Crutches

English: Using underarm crutches. Español: Caminando con dos muletas de aluminio. Polski: Osoba z dwiema kulami pachowymi. Svenska: Kryckor av aluminium. (Photo credit: Wikipedia

It is one of the many ambulatory aid used to help people who have suffered an injury and/or disability to one of their feet, knees, ankles, or legs by transferring weight from the legs to the upper body for reasons ranging from short-term injuries to life-long disabilities. Crutches are made in all sizes, for adults and children. Some devices are adjustable to accommodate differences in height or it can be custom made to fit a particular individual. It is normally recommended by a doctor or a physical therapist to use temporarily to protect the injured area from further damage or it can be use by an individual with permanent disabilities for functional ambulation. Another thing to consider which is equally important are the crutch muscles. Promote strengthening exercise to the upper extremities to better prepare the patient with crutch ambulation.

                                             







Types of Crutches:

Lofstrand (Forearm) Crutch

• This crutch promotes ease of movement but provide slightly less stability. Require highest level of coordination. The hands are free for use without dropping the crutch as secured by forearm cuff. It is used by placing the arm into a cuff and grasping the grip. The cuff should cover the proximal third of the forearm, about 1 to 1.5 inches below the elbow (below olecranon process) so it does not interfere with elbow flexion.

Axillary (Underarm) Crutch 

• This is the most common type. Easily adjusted  according to your overall height and hand height. Require higher coordination to properly use. Provide increased trunk support compared to forearm crutch. Has difficulty moving around in small areas. Avoid prolong leaning on the axillary bar to keep away from axillary artery and/or radial nerve damage.

Platform (Triceps) Crutch

• These are less common and used by those with poor hand grip due to arthritis, cerebral palsy, or other conditions. The arm rests on a horizontal platform and is strapped in place. The hand rests on a grip which, if properly designed, can be angled appropriately depending on the user's disability. Offer support for people who cannot bear weight in their wrists.

Strutter (Underarm) Crutch

• This crutch is a type of underarm crutch is designed with a large base pad with a slip resistant sole. Come with a padded handgrips and a padded, u-shaped axilla support. This allows for improved weight distribution and more even walking gait.

Leg Support Crutches

• These non-traditional crutches are useful for users with an injury or disability affecting one lower leg only. The affected leg is strapped into a support frame on wheels. Leg support crutches are particularly useful for below the knee injuries or postoperatively after below-the-knee surgery that affect one leg only. It has the advantage of not using the hands or arms while walking.

Crutch Measurement:

There are several basic types of crutches and all should be custom fitted properly to help reduce movement problems.

Axillary crutch: 

• In the standing position , the top of the crutch should extend 2 inches (about two finger widths) below the armpit (axilla) to a point on the floor 6 inches in front of your foot and 2 inches lateral to the foot. The handgrip should allow you to flex your elbow about 30°, enough to fully extend your elbow when you take a step.
• In the supine position(unable to stand), simply subtract 16 inches from your height or from the axilla  to a point 6-8 inches lateral to the heel.

Forearm crutch: 

• Proper fit should allow you to flex your elbow 20°-30° while holding the handgrip. The crutch is positioned 6 inches in front and 2 inches lateral of your foot. The arm cuff should sit 1 inch to 1.5 inches below the olecranon process.

Platform crutch:

• This crutch is measured 2 inches below the skin-fold of the armpit. The lower cuff is 0.5 in-1.5 inches below the back of the elbow to avoid bony contact on the arm.

                             
Gait Patterns

Two-Point Gait

• It uses two crutches or canes.
• Each step is one-point and a complete cycle is two-points.
• Slightly faster than a 4-point gait but requires more balance.
• Allows natural arm and leg motion normal gait, good support , and stability (closely resembles normal walking).
• Pattern: Right crutch and left leg; left crutch and right leg.

Three-Point Gait

• It can be seen with walkers or crutches.
• Indicated with involvement of one lower extremity to decrease weight-bearing.
• Fairly rapid but requires arm strength to support significant body weight and maintain balance.
• Pattern: Both crutches and the affected leg move forward simultaneously; then the stronger extremity is moved forward while placing most of the body weight on the arms.

Four-Point Gait

• Very similar to two-point; The difference is that the leg is not moved simultaneous with the crutch/cane instead it waits and moves only after the crutch/canes has advance.
• Prescribed to patient with impaired coordination, balance, or significant strength deficit.
• Pattern: Right crutch, left leg; left crutch, right leg.

Swing-To Gait

• Ideal to patient with bilateral trunk and/or lower extremity weakness
• This type of gait requires considerable arm and upper body strength to support the entire body weight.
• Pattern: Bear weight on unaffected leg (or legs); advance both crutches forward simultaneously, lean forward while swinging the body to a position even with the crutches.

Swing-Through Gait

• The fastest of all crutch gaits but not as safe as swing-to gait.
• It is different from swing-to gait only in that the body lands beyond the crutches with every step.
• Used for patient with bilateral lower extremity involvement and with trunk instability
• Pattern: Advance both crutches forward; lift legs off the ground and swing forward beyond the crutches; bring crutches forward rapidly.

Proper Use and Instructions for Crutches

Standing

• The top of your crutches should be about 2 inches below your armpits.Your weight should rest on your hands(not on the underarm) to avoid damage to the nerves and blood vessels under your armpit.
• Place the tip of the crutches 8 inches to 10 inches in front of you.
• The handgrips of the crutches should be even with the top of your hip line.
• Elbows slightly flexed bent holding the handgrips.

Walking

• Do not try to move too quickly or to cover too long a distance with each step. Keep the crutches close to your body.
• Always look forward, not down at your feet.
• Turn by pivoting on your strong leg, not your weak leg.
• Chose the gait pattern to use.

Stairs

• Ask assistance
• Going down stairs, place the crutches on the next step below, then step down with the good leg.
• Going up stairs, lead with your good foot, keeping your injured foot raised behind you, then bring the crutches up.

Sitting

• Use a chair with armrests to make sitting and standing easier.
• To sit to a chair, bed, or toilet. Put your injured foot in front of you and hold both crutches in one hand.
• Using your free hand, grab the armrest, the seat of the chair, or the bed or toilet.
• Slowly lower yourself into the chair.
• When you are seated, lean your crutches in a nearby spot.
• Rest your crutches upside down when you are not using them so that they do not fall down.

To stand up

• Push yourself forward of the chair as well as your weak leg.
• Hold both crutches in the hand on your uninjured side.
• Push yourself up and stand on your good leg.
• Balance on your strong leg while you place a crutch in each hand.

Safety Tips:

• Avoid slick conditions, such as wet floors; snowy, icy, or rainy conditions.
• Be especially careful on curbs and steps.
• Wear well-fitting, low-heel shoes or slippers with rubber or non-skid soles. Do NOT wear shoes with heels or leather soles.
• Don’t use crutches if you feel dizzy or drowsy.
• Do make sure your crutches have rubber tips.
• Carry things hands-free by using a backpack, or an apron with pockets.
• Simple home modifications for safety and convenience.
• Walk only in well-lit rooms
• Don’t put any weight on the affected foot if your doctor has so advised
• Keep stairs and floor clear of clutter.

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