Fall Prevention: A Practical Guide
Author: Folarin Babatunde, PT PhD, MScSEM, MScPT, BScPT
Falls are one of the most common – and most consequential – setbacks after limb loss. Research from Canadian outpatient clinics found that about one in two amputees with lower-extremity limb loss reported at least one fall in the past 12 months.
But falls are not only a lower-limb issue. In a study of people with upper limb loss, almost half reported at least one fall in the past year as well, and one in four subjects reported two or more falls. Beyond bruises, for amputees, falls frequently lead to injury and can trigger a cycle of reduced activity, community participation and confidence.
Falls after limb loss are common, but contrary to popular belief they aren’t necessarily all that random. Falls follow specific patterns which explains why attempts at prevention can be very effective.
A study of unilateral lower-limb prosthesis users found that falls occur on level ground too, not only on obvious hazards like stairs. The authors suggest that prevention needs to include base-of-support disruptions while walking and not just the usual suspects like throw rugs, slippery and uneven surfaces for example. The fact that falls aren’t just “bad luck” is encouraging in that prevention strategies can be effective. A useful way to think about minimizing the risk of falling is to consider the several factors that interact during movement.
Body + Device + Environment + Attention
When there are changes in any one of these factors - fatigue, pain, socket discomfort, low light, rushing, distraction — the risk of a fall rises quickly. The goal isn’t to be cautious all the time. It’s to be strategic in the moments that matter most. So, let’s focus on fall-proof confidence. That is, identifying your highest-risk moments and training “catch yourself” skills that matter most in real-time. Here are some of the most common high-risk moments and fall prevention strategies.
Falls after limb loss are common, but contrary to popular belief they aren’t necessarily all that random. Falls follow specific patterns which explains why attempts at prevention can be very effective.
A study of unilateral lower-limb prosthesis users found that falls occur on level ground too, not only on obvious hazards like stairs. The authors suggest that prevention needs to include base-of-support disruptions while walking and not just the usual suspects like throw rugs, slippery and uneven surfaces for example. The fact that falls aren’t just “bad luck” is encouraging in that prevention strategies can be effective. A useful way to think about minimizing the risk of falling is to consider the several factors that interact during movement.
Body + Device + Environment + Attention
When there are changes in any one of these factors - fatigue, pain, socket discomfort, low light, rushing, distraction — the risk of a fall rises quickly. The goal isn’t to be cautious all the time. It’s to be strategic in the moments that matter most. So, let’s focus on fall-proof confidence. That is, identifying your highest-risk moments and training “catch yourself” skills that matter most in real-time. Here are some of the most common high-risk moments and fall prevention strategies.
Most Common Causes of Falls: Slips (26%), Trips (22%), Prosthetic Factors (22%).
1) Transfers (toilet, bed, chair, car)
Why it’s risky: Transfers combine turning, shifting weight, and sitting and standing, and often happen when we are tired or distracted.
Try this: “Slow the last 20% down.”
• Slow the final “landing” phase when sitting/standing.
• Be certain that you got your body close to the surface before you sit.
• Stabilize hands first, then move feet — not both at once.
• Use nightlights in hallway and bathroom areas for nighttime safety.
2) Quick Turns (a surprisingly common trigger)
Why it’s risky: Turning too quickly changes your base of support really fast. Many falls happen in tight spaces like the kitchen, bathroom and busy hallways because of quick pivots.
Try this: “Small steps to turn.”
• Turn with several small steps rather than twisting over a planted foot.
• Pivot on your unaffected leg when possible.
• If you are carrying something, slow down and widen your base slightly.
• Use this rule: one risky thing at a time (don’t combine fast turning with carrying with rushing).
3) Stairs and Curbs
Why it’s risky: A combination of changes in step height, narrow base and divided attention make steps and curbs high fall-risk areas.
Try this: “Stop. Align. Step.”
• Treat curbs like mini-stairs: stop and line up, then step with intent.
• Always use rails whenever available.
• Practice controlled step-downs (often harder than step-ups).
4) Slippery When Wet (floors, stairs, icy sidewalks)
Why it’s risky: Slips are sudden and demand quick recovery steps when the ground is wet.
Try this: “Reduce speed. Increase traction.”
• Shorten your stride and slow down on slick surfaces.
• Choose routes with better snow clearing and lighting in winter.
• Use traction footwear; consider ice grippers when conditions warrant.
• Keep your hands free outdoors. For example, carry a backpack instead of carrying things in your hands.
5) Tripping Hazards (uneven ground, toe catchers, clutter)
Why it’s risky: Tripping often happens when the foot is moving fast and there’s little time for recovery. Biomechanics research in unilateral below-knee amputees shows that minimum toe clearance occurs near peak swing-foot velocity, and that prosthetic-side toe clearance may not increase with faster walking the way it does on the sound side. This potentially increases the risk of tripping when you rush.
Try this: “Clear the path to clear the toe.”
• At home, remove loose rugs, cords, clutter in walking paths.
• Outdoors, avoid last-second direction changes and always scan a few steps ahead.
• Avoid sudden speed-ups in crowds or on uneven ground.
• Ask your physiotherapist about toe-clearance strategies and drills.
6) Prosthetic “Off Days” (when fit, comfort and stability are just not right)
Why it’s risky: Fit and comfort changes can change gait mechanics and confidence. Plenty of factors can lead to residual limb volume changes, like heat and humidity, colder temperatures, weight changes, menstrual/hormone changes, diet/salt intake, or dehydration.
Try this: “Don’t push through unstable days.”
• If it feels “off,” reduce high-risk tasks that day (curbs, crowds, winter routes).
• Check skin early; address irritation before breakdown.
• If instability persists for a few days, contact your prosthetist or physiotherapist.
7) Fatigue Is Not Your Friend (it’s a late-day fall multiplier)
Even if your balance is good, attention matters. When you’re fatigued, your reaction time drops.
Why it’s risky: “Sometimes we try to do too much when we’re tired.”
Try this:
• Schedule demanding tasks earlier in the day.
• Break loads into smaller trips.
• Reduce “risk stacking” (fatigue and stairs and carrying and rushing when you arrive home from a full day of work).
8) Dual-Tasking (walking and talking, carrying too much, sight-seeing or checking a phone)
Why it’s risky: Many everyday situations demand dual-tasking — walking while talking, checking a phone, scanning traffic, carrying a tray, or doing mental math (“Where did I park?”). After limb loss, walking can require more attention, and when your attention is split, balance recovery and foot placement can be less reliable. A trial in above-knee amputees found that adding dual-task balance training (combining gait/balance work with a cognitive or motor task) improved dual-task performance and cognitive status more than single-task training.
Try this: “One risky thing at a time.”
• If you’re turning, stepping off a curb, on ice, or carrying a load, pause the conversation, stop texting, or stop multi-tasking for a moment.
• In busy environments (malls, sidewalks or streets), slow down and create some buffer space.
“Catch Yourself” Skills
Fall prevention isn’t only about avoiding hazards. It’s also about improving your ability to recover – reactive balance - when something goes wrong. Train what actually prevents falls.
A clinical trial in people with below-knee amputations tested task-specific fall-prevention training using controlled, trip-like perturbations and reported improvements in recovery mechanics and fewer prospective stumbles and falls.
These findings point directly to skills that many people don’t practice enough:
• Weight shifting (front/back/side control)
• Turning control (start/stop, small-step turns)
• Step-recovery (“catch yourself” stepping)
• Dual-task walking (walking while looking/turning/carrying something light)
Ask your physiotherapist to build these into your program progressively, starting safe and getting more “real-world” exposure.
Noting “Near-Falls”
Researchers have emphasized that fall prevention improves when we document the details around a fall because patterns tell us what to change and what to train. Take just a minute to log the circumstances and consequences of a fall or near-fall to learn from it and prevent it from happening again the same way. After any fall or near-fall, jot down:
1. What were you doing? (transferring/turning/level walking/stairs/curb/carrying)
2. Where were you? (home/outdoors/store/parking lot)
3. What started it? (slip/trip/toe catch/misstep/rushed/distracted/prosthesis off)
4. Outcome? (near-fall vs fall; injury - yes/no)
Bring this to your physiotherapist or prosthetist. It often reveals a scenario where a small change prevents future falls.
Why it’s risky: Transfers combine turning, shifting weight, and sitting and standing, and often happen when we are tired or distracted.
Try this: “Slow the last 20% down.”
• Slow the final “landing” phase when sitting/standing.
• Be certain that you got your body close to the surface before you sit.
• Stabilize hands first, then move feet — not both at once.
• Use nightlights in hallway and bathroom areas for nighttime safety.
2) Quick Turns (a surprisingly common trigger)
Why it’s risky: Turning too quickly changes your base of support really fast. Many falls happen in tight spaces like the kitchen, bathroom and busy hallways because of quick pivots.
Try this: “Small steps to turn.”
• Turn with several small steps rather than twisting over a planted foot.
• Pivot on your unaffected leg when possible.
• If you are carrying something, slow down and widen your base slightly.
• Use this rule: one risky thing at a time (don’t combine fast turning with carrying with rushing).
3) Stairs and Curbs
Why it’s risky: A combination of changes in step height, narrow base and divided attention make steps and curbs high fall-risk areas.
Try this: “Stop. Align. Step.”
• Treat curbs like mini-stairs: stop and line up, then step with intent.
• Always use rails whenever available.
• Practice controlled step-downs (often harder than step-ups).
4) Slippery When Wet (floors, stairs, icy sidewalks)
Why it’s risky: Slips are sudden and demand quick recovery steps when the ground is wet.
Try this: “Reduce speed. Increase traction.”
• Shorten your stride and slow down on slick surfaces.
• Choose routes with better snow clearing and lighting in winter.
• Use traction footwear; consider ice grippers when conditions warrant.
• Keep your hands free outdoors. For example, carry a backpack instead of carrying things in your hands.
5) Tripping Hazards (uneven ground, toe catchers, clutter)
Why it’s risky: Tripping often happens when the foot is moving fast and there’s little time for recovery. Biomechanics research in unilateral below-knee amputees shows that minimum toe clearance occurs near peak swing-foot velocity, and that prosthetic-side toe clearance may not increase with faster walking the way it does on the sound side. This potentially increases the risk of tripping when you rush.
Try this: “Clear the path to clear the toe.”
• At home, remove loose rugs, cords, clutter in walking paths.
• Outdoors, avoid last-second direction changes and always scan a few steps ahead.
• Avoid sudden speed-ups in crowds or on uneven ground.
• Ask your physiotherapist about toe-clearance strategies and drills.
6) Prosthetic “Off Days” (when fit, comfort and stability are just not right)
Why it’s risky: Fit and comfort changes can change gait mechanics and confidence. Plenty of factors can lead to residual limb volume changes, like heat and humidity, colder temperatures, weight changes, menstrual/hormone changes, diet/salt intake, or dehydration.
Try this: “Don’t push through unstable days.”
• If it feels “off,” reduce high-risk tasks that day (curbs, crowds, winter routes).
• Check skin early; address irritation before breakdown.
• If instability persists for a few days, contact your prosthetist or physiotherapist.
7) Fatigue Is Not Your Friend (it’s a late-day fall multiplier)
Even if your balance is good, attention matters. When you’re fatigued, your reaction time drops.
Why it’s risky: “Sometimes we try to do too much when we’re tired.”
Try this:
• Schedule demanding tasks earlier in the day.
• Break loads into smaller trips.
• Reduce “risk stacking” (fatigue and stairs and carrying and rushing when you arrive home from a full day of work).
8) Dual-Tasking (walking and talking, carrying too much, sight-seeing or checking a phone)
Why it’s risky: Many everyday situations demand dual-tasking — walking while talking, checking a phone, scanning traffic, carrying a tray, or doing mental math (“Where did I park?”). After limb loss, walking can require more attention, and when your attention is split, balance recovery and foot placement can be less reliable. A trial in above-knee amputees found that adding dual-task balance training (combining gait/balance work with a cognitive or motor task) improved dual-task performance and cognitive status more than single-task training.
Try this: “One risky thing at a time.”
• If you’re turning, stepping off a curb, on ice, or carrying a load, pause the conversation, stop texting, or stop multi-tasking for a moment.
• In busy environments (malls, sidewalks or streets), slow down and create some buffer space.
“Catch Yourself” Skills
Fall prevention isn’t only about avoiding hazards. It’s also about improving your ability to recover – reactive balance - when something goes wrong. Train what actually prevents falls.
A clinical trial in people with below-knee amputations tested task-specific fall-prevention training using controlled, trip-like perturbations and reported improvements in recovery mechanics and fewer prospective stumbles and falls.
These findings point directly to skills that many people don’t practice enough:
• Weight shifting (front/back/side control)
• Turning control (start/stop, small-step turns)
• Step-recovery (“catch yourself” stepping)
• Dual-task walking (walking while looking/turning/carrying something light)
Ask your physiotherapist to build these into your program progressively, starting safe and getting more “real-world” exposure.
Noting “Near-Falls”
Researchers have emphasized that fall prevention improves when we document the details around a fall because patterns tell us what to change and what to train. Take just a minute to log the circumstances and consequences of a fall or near-fall to learn from it and prevent it from happening again the same way. After any fall or near-fall, jot down:
1. What were you doing? (transferring/turning/level walking/stairs/curb/carrying)
2. Where were you? (home/outdoors/store/parking lot)
3. What started it? (slip/trip/toe catch/misstep/rushed/distracted/prosthesis off)
4. Outcome? (near-fall vs fall; injury - yes/no)
Bring this to your physiotherapist or prosthetist. It often reveals a scenario where a small change prevents future falls.
Falls Risk Screening Tool
ARE YOU AT RISK OF FALLING? Yes or No? This is a screening checklist — not a diagnostic test.
ARE YOU AT RISK OF FALLING? Yes or No? This is a screening checklist — not a diagnostic test.
Falls History
Fallen in the past 12 months? (Yes or No)
Two or more near-falls in the past month? (Yes or No)
Confidence
Less confident outdoors than indoors? (Yes or No)
Avoid activities due to fear of falling? (Yes or No)
High-Risk Situations
Unsteady during transfers (toilet/bed/chair/car)? (Yes or No)
Stairs/curbs feel high stress? (Yes or No)
Unsteady when turning quickly or in crowds? (Yes or No)
Unsteady when carrying items (bags/laundry/groceries)? (Yes or No)
Body & Health
Often fatigued by late day? (Yes or No)
Episodes of dizziness/light-headedness? (Yes or No)
Reduced sensation in intact foot (e.g., diabetes/neuropathy)? (Yes or No)
Prosthesis “Off Days”
Prosthesis sometimes feels “not quite right”? (Yes or No)
Skin irritation/pain/swelling changes your walking? (Yes or No)
Next Step: Multiple “Yes” answers = consider a falls-prevention check-in with your physiotherapist and prosthetist.
HOW TO SCORE THIS CHECKLIST
Step 1 — Score each item. Yes = 1 point; No = 0 points
Step 2 — Add your total. Total Score = ____ / 13
Step 3 — What your score suggests.
• 0–2 (Low screen): Keep building confidence and balance skills; review slip/trip habits.
• 3–5 (Moderate screen): Consider a targeted falls-prevention plan supervised by a physiotherapist.
• 6–8 (High screen): Physiotherapy reassessment recommended; focus on reactive stepping, turning/dual-task, and scheduled prosthesis fit checks.
• 9–13 (Very high screen): Prioritize reassessment soon; consider home safety upgrades and supervised falls prevention and progression training until confidence improves.
Step 4 — Safety “upgrade” rule. No matter what your score is, move up one level if you answered Yes to any of these: fallen in the past 12 months, dizziness/light-headedness episodes, reduced sensation in intact foot (e.g., diabetes/neuropathy).
Step 5 — Seek help. Book reassessment sooner if: falls/near-falls are increasing, there’s new dizziness, or prosthetic fit/skin issues are changing how you walk.
Ask Your Physiotherapist
If trips/toe catching is an issue, ask about:
• Toe-clearance training and obstacle/curb practice
• Safe speed progression (how to build pace without more toe catches)
• Prosthetic review (alignment, foot behaviour, swing/clearance strategy)
If slips are an issue, ask about:
• Reactive stepping (“catch yourself” drills)
• Start/stop and turning control
• Winter gait strategies (route + technique + traction)
If turning in crowds is an issue, ask your physiotherapist about:
• Dual-task walking progression (walk + head turns + carry + conversation)
• Community simulations (busy hallway, tight spaces)
If transfers are an issue, ask about:
• Transfer retraining (“slow last 20% down”)
• Home setup: lighting, rails, chair height, cluttered pathways
Bring your fall or near-fall notes to your appointment to identify patterns.
Get a Prosthesis Reassessment
Early help is preventive care. Book a check-in with your prosthetist if you notice:
• Increasing near-falls
• Worsening fear of falling that limits activity
• Prosthetic fit feels “off” for more than a few days
• Skin issues that change how you walk
Confidence doesn’t come from avoiding life. It comes from practicing life — safely and progressively — especially the moments that trigger falls. Many falls happen during ordinary walking, which means everyday strategies and targeted training can make a meaningful difference.
ABOUT THE AUTHOR: Folarin Babatunde, PT PhD, is a physiotherapist, researcher and educator with expertise in evidence-informed rehabilitation, performance training and community reintegration for people living with limb loss. He is the Owner/Principal at Cogent Physical Rehabilitation Center, a physiotherapy, rehab and wellness clinic. A former Western University Assistant Professor, he provides practical, real-world rehabilitation solutions after limb loss. For more information, visit cogent-rehab.com.
References
1. Miller WC, Speechley M, Deathe B. The prevalence and risk factors of falling and fear of falling among lower extremity amputees. Arch Phys Med Rehabil. 2001;82(8):1031–1037. doi:10.1053/apmr.2001.24295.
2. Major MJ. Fall prevalence and contributors to the likelihood of falling in persons with upper limb loss. Phys Ther. 2019;99(4):377–387. doi:10.1093/ptj/pzy156.
3. Kim J, Major MJ, Hafner BJ, et al. Frequency and circumstances of falls reported by ambulatory unilateral lower limb prosthesis users: A secondary analysis. PM R. 2019;11(4):344–353. doi:10.1016/j.pmrj.2018.08.385.
4. Hunter SW, et al. Risk factors for falls in people with a lower limb amputation: A systematic review. PM R. 2017;9(2):170–180.e1. doi:10.1016/j.pmrj.2016.07.531.
5. De Asha AR, Buckley JG. The effects of walking speed on minimum toe clearance and on the temporal relationship between minimum clearance and peak swing-foot velocity in unilateral trans-tibial amputees. Prosthet Orthot Int. 2015;39(2):120–125. doi:10.1177/0309364613515493.
6. Kaufman KR, et al. Task-specific fall prevention training is effective for warfighters with transtibial amputations. Clin Orthop Relat Res. 2014;472(10):3076–3084. doi:10.1007/s11999-014-3664-0.
7. Sawers A, McDonald CL, Hafner BJ. A survey for characterizing details of fall events experienced by lower limb prosthesis users. PLoS One. 2022;17(7):e0272082. doi:10.1371/journal.pone.0272082.
8. Demirdel S, Erbahçeci F. Investigation of the effects of dual-task balance training on gait and balance in transfemoral amputees: A randomized controlled trial. Arch Phys Med Rehabil. 2020;101(10):1675–1682. doi:10.1016/j.apmr.2020.06.009.
Fallen in the past 12 months? (Yes or No)
Two or more near-falls in the past month? (Yes or No)
Confidence
Less confident outdoors than indoors? (Yes or No)
Avoid activities due to fear of falling? (Yes or No)
High-Risk Situations
Unsteady during transfers (toilet/bed/chair/car)? (Yes or No)
Stairs/curbs feel high stress? (Yes or No)
Unsteady when turning quickly or in crowds? (Yes or No)
Unsteady when carrying items (bags/laundry/groceries)? (Yes or No)
Body & Health
Often fatigued by late day? (Yes or No)
Episodes of dizziness/light-headedness? (Yes or No)
Reduced sensation in intact foot (e.g., diabetes/neuropathy)? (Yes or No)
Prosthesis “Off Days”
Prosthesis sometimes feels “not quite right”? (Yes or No)
Skin irritation/pain/swelling changes your walking? (Yes or No)
Next Step: Multiple “Yes” answers = consider a falls-prevention check-in with your physiotherapist and prosthetist.
HOW TO SCORE THIS CHECKLIST
Step 1 — Score each item. Yes = 1 point; No = 0 points
Step 2 — Add your total. Total Score = ____ / 13
Step 3 — What your score suggests.
• 0–2 (Low screen): Keep building confidence and balance skills; review slip/trip habits.
• 3–5 (Moderate screen): Consider a targeted falls-prevention plan supervised by a physiotherapist.
• 6–8 (High screen): Physiotherapy reassessment recommended; focus on reactive stepping, turning/dual-task, and scheduled prosthesis fit checks.
• 9–13 (Very high screen): Prioritize reassessment soon; consider home safety upgrades and supervised falls prevention and progression training until confidence improves.
Step 4 — Safety “upgrade” rule. No matter what your score is, move up one level if you answered Yes to any of these: fallen in the past 12 months, dizziness/light-headedness episodes, reduced sensation in intact foot (e.g., diabetes/neuropathy).
Step 5 — Seek help. Book reassessment sooner if: falls/near-falls are increasing, there’s new dizziness, or prosthetic fit/skin issues are changing how you walk.
Ask Your Physiotherapist
If trips/toe catching is an issue, ask about:
• Toe-clearance training and obstacle/curb practice
• Safe speed progression (how to build pace without more toe catches)
• Prosthetic review (alignment, foot behaviour, swing/clearance strategy)
If slips are an issue, ask about:
• Reactive stepping (“catch yourself” drills)
• Start/stop and turning control
• Winter gait strategies (route + technique + traction)
If turning in crowds is an issue, ask your physiotherapist about:
• Dual-task walking progression (walk + head turns + carry + conversation)
• Community simulations (busy hallway, tight spaces)
If transfers are an issue, ask about:
• Transfer retraining (“slow last 20% down”)
• Home setup: lighting, rails, chair height, cluttered pathways
Bring your fall or near-fall notes to your appointment to identify patterns.
Get a Prosthesis Reassessment
Early help is preventive care. Book a check-in with your prosthetist if you notice:
• Increasing near-falls
• Worsening fear of falling that limits activity
• Prosthetic fit feels “off” for more than a few days
• Skin issues that change how you walk
Confidence doesn’t come from avoiding life. It comes from practicing life — safely and progressively — especially the moments that trigger falls. Many falls happen during ordinary walking, which means everyday strategies and targeted training can make a meaningful difference.
ABOUT THE AUTHOR: Folarin Babatunde, PT PhD, is a physiotherapist, researcher and educator with expertise in evidence-informed rehabilitation, performance training and community reintegration for people living with limb loss. He is the Owner/Principal at Cogent Physical Rehabilitation Center, a physiotherapy, rehab and wellness clinic. A former Western University Assistant Professor, he provides practical, real-world rehabilitation solutions after limb loss. For more information, visit cogent-rehab.com.
References
1. Miller WC, Speechley M, Deathe B. The prevalence and risk factors of falling and fear of falling among lower extremity amputees. Arch Phys Med Rehabil. 2001;82(8):1031–1037. doi:10.1053/apmr.2001.24295.
2. Major MJ. Fall prevalence and contributors to the likelihood of falling in persons with upper limb loss. Phys Ther. 2019;99(4):377–387. doi:10.1093/ptj/pzy156.
3. Kim J, Major MJ, Hafner BJ, et al. Frequency and circumstances of falls reported by ambulatory unilateral lower limb prosthesis users: A secondary analysis. PM R. 2019;11(4):344–353. doi:10.1016/j.pmrj.2018.08.385.
4. Hunter SW, et al. Risk factors for falls in people with a lower limb amputation: A systematic review. PM R. 2017;9(2):170–180.e1. doi:10.1016/j.pmrj.2016.07.531.
5. De Asha AR, Buckley JG. The effects of walking speed on minimum toe clearance and on the temporal relationship between minimum clearance and peak swing-foot velocity in unilateral trans-tibial amputees. Prosthet Orthot Int. 2015;39(2):120–125. doi:10.1177/0309364613515493.
6. Kaufman KR, et al. Task-specific fall prevention training is effective for warfighters with transtibial amputations. Clin Orthop Relat Res. 2014;472(10):3076–3084. doi:10.1007/s11999-014-3664-0.
7. Sawers A, McDonald CL, Hafner BJ. A survey for characterizing details of fall events experienced by lower limb prosthesis users. PLoS One. 2022;17(7):e0272082. doi:10.1371/journal.pone.0272082.
8. Demirdel S, Erbahçeci F. Investigation of the effects of dual-task balance training on gait and balance in transfemoral amputees: A randomized controlled trial. Arch Phys Med Rehabil. 2020;101(10):1675–1682. doi:10.1016/j.apmr.2020.06.009.
