What is a reasonable duration for a 70-year-old individual with shaky ankles and diminished balance to stand on one foot, with eyes open and hands by their sides, to indicate good fitness and balance?

Single-Leg Stance Duration for Balance Assessment in Older Adults

For a 70-year-old with shaky ankles and diminished balance, being able to stand on one foot with eyes open for 10 seconds indicates adequate balance and is associated with better survival outcomes, while inability to achieve this duration signals increased fall risk and warrants intervention. 1

Evidence-Based Duration Benchmarks

The 10-Second Standard

• The ability to successfully complete a 10-second one-legged stance (10-s OLS) is independently associated with all-cause mortality in middle-aged and older adults (ages 51-75 years), with those unable to complete this duration having 1.84 times higher mortality risk. 1
• Among individuals in this age range, 20.4% were unable to complete the 10-second test, and these individuals had a 17.5% mortality rate over 7 years compared to 4.6% in those who could complete it. 1
• The 10-s OLS adds significant prognostic information beyond age, sex, body mass index, and comorbidities, making it a valuable screening tool that should be incorporated into routine physical examination. 1

Clinical Assessment Context

• The Balance Error Scoring System (BESS) uses 20-second trials for single-leg stance testing on the non-dominant foot, with hands on hips and eyes closed, though this is primarily validated for concussion assessment in younger populations. 2
• For fall risk screening in older adults, the 4-Stage Balance Test requires holding a tandem stand for 10 seconds, and inability to achieve this indicates high fall risk requiring comprehensive evaluation. 3, 4

Addressing Ankle Instability

Should You Work to Reduce Ankle Shaking?

Yes, reducing ankle instability through targeted exercise is beneficial and evidence-based. The ankle shaking represents diminished postural control that can be improved through specific interventions:

• Ankle-foot exercises significantly improve ankle plantarflexion strength (SMD = 0.35), ankle flexibility (SMD = 0.48), and balance performance with eyes open (SMD = 0.41) in older adults. 5
• Balance training that selectively manipulates sensory inputs from visual, vestibular, and somatosensory systems improves stability, particularly when ankle/foot somatosensory inputs are challenged, and results in longer single-leg stance duration. 6
• Training programs that run three times per week for three months involving dynamic exercise in standing position are most effective for improving balance outcomes. 7

Specific Exercise Recommendations

• Toe-strengthening exercises performed 3 times per week appear particularly important for improving balance performance. 5
• Ankle weight training can improve lower limb and trunk muscle strength as measured by the 30-second chair stand test, which reflects fall risk. 8
• Multiple exercise types combining gait, balance, coordination, functional tasks, and strengthening exercises show moderate effectiveness, with improvements in Timed Up & Go test (mean difference -1.63 seconds) and single-leg stance with eyes open (mean difference 5.03 seconds). 7

Practical Testing Protocol for Your Patient

Initial Assessment

• Test single-leg stance on both legs (starting with non-dominant foot) with eyes open, hands on hips, for up to 20 seconds. 2
• If the patient cannot achieve 10 seconds, this indicates increased fall risk and mortality risk requiring intervention. 1
• Document which leg performs better and the degree of ankle instability observed. 2

Interpretation Framework

• ≥10 seconds = Adequate balance for age, associated with better survival outcomes 1
• <10 seconds = Increased fall and mortality risk, requires comprehensive fall risk assessment and intervention 3, 4, 1
• Unable to attempt or immediate loss of balance = High risk, requires immediate multifactorial fall prevention program 4

Critical Caveats

• Balance testing should be performed more than 15 minutes after cessation of exercise and in a consistent environment, as the BESS shows practice effects and is affected by timing and setting. 2
• The 10-second benchmark is derived from middle-aged and older adults (51-75 years), and your 70-year-old patient falls within this validated age range. 1
• While the evidence shows ankle-foot exercises improve balance with eyes open, there is insufficient evidence for improvement in eyes-closed conditions or direct fall prevention. 5
• Most balance training studies only report outcomes up to the end of the exercise program, so long-term maintenance requires ongoing practice. 7

Recommended Action Plan

Given the patient's shaky ankles and diminished balance, implement a structured 3-month program of ankle-foot exercises and balance training 3 times per week, focusing on toe-strengthening and dynamic standing exercises, with reassessment of 10-second single-leg stance performance at program completion. 7, 5