Falls are the leading cause of injury in older adults, and most of what is sold to prevent them has never been tested. So before anything about toes, here is what has been.
What is proven to reduce falls
The 2019 Cochrane review pooled trials of exercise in older people living at home. Balance and functional exercise reduced the rate of falls by about 24%. Programs that combined balance, functional and strength training did better still, at around 34%.1
A 2025 systematic review of 27 randomized trials found the same pattern. Tai Ji Quan programs were associated with 31–58% fewer falls, the Otago Exercise Program with 23–40% fewer, and combined strength-and-balance training with 20–45% fewer.2
These are structured programs, done regularly, usually for months. If you take one thing from this article, take this: ask your doctor or a physical therapist about a fall-prevention exercise program. Ask for Otago or Tai Chi by name. This is the intervention with the evidence behind it, and nothing below replaces it.
The part most programs leave out
Those programs train the hips, thighs, ankles and balance. Almost none of them train the toes. That is a gap, because the research on toes and falls is unusually clear.
Toe grip weakens before hand grip does. A study of community-dwelling older men found toe grip strength declining earlier than both hand grip and knee extension strength.3 You may notice your handshake getting weaker. You are unlikely to notice your toes.
It predicts falls — better than the tests doctors usually run. In a one-year prospective study of older adults, toe grip strength was associated with both whether people fell and how many times, and it added predictive information beyond knee extension and hand grip strength.4 An earlier prospective study of 312 people aged 60 to 90 found that reduced toe flexor strength and toe deformities each increased the risk of falling over the following year.5 The same research group later estimated that every 1% of body weight lost from toe strength raises fall risk by around 7%.
It shows up in the simplest movement of the day. Among older adults who struggled to rise from a chair, those who needed assistance had significantly lower toe pressure while standing than those who could stand on their own.6 Standing up is not a hip movement that happens to involve the feet. The toes are pressing the whole way.
Toe shape matters too. Hallux valgus affects somewhere between 35% and 74% of older adults, and around 60% have some deformity of the smaller toes. In the prospective study above, people with a lesser-toe deformity were about twice as likely to fall as those without.5
Why toes are hard to train on your own
You can strengthen your thighs by standing up from a chair. You can train balance by standing on one leg near a counter. Toes are awkward. There is nothing to push against, nothing to hold, and no easy way to make the exercise harder over time. Most people who try "toe scrunches" on a towel stop within a fortnight because they cannot tell whether anything is happening.
That is the specific problem a toe trainer solves. It holds the toes apart so they can be worked through their full range, and it gives them something to close against. Pooled data from 13 randomized trials found that training the small muscles of the foot significantly improved balance, strength and self-reported foot function.7
What has not been shown
We want to be exact here, because the audience for this article deserves it. Toe grip strength predicts falls. That is well established. Whether training toe grip reduces falls has not been tested in a trial that measured falls as the outcome. It is a reasonable thing to do, it improves measures that track with falling, and it fits naturally alongside a proven program. It is not, on its own, a fall-prevention intervention, and we will not describe it as one.
The 13 pooled trials also measured pain and found no significant improvement. If your feet hurt, that is a reason to see a podiatrist, not to buy a foot product.
How to do it safely
Everything here is done sitting down, on bare feet, on a surface that will not slip. A session takes five to ten minutes per foot:
- Open. Work each toe into its slot and sit with them held apart for a few minutes. No effort needed.
- Circle. Use your hand to turn the tips of your toes in small circles, ten each way.
- Grip. Lift your toes, then press them down into the floor, squeezing as they close. Fifteen to twenty times. This is the part that trains strength.
Every other day is enough. Full instructions with photos are here.
Do not stand up while wearing it. A device between the toes changes how your foot meets the floor, and for someone at risk of falling that is the wrong moment to find out. Take it off first.
If you have diabetes, neuropathy, or reduced feeling in your feet, talk to your doctor before using anything that presses between the toes. You may not feel pressure that is doing harm.
Get the size right. Toe-Rx comes in three sizes and two firmnesses; it is not one-size-fits-all, and the wrong size can cause injury. Start with the Soft type and your everyday shoe size, and check the sizing guide. If it pinches or slips, contact us and we will exchange it.
Putting it together
A fall-prevention program, done regularly, is the thing that has been shown to work. Toe grip is the strength that program probably does not cover, that declines before you notice, and that predicts falls better than the tests you have already had. Ten minutes, sitting down, every other day, is a reasonable way to close that gap — and a reasonable thing to mention to whoever is helping you with the rest.
*These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.
References
- Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A,
Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for
preventing falls in older people living in the community. Cochrane
Database of Systematic Reviews. 2019;1:CD012424.
The reference standard for fall-prevention exercise. Effects were in people living independently; evidence is weaker in residential care. - Choudhary PK, Choudhary S, Saha S, Katanić B, İlbak İ,
Tornóczky GJ. Effectiveness of balance- and strength-based exercise
interventions for fall prevention in community-dwelling older adults: a
systematic review of randomized controlled trials. Life.
2025;16(1):41. doi:10.3390/life16010041.
Read it
27 trials, narrative synthesis. The percentage ranges are across studies, not a single pooled estimate. - Miura S, Seko T, Himuro N, Koyama M, Saitoh S, Ohnishi H.
Toe grip strength declines earlier than hand grip strength and knee
extension strength in community-dwelling older men: a cross sectional
study. Journal of Foot and Ankle Research. 2022;15(1):79.
doi:10.1186/s13047-022-00584-x. PMID: 36280859.
Read it
Men only, cross-sectional. - Toe grip strength shows stronger associations with falls
than knee extension or hand grip in older adults: a 1-year prospective
cohort study.
Read it
Prospective, community-dwelling. Predicts falls; did not test an intervention. - Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR. ISB
Clinical Biomechanics Award 2009: toe weakness and deformity increase the
risk of falls in older people. Clinical Biomechanics.
2009;24(10):787–791. PMID: 19751956.
312 people aged 60–90, followed for 12 months. The "7% per 1% body weight" figure is from the same group's later work citing this study. - Kamasaki T, Tabira T, Hachiya M, Tanaka S, Kitajima T, Ochishi K, Shimokihara S, Maruta M, Han G, Otao H. Comparison of toe pressure strength in the standing position and toe grip strength in association with the presence of assistance in standing up: a cross-sectional study in community-dwelling older adults. European Geriatric Medicine. 2023;14(3):429–438. doi:10.1007/s41999-023-00776-z. PMID: 37024644. Read it
- Jaffri AH, Koldenhoven R, Saliba S, Hertel J. Evidence for
intrinsic foot muscle training in improving foot function: a systematic
review and meta-analysis. Journal of Athletic Training.
2023;58(11–12):941–951. doi:10.4085/1062-6050-0162.22. PMID: 35724360.
Read it
General population, not specifically older adults. Pain did not significantly improve.
