Background <p>Balance training on different surfaces is important in the rehabilitation of children with spastic cerebral palsy. However, the impact of balance training on different surfaces on ankle proprioception has not yet been investigated. This study aims to investigate the effects of balance exercises performed on rough and smooth unstable surfaces on ankle proprioception and dynamic balance in children with spastic cerebral palsy.</p> Methods <p>The study included 16 children aged 5–10 years with spastic hemiplegic and diplegic type cerebral palsy who were at the Gross Motor Function Classification System Level I and II. The children participating in the study were randomly assigned to two groups. One group performed balance exercises comprising six movements on a balance board for an average of 10&#xa0;min following a 45-minute physical therapy session on a smooth surface, while the other group performed the same exercises on a rough surface. The intervention was conducted twice weekly for a duration of eight weeks. Balance was assessed using the Pediatric Balance Scale, the Functional Reach Test, and the Single Leg Stance Test. A digital goniometer was used to assess ankle joint proprioception.</p> Results <p>Significant improvement was observed in balance test scores in both groups. However, in the joint position sense tests for 15° dorsiflexion and plantar flexion on both the dominant and non-dominant sides, significant improvement was observed only in children who performed exercises on the rough balance surface (<i>p</i> &lt; 0.05).</p> Conclusions <p>Balance training on unstable surfaces was found to be effective in improving balance parameters, with training on rough surfaces demonstrating greater efficacy than training on smooth surfaces in enhancing ankle proprioception.</p> Trial registration <p>NCT05676983 (03/01/2023; retrospectively).</p>