foot pain.

Custom Orthotics for Balance Improvement

Orthotics improve proprioceptive feedback through the foot by providing more surface contact with the ground and correcting alignment. Research demonstrates that custom and semi-custom orthotics improve balance scores in older adults — a meaningful benefit independent of their primary function of pain relief.

Therapeutic Footwear Prescription

Medicare covers therapeutic footwear for diabetic patients under the Therapeutic Shoe Bill. For non-diabetic seniors, our practice helps identify footwear that provides adequate cushioning, a wide toe box for deformity accommodation, a low heel, and non-slip outsoles. These simple footwear characteristics significantly reduce fall risk compared to typical casual footwear.

Diabetic Foot Care and Neuropathy Management

Regular diabetic foot exams include balance assessment and gait observation. When neuropathy is identified, we coordinate with the patient primary care physician and physical therapy for comprehensive fall prevention programming. Monitoring A1C control, vitamin supplementation for B12 deficiency neuropathy, and medication review for drugs that cause dizziness are part of the multidisciplinary approach.

Scheduling a Fall Risk Foot Evaluation

If you or a loved one has experienced falls or near-falls, or if foot pain, neuropathy, or deformity is limiting mobility and confidence, a podiatric evaluation is an important part of fall prevention planning. Balance Foot & Ankle welcomes seniors and their caregivers from across Southeast Michigan. Same-week appointments are available — call (734) 479-0693 to schedule.

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Senior Fall Prevention & Foot Care in Michigan

Foot problems are a leading contributor to falls in older adults. Dr. Tom Biernacki provides comprehensive geriatric foot assessments, custom orthotics for balance improvement, and treatment of conditions that increase fall risk at Balance Foot & Ankle.

Learn About Our Geriatric Foot Care | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Menz HB, et al. “Foot problems as a risk factor for falls in community-dwelling older people: a systematic review and meta-analysis.” Maturitas. 2018;118:7-14.
2. Tinetti ME, et al. “Risk factors for falls among elderly persons living in the community.” N Engl J Med. 1988;319(26):1701-1707.
3. Mickle KJ, et al. “ISB Clinical Biomechanics Award 2009: toe weakness and deformity increase the risk of falls in older people.” Clin Biomech. 2009;24(10):787-791.

When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics

About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.