OBJECTIVE: Ankle-foot control is essential to maintain balance and gait stability. However, there has been limited evidence on the effect of ankle-foot exercises on balance and falls in older people. This study aimed to summarize the effects of ankle-foot exercises on ankle flexibility and strength, balance, mobility, and falls in older people, and to identify determining factors for ankle-foot exercises to improve balance and mobility. METHODS: CINAHL, Embase, PubMed, and PEDro were searched to identify randomized controlled trials that studied the effects of ankle-foot exercises on ankle control, balance, and falls in older people. PEDro scale was used to evaluate the methodological quality of the studies. Meta-analyses were done for similar outcomes. The quality of evidence was rated by GRADE. RESULTS: Sixteen papers (n = 651) were included. Meta-analyses showed that ankle-foot exercises significantly improved ankle plantarflexion strength (SMD 0.35, 95% CI 0.04 to 0.65, low-quality evidence), ankle flexibility (SMD 0.48, 95% CI -0.01 to 0.96, low-quality evidence), and balance in an eyes-open condition (SMD 0.41, 95% CI 0.19 to 0.70, low-quality evidence). There was no significant change in ankle dorsiflexion strength (SMD 0.29, 95% CI -0.24 to 0.82, very low-quality evidence), balance under eyes-closed condition (SMD 0.41, 95% CI -0.1 to 0.92, very low-quality evidence), and gait speed (SMD 0.36, 95% CI -0.24 to 0.96, very low-quality evidence). Two studies reported insignificant findings on fear of falling, fall incidence, and risk of falls. CONCLUSIONS: Very low to low-quality evidence showed that ankle-foot exercises effectively improve ankle plantarflexion strength, flexibility, and balance with eyes open, whereas no effect on falls was found. Improvements in balance and gait tend to be associated with improvements in ankle strength and flexibility. Toe-strengthening exercise and training 3 times per week appear to be important for improving balance.

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