We’ve all tripped over an uneven pavement, missed a step or caught our foot on one of the children’s toys. Yet most of the time, we don’t actually fall. We instinctively correct our position, regain our balance and carry on.
As we get older, however, that ability to recover can become more difficult, making falls increasingly likely. So why does this happen?
Is it simply because our balance deteriorates with age, or is there more going on?
Balance starts with the feet. A wide, strong foot is able to adapt to changes in the ground beneath us. Our feet are full of nerve endings, constantly sending messages back to the brain about their position relative to the ground.
We are currently seeing a generation of older people with poor foot mechanics. Their feet are often very narrow, with bunions bringing the big toe in towards the smaller toes. Narrow feet are inherently unstable.
The width and strength capabilities of your feet have very little to do with ageing. You can strength train an older foot in much the same way as a younger foot. Adaptation may take longer, but the aim is the same: a stronger, wider foot that can react more effectively to changes in terrain.
Many women struggle because of a lifetime spent wearing heels and shoes with narrow toe boxes, which can literally create narrower feet and toes. We see this affecting not just balance, but knee and hip health as well.
Why does our risk of falling increase with age?
As we get older, muscle tone declines because muscle breakdown begins to outpace the rate at which we rebuild it. This happens throughout the body, including the muscles in our feet.
As our feet become weaker, balance becomes more difficult. We often respond by taking smaller steps, keeping our feet closer to the ground and spending longer with both feet on the floor to improve stability. We also tend to lean forwards so we can watch where our feet are going.
But these adaptations can create further problems. Taking smaller steps and looking down means we don’t lift our feet as high as we would when striding out. As a result, even a small change in pavement height can cause our toes to catch and trip us up.
Smaller steps also mean we spend less time balancing on one leg. Our feet don’t have to work as hard, which can weaken them further. Finally, leaning forwards shifts our centre of balance towards the front of the foot. Important structures within the arch help absorb and distribute forces, while our toes splay out to create a wide, stable surface.
What can I do about it?
The body is capable of building muscle strength at any age. In fact, one of the most important messages for people over 40 is that strength training plays a vital role in keeping our bodies healthy as we get older.
The same principle applies to our feet. We can strengthen the foot muscles, train the muscles involved in balance and improve the way we walk. We work with many older clients who are afraid to walk in case they fall. So we start with something simple, watching them walk up and down our clinic. Often, just pointing out that they’re looking down and shuffling helps them begin to look up and stride out further.
Next, we work on improving their confidence in their ability to balance. We do this in two ways. Firstly, we practise balance exercises, such as standing on one leg or simply shifting more weight onto one leg while standing still. This starts the process of stimulating the nerves supplying the foot.
We also work on foot strength, using simple towel-scrunching exercises alongside toe separators to encourage the toes back towards a wider position. Strengthning the body takes time, but improving balance, foot strength and walking technique can make a considerable difference to someone’s walking confidence.
And if you do catch your foot on a pavement edge? Well, the stronger your foot, the better your chance of correcting your position before you fall.
Which exercises should I use to improve my balance?
There are several simple exercises you can try.
Backwards walking
This might sound odd, but it’s very difficult to lean forwards or look down when walking backwards. If your balance is poor, start somewhere you can hold on for support. A corridor is a great place to practice. As you become more confident, gradually increase the length of your stride as you walk backwards.
Balancing on one foot
Standing on one foot, with a toe separator between your big toe and the next toe, is an important exercise. Initially, hold on to a wall for support. Make sure your foot points straight forwards rather than turning out to the side.
Challenging your balance further
Once you can stand on one foot unaided, try closing one eye, then try closing both! This is important because, if you rely heavily on your eyes to maintain balance, you may struggle to react quickly enough when you trip. We need to train our internal senses, which help us recognise where our body is in space. These are used when you practice balancing with one or both eyes closed.
Strengthening your feet
Place a small towel on the floor. Keep the ball of your foot flat against the ground and bend your toes to scrunch the towel towards you.
Many people perform this exercise by lifting the ball of the foot off the floor. However, doing this changes which muscles you’re using. Keeping the ball of your foot down helps target the muscles on the underside of your foot. These muscles support the arch, an important structure for absorbing and distributing forces.
Building confidence in your walking
These exercises are designed to strengthen the muscles involved in balance and improve your ability to control your movement. As you become stronger, you should start to feel more confident. That confidence can help you look up, stride out and walk faster.
The benefits extend beyond your feet. Improving your walking pattern can influence your shoulder position, posture, back and leg strength. All these exercises can be made easier or harder, depending on your current ability.
If you’re unsure where to start, come and see us at The Reinge Clinic in Kenilworth. We can assess your balance, foot strength and walking pattern, identify what’s contributing to your difficulties and help you start walking with confidence again.
We have some great articles on fall and trips, how to prevent them and help yourself. Take a look at our articles here.
For more information about Falls, take a look at the NHS website.