Correct prescription and measurement of walking aids are vital skills for a physiotherapist. Incorrect fitting can lead to secondary complications like nerve palsies or falls. This guide covers the standard measurement techniques for crutches and the gait patterns used with canes.
1. Crutch Measurement Techniques
Proper measurement ensures mechanical efficiency and safety. Measurements can be taken in standing (preferred) or lying down positions.
A. Axillary Crutches
These are used for short-term assistance (e.g., fractures). Incorrect height often leads to "Crutch Palsy" (Radial Nerve injury) due to pressure in the axilla.
| Component | Measurement Standard |
|---|---|
| Total Length | Standing: Place crutch tip 15 cm (6 inches) lateral and 15 cm anterior to the little toe. Top of crutch should be 2-3 finger widths (approx 5 cm) below the axilla. Lying: Anterior axillary fold to a point 15 cm lateral to the heel. |
| Handgrip Height | Measured when the patient is standing with shoulders relaxed. The handgrip should be at the level of the Ulnar Styloid Process (Wrist crease). |
| Elbow Flexion | When holding the handgrip, the elbow should be flexed at 20-30 degrees. |
B. Elbow (Forearm/Lofstrand) Crutches
Used for long-term conditions (e.g., Polio, CP) as they are lighter and allow hands to be free occasionally without dropping the crutch.
- Handgrip Height: Same as axillary crutch (Level of Ulnar Styloid / 20-30° elbow flexion).
- Forearm Cuff: The top of the cuff should be approx. 1 to 1.5 inches (2-4 cm) below the Olecranon process. If it is too high, it restricts elbow flexion; if too low, it offers less leverage.
2. Gait Patterns with a Cane
A cane (walking stick) is used to offload weight (approx 15-20% of body weight) and improve balance. It is almost always held on the Unaffected (Good) side.
Key Gait Types
| Gait Pattern | Sequence of Movement | Indication |
|---|---|---|
| Two-Point Gait | Move the Cane and the Affected Leg forward simultaneously. Then move the Good leg. | Standard pattern mimics normal walking rhythm. Faster. |
| Modified Three-Point Gait | 1. Cane forward. 2. Affected leg forward. 3. Good leg forward. |
Used when the patient needs maximum stability or is slower (Step-to pattern). |
3. Stair Climbing (The Golden Rule)
This is the most frequently asked practical question. Remember the phrase: "Good goes to Heaven, Bad goes to Hell".
Ascending Stairs (Going Up)
- Unaffected (Good) Leg goes up first.
- Then, the Cane and the Affected (Bad) Leg come up together to the same step.
- Reason: The strong leg lifts the body weight.
Descending Stairs (Going Down)
- Cane and Affected (Bad) Leg go down first.
- Then, the Unaffected (Good) Leg follows.
- Reason: The strong leg lowers the body weight in a controlled manner (eccentric control).
Frequently Asked Questions (FAQs)
Holding it on the good side widens the Base of Support and shifts the Center of Gravity away from the affected hip, reducing the joint reaction force on the painful side.
Before starting to walk, the patient stands with crutch tips placed anterior and lateral to the feet, forming a triangle. This provides the most stable starting position.
A standard single-point cane offloads about 15-20% of body weight. Crutches can offload up to 80-100%.
Exam Quiz: Walking Aids (10 MCQs)
Test your knowledge. Click the correct option to see the answer and reasoning.
1. While measuring for axillary crutches, where should the handgrip be positioned?
The handgrip is placed at the level of the ulnar styloid process when the patient is standing with arms hanging loosely. This allows for 20-30 degrees of elbow flexion.
2. Which nerve is at risk if axillary crutches are too long?
Compression in the axilla primarily damages the Radial Nerve, leading to "Crutch Palsy" (Wrist Drop).
3. When ascending stairs with a cane, which limb moves first?
"Up with the Good". The strong leg must go up first to lift the body weight against gravity.
4. Ideally, how many degrees of elbow flexion should a patient have when holding a standard walker or crutches?
20-30 degrees of flexion allows the triceps to work efficiently to lift the body weight during the swing phase.
5. Which gait pattern requires the highest energy expenditure and requires good balance and upper limb strength?
Swing-through gait involves swinging the legs beyond the crutches. It is the fastest but requires significant energy and coordination (common in paraplegics).
6. The placement of the crutch tip for measurement is:
This 15cm x 15cm placement ensures a wide base of support (Tripod) for stability during measurement.
7. A patient with Right Hip Osteoarthritis should hold the cane in which hand?
The cane is always held on the Contralateral (Unaffected) side to reduce the joint reaction force on the affected hip by engaging the latissimus dorsi and abductors.
8. Where should the cuff of an elbow crutch be positioned?
Placing it slightly below the olecranon avoids restricting elbow flexion while providing a sufficient lever arm for stability.
9. Four-point gait is characterized by:
In four-point gait, three points of contact remain on the ground at all times (Right Crutch -> Left Foot -> Left Crutch -> Right Foot). It is very stable but slow.
10. The gap between the axillary pad and the axilla should be:
This gap prevents direct pressure on the neurovascular structures in the axilla during ambulation.
References
- O'Sullivan, S. B., & Schmitz, T. J. (2016). Physical Rehabilitation. F.A. Davis.
- Kisner, C., & Colby, L. A. (2012). Therapeutic Exercise: Foundations and Techniques. F.A. Davis.
- Pierson, F. M., & Fairchild, S. L. (2013). Principles and Techniques of Patient Care. Saunders.
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