“Foot and Ankle Risk Factors for Future Falls in Older Adults: A Systematic Review With Meta‐Analysis of Prospective Cohort Studies”
Samuele Valeriani, Gianluca Melotto, Thanaporn TunprasertABSTRACT
Background
Falls represent a major cause of morbidity and healthcare costs in older adults. Previous systematic reviews have identified certain foot and ankle problems as potential fall risk factors in older adults, but evidence has been predominantly cross‐sectional, limiting causal inference. This review evaluates which foot and ankle problems are prospectively associated with falls in older adults across various settings.
Methods
Six electronic databases were searched from inception to October 2025. Prospective cohort studies on foot and ankle problems and fall risk in adults aged ≥ 60 years were included. Reviewers screened for eligibility, extracted data of included articles and assessed methodological quality using the National Institute of Health (NIH) tool. Meta‐analyses were conducted using random‐effects models when appropriate. Narrative synthesis was used when pooling was not feasible.
Results
A total of 2,189 unique articles were screened, and 14 studies met the eligibility criteria. Meta‐analyses showed significant associations between increased fall risk and foot pain (pooled OR = 1.99; 95% CI: 1.38–2.88), impaired sensory function (pooled OR = 1.52; 95% CI: 1.37–1.68) and intrinsic foot muscle weakness (hallux plantarflexor: pooled OR = 1.65; 95% CI: 1.14–2.38) (lesser toes plantarflexor: pooled OR = 2.04; 95% CI: 1.43–2.92). Findings for deformities, ankle range of motion, lesions, posture and general foot problems were inconsistent or based on limited data. The methodological quality of the included studies was variable, and a common limitation was the lack of adjustment for confounders.
Conclusions
Foot pain, impaired sensory function and intrinsic foot muscle weakness are associated with an increased fall risk in older adults. These findings reinforce the importance of including foot health assessment within fall prevention strategies. Future research should focus on developing and validating screening tools for foot‐related risk factors to help clinicians identify what to assess and guide targeted interventions.