Cerebral small vessel disease (cSVD) is a common, potentially modifiable cause of poor balance control and falls in older people, but its early effects on balance control are difficult to detect. In this exploratory study, 20 older people with a broad range of cSVD on head MRI scans (median age 74.5 years, interquartile range 68–79 years) had their balance perturbed by motorised pulls at the shoulder. Body movements, ground reaction forces and prefrontal functional near-infrared spectroscopy (fNIRS) haemodynamic responses were recorded. Head MRI scans were reviewed to produce a score of cSVD burden ranging from 0 to 7 points based on lacunes (0–3), white matter hyperintensities (0–3), and cerebral microbleeds (0–1). Participants were divided into “low” (0–2 points) and “moderate” (3–7 points) cSVD burden subgroups, each of 10 participants. Moderate vs. low cSVD burden associated with worse cognitive function. Balance and gait measures (Short Physical Performance Battery test score, tandem walking, stepping responses to manual retropulsion) were similar in the two cSVD burden groups, as were pull-related body sway and resisting ground reaction forces. More cSVD associated with less pull force to induce steps, and with greater balance-related fNIRS prefrontal cortical haemodynamic responses. Prefrontal cortical activation was the most significant measure, explaining 33% of the variation in cSVD burden, while the stepping force threshold explained 17%. Our results suggest that, in addition to cognition, prefrontal cortical responses and stepping force thresholds are likely sensitive to effects of cSVD.