Canes

Aka: Canes, Standard Cane, Single Prong Cane, Offset Cane, Offset Handle Cane, Pedestal Base Cane, Multi-Leg Cane, Multiple Leg Cane, Quadripod Caneb, Quad Cane, Walk Cane, Hemi-Walker

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II. Indication

  1. Gait disturbance
  2. Weight redistribution (~10% off loading) from painful lower limb
  3. Stability when balance is impaired

III. Contraindications

  1. Insufficient balance, dexterity or upper body strength with one handed support on cane

IV. Types: Cane (in order of weight bearing support)

  1. Standard Cane (Stright cane)
    1. For balance only (not for weight bearing)
      1. For Ataxia, Vertigo or Decreased Visual Acuity
    2. Materials
      1. Wood (light and inexpensive)
      2. Aluminum (light and adjustable length, higher cost)
    3. Advantages
      1. Least expensive canes ($10-20 in 2021)
    4. Disadvantages
      1. Risk of Carpal Tunnel Syndrome from holding the curved handle
      2. Less supportive with the curved handle and weight bearing line behind the cane shaft
        1. Corrected with use of an Offset Cane
  2. Offset Cane (Crook or offset below handle)
    1. Aluminum cane with adjustable length
    2. Distributes patient's weight over cane shaft
      1. Contrast with Standard Cane which has a weight bearing line behind the cane shaft
    3. Allows for one-handed partial weight bearing
      1. For moderate hip or Knee Osteoarthritis
  3. Multiple Leg Cane (Quadripod cane, Quad Cane, Pedestal Base Cane)
    1. Cane with 4 legs at base
    2. Indications
      1. Severe hip or Knee Osteoarthritis
      2. Hemiplegia (allows use of hands - not encumbered by always holding cane)
    3. Advantages
      1. Allows for greater weight bearing than Offset Cane
      2. Stands upright even when not being held
    4. Disadvantages
      1. All 4 legs must be in contact with floor (use may be awkward)
      2. Heavier than other canes
      3. Adjust cane base size for gait speed
        1. Fast paced gait: Smaller cane base
        2. Slow paced gait: Larger cane base
          1. Also needed for greater weight bearing
  4. Walk Cane (Hemi-Walker, one handed, four legged walker)
    1. For severe leg weakness (e.g. post-CVA Hemiparesis)
    2. Allows for greater weight bearing than Quad Cane
    3. Uses only 1 hand (contrast with Standard Walker)

V. Technique: Cane use

  1. Cane should support 15-20% of patient's body weight
  2. Curved handle should face backwards
  3. Cane held by hand opposite deficient leg
    1. Weak right leg: Hold cane in left hand
    2. Weak left leg: Hold cane in right hand
  4. Advance cane while advancing deficient leg
    1. Resembles tripod with 3 points in contact with floor
    2. Weak right leg advances with left arm and cane
    3. Weak left leg advances with right arm and cane

VI. Preparation

  1. Fitting
    1. Patient stands upright with arm relaxed at side
    2. Keep elbow flexed at side to 15 to 30 degrees when cane held vertically on ground
    3. Cane length
      1. Wrist crease (with arm hanging at side) or
      2. Hip Greater trochanter to floor (with shoes)
  2. Handles
    1. Umbrella handle
      1. Typical handle on a Standard Cane
      2. Risk of Carpal Tunnel due to pressure on palm
    2. Shotgun handle
      1. Flat handle similar in shape to a shotgun butt
      2. Distributes pressure across entire hand (not just palm)
      3. Less risk of secondary Carpal Tunnel
    3. Finger and thumb groove handle
      1. Forces use of the correct hand to hold the cane

VII. References

  1. Bradley (2011) Am Fam Physician 84(4): 405-11 [PubMed]
  2. Sehgal (2021) Am Fam Physician 103(12): 737-44 [PubMed]
  3. Van Hook (2003) Am Fam Physician 67(8):1717-24 [PubMed]

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