Understanding the Role of Orthotics in Enhancing Mobility and Independence for Older Adults with Frailty

When we think about frailty in older adults, our minds often turn to medication reviews, nutrition, falls, delirium, dementia, hydration, and hospital admissions. These are all critical areas, but sometimes the most important question is much simpler: What is happening at ground level?

For many older adults living with frailty, foot pain, poor footwear, reduced ankle strength, altered gait, or difficulty transferring safely can quietly chip away at confidence, mobility, and independence. Recognizing this, the National Institute for Health and Care Excellence (NICE) has included footwear and foot condition alongside gait, balance, mobility, and muscle strength in its 2025 falls guidance as part of a comprehensive falls assessment.

This post explores how orthotics can play a vital role in supporting older adults with frailty, helping to reduce pain, improve stability, and maintain independence.

What Are Orthotics?

Orthotics are supportive devices designed to improve comfort, positioning, stability, or function of the foot and ankle. They come in various forms, including:

• Insoles

• Heel raises

• Custom foot orthoses

• Ankle supports

• Ankle-foot orthoses

  
  

According to NHS orthotic guidance, foot orthoses refer to insoles prescribed for foot and sometimes knee conditions. Ankle-foot orthoses provide support to both the foot and ankle, aiding standing and walking.

For older adults with frailty, orthotics are not just about correcting foot shape or alignment. Their purpose is broader and more functional:

• Reducing pain

• Improving stability

• Supporting safer transfers

• Maintaining walking ability

• Reducing fear of falling

• Helping preserve independence

  
  
  
  

Why Orthotics Matter in Frailty

Frailty is a state of reduced reserve, meaning small changes can have a big impact. Consider this common cycle:

• A painful foot leads to less walking

• Less walking causes muscle loss

• Muscle loss worsens balance

• Poor balance increases fear of falling

• Fear of falling reduces activity even further

  
  

This cycle can quickly lead to loss of independence and increased risk of falls.

Research shows that foot pain in older adults is linked with reduced physical activity, impaired mobility, and increased falls risk. Orthotics may help by reducing foot pain and improving stability, but they must be carefully chosen and regularly reviewed to be effective.

Custom foot orthotic being fitted into a shoe to improve mobility and reduce pain in older adults

Custom foot orthotics can provide targeted support to reduce pain and improve walking stability in older adults.

How Orthotics Support Mobility and Independence

Orthotics can address several challenges faced by older adults with frailty:

1. Reducing Foot Pain

Painful feet discourage walking and standing. Orthotics can cushion pressure points, redistribute weight, and correct minor deformities, making movement less painful.

2. Improving Stability and Balance

Devices like ankle-foot orthoses provide extra support to weak ankles, helping prevent ankle rolls and improving overall balance during walking or standing.

3. Supporting Safer Transfers

Transfers from sitting to standing or moving in and out of bed require good foot and ankle function. Orthotics can enhance stability during these movements, reducing the risk of falls.

4. Maintaining Walking Ability

By improving comfort and support, orthotics encourage continued walking and physical activity, which is crucial for maintaining muscle strength and cardiovascular health.

5. Reducing Fear of Falling

When people feel more stable and experience less pain, their confidence grows. This can reduce fear of falling, encouraging more activity and social engagement.

Choosing and Reviewing Orthotics

Orthotics are not one-size-fits-all. Selecting the right device requires a thorough assessment by healthcare professionals such as podiatrists or physiotherapists. Factors to consider include:

• The specific foot condition or deformity

• Level of pain and its location

• Muscle strength and joint mobility

• Type of footwear used daily

• The person’s usual activities and lifestyle

  
  

Regular follow-up is essential to ensure the orthotics continue to meet the person’s needs. Changes in health, weight, or activity level may require adjustments or new devices.

Practical Tips for Older Adults and Caregivers

• Check footwear regularly for wear and fit. Shoes should be supportive, comfortable, and wide enough to accommodate orthotics.

• Encourage daily foot care to prevent skin breakdown, infections, or other issues that can worsen mobility.

• Work with healthcare providers to get professional assessments and prescriptions for orthotics.

• Monitor changes in walking ability, pain levels, or balance and report these promptly.

• Incorporate gentle exercises to maintain ankle strength and flexibility alongside orthotic use.