Crutches

Aka: Crutches, Axillary Crutches, Forearm Crutches, Canadian Crutches, Lofstrand Crutches, Platform Crutches

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II. Indication

  1. Gait disturbance (full weight bearing)

III. Advantages

  1. Significant weight bearing support (80% for one crutch and 100% for two Crutches)
  2. Most Crutches are adjustable for patient height (fit is critical to proper use - see below)
  3. Crutches have two points of body contact (axilla and hand)
    1. Contrast with canes that have only one point of body contact

IV. Disadvantages

  1. High Energy Expenditure and upper body strength requirement
  2. Unsuitable option for frail elderly

V. Types

  1. Axillary Crutches
    1. For temporary use (acute injuries)
    2. Adjustable aluminum or wooden Crutches
    3. Requires significant upper body strength
    4. May be difficult to use and cumbersome
    5. Padded crutch top that fits within the axilla
      1. However the padded top is NOT intended to support body weight
      2. Maintain a gap of 1.5-2.0 inches between crutch top and axilla
      3. Risk of nerve or artery compression in axilla if incorrectly used and full body weight is applied to crutch top
  2. Forearm Crutches (Canadian crutch, Lofstrand crutch)
    1. For longterm use in active patients with severe leg weakness
    2. Requires good upper body strength and truncal balance
    3. Lightweight, adjustable Crutches
    4. Offers easier mobility than with Axillary Crutches
    5. Forearm cuff attaches 2 inches below elbow
    6. Hands grasp handpiece with elbows flexed to 2-30 degrees
    7. Brace fixes crutch to Forearm and hands grasp handles
      1. Allows use of hands without dropping Crutches
      2. Less cumbersome on stairs than axillary crutch
  3. Platform Crutches
    1. Axillary crutch that adds a horizontal padded platform to support the Forearm
    2. Better stability than with Axillary Crutches
    3. Consider in patients with weak hand grip
    4. Decreased maneuverability and least used of Crutches

VI. Technique

  1. Two point
    1. Advance left crutch and right leg together, then
    2. Advance right crutch and left leg together
  2. Four point (most stable)
    1. Crutches and legs move independently
    2. Advance left crutch
    3. Advance right leg
    4. Advance right crutch
    5. Advance left leg

VII. Fitting

  1. Axillary Crutches
    1. Elbows bent to 30 degrees flexion while holding crutch handles
    2. Crutch base sits 6 inches anterior and 2 inches lateral to foot
    3. Allow adequate space between top of crutch and axilla
      1. Crutch top should have a space of 4-5 cm (~2 inches) below axilla
      2. Axilla should not rest on top of crutch
  2. Forearm Crutches (Canadian crutch, Lofstrand crutch)
    1. Plant crutch end in front of foot by 6 inches
    2. Keep elbow slightly flexed to 15 to 30 degrees
    3. Place cuff at proximal Forearm just distal to elbow (2.5 to 4 cm below the olecranon)

VIII. 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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