Ladder accidents account for nearly 200,000 hospital emergency room visits per year in the United States, with a large proportion of these being due to falls from stepladders (CPSC, 2010). This paper explores various aspects of human balance that are of particular importance for stepladder users with an eye towards better understanding, and reducing the number of, falls from stepladders. We review and discuss human balance literature that is relevant to stepladder use, as well as current ladder designs and standards, to better understand how and why losses of balance on stepladders occur. Based on these findings, we make recommendations concerning ladder design and user behavior that are expected to improve stepladder safety. Directions for further research in this area are also proposed.