Crutches: Fitting, Gaits, Navigation, and Safety Tips

How to manage crutches?

Proper crutch management involves precise fitting, mastering specific gaits for various weight-bearing statuses, and employing safe techniques for everyday activities and obstacles, all while prioritizing safety to prevent further injury and complications.

Introduction to Crutch Management

Crutches are assistive devices designed to help individuals maintain mobility while reducing or eliminating weight-bearing on an injured or surgically repaired lower limb. Their proper use is crucial for effective rehabilitation, preventing re-injury, and ensuring user safety. Whether recovering from a fracture, sprain, or post-surgical procedure, understanding the biomechanics and practical application of crutches is paramount. This guide will detail the essential steps for fitting, navigating, and safely managing crutches.

Proper Crutch Fitting: The Foundation of Safety

An incorrectly fitted crutch can lead to discomfort, instability, and even nerve damage. Proper adjustment ensures optimal support and reduces the risk of secondary injuries.

• Axillary (Underarm) Crutches:

  • Crutch Height: When standing upright with crutches placed about 6 inches out from your feet, the top of the crutch pad should be 2-3 finger widths (approximately 1.5 to 2 inches) below your armpit. This prevents excessive pressure on the axillary nerves and blood vessels, which can lead to "crutch paralysis" or nerve damage.
  • Handgrip Height: With your arms relaxed at your sides, the handgrip should be adjusted so that your elbow is bent at approximately 20-30 degrees when you grasp the handgrip. This allows for optimal arm extension and weight bearing through the hands and wrists, not the armpits.

• Forearm (Lofstrand) Crutches:

  • Cuff Position: The forearm cuff should be positioned 1 to 1.5 inches below the elbow, allowing for elbow flexion and extension without binding.
  • Handgrip Height: Similar to axillary crutches, the handgrip should allow for a 20-30 degree bend at the elbow when you grasp it.

Mastering Basic Crutch Gaits

The type of gait you use depends on your prescribed weight-bearing status, which will be determined by your healthcare provider.

• Non-Weight Bearing (NWB) – The Three-Point Gait:

  • This gait is used when no weight can be placed on the injured leg.
  • Sequence: Advance both crutches forward approximately one step. Then, keeping the injured leg off the ground, swing your uninjured leg through, landing slightly in front of the crutches. Bring your body forward over the crutches.
  • Focus: Maintain balance and avoid touching the ground with the injured foot.

• Partial Weight Bearing (PWB) – The Four-Point or Two-Point Gait:

  • This gait is used when some weight is allowed on the injured leg.
  • Four-Point Gait (Slow and Stable): Advance one crutch, then the opposite foot, then the other crutch, then the other foot. This provides maximum stability but is slower.
  • Two-Point Gait (Faster, Requires More Balance): Advance one crutch and the opposite foot simultaneously, then the other crutch and the other foot simultaneously. This mimics normal walking patterns but requires better balance.

• Weight Bearing As Tolerated (WBAT):

  • This means you can put as much weight on your injured leg as you can comfortably tolerate. Crutches are used primarily for balance and support. You can progress towards a normal walking pattern, using the crutches as needed for stability.

Navigating Obstacles with Crutches

Moving around safely with crutches requires specific techniques for different environments.

• Stairs (with a Handrail):

  • Going Up (Up with the Good): Place both crutches under one arm (usually the arm opposite the handrail). Hold the handrail with your free hand. Step up with your uninjured leg first onto the next step. Then, bring your injured leg and crutches up to the same step.
  • Going Down (Down with the Bad): Place both crutches under one arm and hold the handrail. Lower your crutches and injured leg down to the next step. Then, bring your uninjured leg down to the same step.
  • Without a Handrail: This is more challenging and may require assistance. Alternatively, you can sit on the bottom step, then use your arms and uninjured leg to push yourself up one step at a time, scooting backward. For going down, sit and scoot forward.

• Sitting Down and Standing Up:

  • To Sit: Back up to the chair until you feel it against the back of your uninjured leg. Move both crutches to the side of your injured leg and hold them in one hand. Use your free hand to grasp the armrest or seat. Lower yourself slowly onto the chair, keeping your injured leg extended.
  • To Stand: Slide to the edge of the chair. Hold both crutches in the hand on the side of your injured leg. Place your uninjured foot firmly on the floor. Push up using your free hand on the armrest and the crutches for support. Once standing, balance, then position the crutches under your arms.

• Opening Doors:

  • Push Door: Approach the door so it opens away from you. Use one crutch to push the door open, then wedge the crutch tip in the door frame to hold it open as you move through.
  • Pull Door: Approach the door so it opens towards you. Use your uninjured hand to open the door, step back slightly, and then use your body to block the door from closing as you step through.

Essential Safety Tips and Common Pitfalls

Adhering to safety guidelines is critical to prevent falls and complications.

• Look Forward: Always look straight ahead, not down at your feet, to maintain balance and awareness of your surroundings.
• Clear Your Path: Remove rugs, cords, clutter, and other tripping hazards from your walking areas.
• Wear Appropriate Footwear: Choose shoes that are flat, supportive, and have non-slip soles. Avoid high heels, sandals, or loose-fitting shoes.
• Keep Crutch Tips Clean and Dry: Inspect crutch tips regularly for wear and ensure they are free of dirt or debris that could reduce traction. Replace worn tips promptly.
• Avoid Axillary Pressure: Never rest your body weight on the crutch pads under your armpits. This can compress nerves and blood vessels, leading to tingling, numbness, weakness, or nerve damage (crutch paralysis). All weight should be borne through your hands and wrists.
• Take Small Steps: Use short, deliberate steps, especially when turning or on uneven surfaces.
• Rest Frequently: Using crutches can be physically demanding. Take breaks to avoid fatigue, which can increase the risk of falls.
• Stay Hydrated: Proper hydration supports overall well-being and muscle function.

Potential Complications of Improper Crutch Use

Ignoring proper technique can lead to several preventable issues:

• Axillary Neuropathy: Damage to nerves in the armpit, causing numbness, tingling, or weakness in the arm or hand.
• Shoulder, Wrist, and Hand Pain: Overuse or improper loading can strain joints and muscles in the upper body.
• Falls and Re-injury: The most significant risk, often due to poor balance, incorrect technique, or environmental hazards.
• Skin Irritation: Chafing or pressure sores from ill-fitting crutches.

When to Seek Professional Guidance

While this guide provides comprehensive information, always consult with a healthcare professional.

• Persistent Pain: If you experience new or worsening pain in your shoulders, wrists, hands, or armpits.
• Difficulty with Mobility: If you find it challenging to master crutch gaits or navigate obstacles safely.
• Numbness, Tingling, or Weakness: Especially in your arms or hands, as this could indicate nerve compression.
• Uncertainty: If you are unsure about the correct crutch fitting or technique for your specific condition.

Conclusion

Managing crutches effectively is a skill that requires patience, practice, and adherence to proper technique. By ensuring correct fitting, mastering the appropriate gaits, and implementing safety precautions, individuals can maintain mobility and facilitate a safe recovery. Remember that crutches are a temporary aid; your rehabilitation team will guide you on progression and eventual weaning off these devices as your strength and stability improve.