Falls among the elderly are a significant public health issue, resulting in about 684,000 deaths annually. Such incidents often lead to severe consequences including fractures, contusions, and cranial injuries, immensely affecting the quality of life and independence of the elderly. Existing fall detection methods using cameras and wearable sensors face challenges such as privacy concerns, blind spots in vision and being troublesome to wear. In this paper, we propose PIFall, a Pressure Insole-Based Fall Detection System for the Elderly, utilizing the ResNet3D algorithm. Initially, we design and fabricate a pair of insoles equipped with low-cost resistive films to measure plantar pressure, arranging 5×9 pressure sensors on each insole. Furthermore, we present a fall detection method that combines ResNet(2+1)D with an insole-based sensor matrix, utilizing time-series ‘stress videos’ derived from pressure map data as input. Lastly, we collect data on 12 different actions from five subjects, including fall risk activities specifically designed to be easily confused with actual falls. The system achieves an overall accuracy of 91% in detecting falls and 94% in identifying specific fall actions. Additionally, feedback is gathered from eight elderly individuals using a structured questionnaire to assess user experience and satisfaction with the pressure insoles.