Heel-to-Toe Stand

Purpose. Reduces the width of the base of support so the balance system has to work harder to keep the body upright. It is a graded way to challenge standing balance without any movement, which makes it safe to hold near a support.

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How it fits the system. A core Otago Exercise Programme balance exercise, usually called tandem stance. It progresses from holding a support, to fingertip contact, to no support, and then to closing the eyes if appropriate.

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Primary muscles

Gluteus Medius, Tibialis Anterior

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Secondary muscles

Gastrocnemius, Soleus, Erector Spinae, Peroneals

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Movement pattern

Static Balance

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Equipment

Chair

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Difficulty

Beginner

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Technical detail

Balance in standing is maintained largely by small, continuous corrections at the ankle. Narrowing the base of support reduces how much correction the ankle can provide, so the hip strategy is recruited more, which is precisely the adaptation being trained.

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The progression is about how much support is used, not about how long the position is held. Moving from a full grip to fingertip contact to no contact is a genuine increase in difficulty even if the hold time stays the same.

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A semi-tandem position, where the feet are offset rather than directly in line, is a useful intermediate step if full heel-to-toe is not yet achievable.

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1. Stand beside a firm chair, kitchen counter or wall within easy reach.
2. Place one foot directly in front of the other so the heel of the front foot is close to the toes of the back foot.
3. Hold on to the support as much as needed, then reduce to fingertips if you can.
4. Stand tall and hold the position steady, looking straight ahead at a fixed point.
5. Hold for the prescribed time, then swap which foot is in front and repeat.

• “One foot directly in front”
• “Look at a fixed point ahead”
• “Stand tall”
• “Only as much support as you need”
• “Swap feet and repeat”

• Placing the feet side by side rather than in line, which removes the challenge.
• Looking down at the feet, which reduces the visual reference and makes balancing harder than intended.
• Holding the breath while concentrating.
• Practising away from a support, which makes a loss of balance unsafe.