Crutches are assistive devices used by patients for walking when they are not able to bear full or partial weight on an injured leg.
Indications
Lower-limb injuries that cannot or should not bear full or partial weight
Contraindications*
Absolute contraindications
Upper-extremity injury that prevents use of crutches
Ataxia
Poor balance
General weakness or frailty
Relative contraindications
Abnormality or weakness of uninjured leg
* Using crutches safely requires a moderate amount of strength, balance, and coordination and full use of both arms. Going up and down stairs is even more challenging, and patients who are permitted to do so must be carefully selected. Patients must also be able to understand instructions and to demonstrate safe use of crutches after instruction. Among older patients, absence of one or more of these requirements make walking with crutches problematic.
Complications
Poorly fitting or incorrectly used crutches (leaning or putting body weight on the crutches in the axillae) may cause radial nerve neurapraxia.
Equipment
Crutches
There are 2 general types of crutches: underarm crutches and forearm crutches (also called elbow or Lofstrand crutches). They are available in different sizes, and each of the sizes is also adjustable for length. The underarm crutches are used more commonly. For underarm crutches, the hand grip distance from the top is adjustable separately from the total length of the crutch. Forearm crutches require that most of the weight be supported by the hands and do not allow patients to bear weight on their axillae, which eliminates the risk of radial nerve neurapraxia; forearm crutches are usually used later in the healing process for patients who require prolonged use of crutches.
Relevant Anatomy
The radial nerve is superficial in the axilla, predisposing it to neuropraxia with pressure.
Positioning
The patient should be supported in a standing position while being fitted for crutches.
Step-by-Step Description of Fitting Underarm Crutches
Adjust the length of one crutch so the axillary pad is 2.5 to 5 cm (1 to 2 inches) below the axilla.
Adjust the position of the hand grip of that crutch so that the elbow is slightly flexed (about 15 to 30°).
Adjust the second crutch so that its length and grip location match those established for the first crutch.
Ensure adjustment pins or screws are securely fastened.
Fitting Underarm Crutches
Patients should wear the type of shoes usually worn, stand erect, and look straight ahead with the shoulders relaxed. For a correct fit, the end of each crutch should be placed about 5 cm from the side of the shoe and about 15 cm in front of the toe, and the length of the crutch should be adjusted so that the top of the crutch is about 2 to 3 finger widths (about 5 cm) below the axilla. The hand grip should be adjusted so that the elbow bends 20 to 30°. |
Step-by-Step Description of Non–Weight-Bearing Crutch Walking
The patient stands on the uninjured leg supported by a crutch in each hand.
The injured leg should be held off the ground.
Weight is borne on the hands, not the axillae; the axillary pad is actually braced against the chest wall just below the axilla.
Before taking a step, the patient places the crutch tips about one stride length ahead while bearing weight on the uninjured leg.
To take a step, the patient transfers weight onto the crutch hand grips and swings the uninjured leg forward off the ground, landing that foot about one stride length in front of the crutch tips.
To take additional steps, the process is repeated.
Step-by-Step Description of Sitting On and Arising From a Chair
The patient approaches the chair and turns so that the chair is directly behind the patient.
The patient holds both crutches in the hand of the uninjured side and uses them for support while sitting down.
After sitting down, the crutches should be placed nearby so the patient can reach them when ready to stand up.
To arise from the chair, the patient picks up both crutches with the hand on the uninjured side and sits at the front edge of the chair.
The patient then stands up on the uninjured leg with assistance from the crutches in the hand on the uninjured side.
While standing on the uninjured leg, the patient transfers one crutch to the injured side before taking any steps.
Step-by-Step Description of Walking Up Stairs Using Crutches
Only patients who are strong and agile and have good balance should use crutches on stairs without assistance. Ideally, a sturdy handrail is available.
The patient stands close to the bottom step.
The patient places both crutches under the arm opposite the handrail.
The patient supports himself by holding both crutches in one hand and the handrail in the other hand.
The patient leans on the crutches and grasps the handrail for support while stepping up one step with the foot on the uninjured side.
After stepping up, the crutches are lifted and placed onto the same step that the patient now occupies.
The patient should reposition the supporting hand higher on the handrail to prepare for the next step.
To take additional steps up the stairs, the process is repeated.
If no handrail is available, patients can ascend steps using normal crutch walking, but only if they have excellent strength, agility, and balance.
Patients not capable of ascending stairs using crutches may be able to ascend stairs by sitting down and then lifting themselves up one stair at a time.
Step-by-Step Description of Walking Down Stairs Using Crutches
Only patients who are strong and agile should use crutches on stairs without assistance. Ideally, a sturdy handrail is available.
The patient stands close to the top step.
The patient places both crutches under the arm opposite the handrail.
The patient supports himself by holding both crutches in one hand and grasping the handrail with the other hand.
The patient leans on the crutches and grasps the handrail for support, then moves the crutches down to the step below.
The patient moves down to the step where the crutches are using the foot on the uninjured side.
The patient repositions the supporting hand lower on the handrail to prepare for the next step.
To take additional steps down the stairs, the process is repeated.
If no handrail is available, patients can descend steps using normal crutch walking, but only if they have excellent strength, agility, and balance.
Patients not capable of descending stairs using crutches may be able to descend stairs by sitting down and then lifting and then lowering themselves to reach the stair below one stair at a time.
Warnings and Common Errors
Be sure that the hand grips are not too low so the arms are almost fully extended.
Because patients instinctively bear weight on their axillae instead of on the hand grips, caution them specifically against this.
If the crutches have separately packaged nonslip tips, place them on the base of the crutches.
Tips and Tricks
To lean the crutches against a wall or piece of furniture, place them with the axillary pads down so they are less likely to fall over.
