Falls among the aging population is an extremely important problem in our society.

In the United States alone, 36 million people over 65 report falling annually, resulting in staggering numbers of injuries, emergency room visits and long-term disability. It’s not surprising that if you search the internet for advice on decreasing fall risk, you will find a wide range of helpful information. This includes exercises to strengthen large muscles of the lower extremities, making sure you have adequate railings and handles in the home, medications that can increase the risk of falling, and staying hydrated.

While those tips are crucial, something that is often missing might actually be the most-important aspect of fall prevention, and certainly the most underutilized.

That missing piece is toe strength. Research has shown that it is one of the most-significant predictors as to whether an older person will fall. In particular, the study of toe weakness and deformity increased the risk of falls in older people and discovered that seniors without a history of falling had 20% more toe strength than those who fell. It also reported that people who fell and those who didn’t had similar strength in the larger lower extremity muscles, indicating that toe weakness, rather than weakness in general, increases the risk of falling.

Other research has demonstrated that even minor improvements in toe strength can make a sizable difference in fall prevention risk. Strength of the big toe is especially important, particularly how much pressure it can exert into the ground. That was evidenced in the study efficacy of a progressive resistance exercise program to increase toe flexor strength in older people, which revealed that for every 1% increase of body weight generated beneath the big toe, the risk of falling decreases by 7%.

Let’s use a real-life example. Based on that information, if a 160-pound man increased the pressure under his big toe by 8 pounds (5% of his body weight), it would decrease his risk of falling by 35%.

Dr. Tom Michaud, an expert on lower extremity injuries, recommends a simple exercise to increase the strength of big toes. Stand facing a wall, close enough to catch yourself if needed. While keeping your body straight, slowly lean forward while forcefully pushing your toes into the ground. Hold that position for 5 seconds, then push your body back to vertical by vigorously pressing down with your toes. Michaud suggests that people perform the exercise 20 times per day. As your toes become stronger, the distance you can lean forward should gradually increase.

Small strength gains are relatively easy to achieve. After a few months of doing that exercise, people have seen their ability to exert pressure under their big toe improve by 30%. Even increases in strength equaling half that amount could profoundly decrease someone’s risk of falling.

While addressing all areas of fall risk is critical, the importance of toe strength cannot be overstated. Because of the proven connection between falling and toe weakness, toe-strengthening exercises should be a part of every older person’s daily exercise regime.

Dr. Jordan Duncan is from Kitsap County and writes a monthly online health column for Kitsap News Group. He is the owner of Silverdale Sport & Spine.