Types of crutches for walking. Comprehensive Guide to Crutch Types, Measurement, and Walking Patterns

20.07.202328.06.2023 by alexxlab

What are the different types of crutches available for walking. How should crutches be properly measured and fitted. Which walking patterns can be adopted when using crutches. What are the indications for using specific crutch types.

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Types of Crutches: Enhancing Mobility and Support

Crutches are essential mobility aids designed to increase an individual’s base of support and transfer weight from the legs to the upper body. They serve as crucial tools for people who cannot fully rely on their legs for weight-bearing, whether due to short-term injuries or lifelong disabilities. Understanding the different types of crutches available is key to selecting the most appropriate aid for specific needs.

Axilla or Underarm Crutches

Axilla crutches, also known as underarm crutches, are a common type of mobility aid. These crutches feature:

An axilla bar for upper body support
A handpiece for grip and control
Double uprights joined distally by a single leg
Adjustable height settings (typically 48 to 60 inches / 12 to 153 cm)

How should axilla crutches be positioned? For optimal use and comfort, position axilla crutches with a two-finger distance between the axilla (armpit) and the axilla pad. The elbow should be flexed between 20-30 degrees to ensure proper arm positioning and weight distribution.

Forearm Crutches

Forearm crutches, also referred to as Lofstrand, elbow, or Canadian crutches, offer an alternative design to axilla crutches. Their key features include:

A single upright for a streamlined design
A forearm cuff for added stability
A handgrip for control and support
Adjustable height settings (typically 29 to 35 inches / 74 to 89 cm)

Why might someone choose forearm crutches over axilla crutches? Forearm crutches often provide greater maneuverability and are preferred by individuals who require long-term mobility assistance. They allow for more natural arm movement and can be easier to use on stairs or uneven surfaces.

Gutter Crutches

Gutter crutches, also known as adjustable arthritic crutches or forearm support crutches, are specialized mobility aids designed for specific needs. These crutches feature:

A padded forearm support made of metal
A strap for secure positioning
An adjustable handpiece for customized comfort
A rubber ferrule for traction and stability

Who benefits most from gutter crutches? These crutches are particularly useful for patients who are partial weight-bearing and those with rheumatoid conditions. The additional forearm support helps distribute weight more evenly and provides extra stability for individuals with weakened grip strength or joint pain.

Proper Crutch Measurement: Ensuring Comfort and Safety

Proper measurement and adjustment of crutches are crucial for user comfort, safety, and effectiveness. Ill-fitting crutches can lead to discomfort, reduced mobility, and even injury. How can you ensure crutches are properly fitted?

Stand upright with shoes on
Place the crutch tip 6 inches to the side and slightly in front of the foot
Adjust the crutch height so that the top pad is 1-2 inches below the armpit
Set the handgrip so that the elbow is flexed at 15-30 degrees
Ensure the wrist is straight when gripping the handpiece

Why is proper crutch measurement so important? While the incidence of adverse events related to crutch use is generally low, serious medical complications can occur if crutches are not properly fitted. Adjusting the device to fit the user can significantly reduce the risk of these adverse events, ensuring safer and more comfortable mobility assistance.

Crutch Walking Patterns: Adapting to Individual Needs

When using crutches, individuals may adopt different walking patterns based on their specific condition, balance, and weight-bearing capabilities. Understanding these patterns is crucial for both users and healthcare providers in ensuring safe and effective mobility.

Two-Point Crutch Gait

What is the two-point crutch gait? This pattern involves:

Advancing the crutches and the affected limb as one unit
Bringing the uninvolved weight-bearing limb forward to the crutches as the second unit

Is the two-point crutch gait suitable for everyone? This gait pattern requires good balance as only two points are in contact with the floor at any given time. It’s typically used by individuals who can partially bear weight on the affected limb.

Three-Point Gait

How does the three-point gait work? This pattern involves:

Moving both crutches forward
Stepping the affected limb up to the crutches
Stepping the weight-bearing limb through, beyond the crutches

When is the three-point gait most appropriate? This gait is used when one lower extremity is unable to fully bear weight, such as after a fracture, amputation, or joint replacement. It provides more stability than the two-point gait, with three points of contact with the floor at all times.

Four-Point Gait

What characterizes the four-point gait? This pattern involves:

Advancing the crutch on the involved side
Stepping with the uninvolved leg
Moving the involved leg
Advancing the crutch on the uninvolved side

Why might someone use a four-point gait? This gait pattern is ideal for individuals with poor balance, lack of coordination, or muscle weakness in both lower extremities. It provides a slow but stable gait with three of the four points on the ground at any given time.

Indications for Crutch Use: Matching Aid to Need

Selecting the appropriate type of crutch depends on various factors, including the user’s physical condition, balance, strength, and the nature of their mobility limitation. What are some common indications for different crutch types?

Axilla Crutches

When are axilla crutches most commonly prescribed?

Short-term injuries (e.g., fractures, sprains)
Post-surgical recovery
Temporary disabilities

Axilla crutches are often the go-to choice for individuals needing temporary support, as they’re generally easier to learn to use quickly.

Forearm Crutches

In which situations are forearm crutches typically recommended?

Long-term disabilities
Chronic conditions affecting mobility
Individuals with good upper body strength and coordination

Forearm crutches offer more freedom of movement and are often preferred for long-term use, as they allow for more natural arm positioning and movement.

Gutter Crutches

What conditions typically warrant the use of gutter crutches?

Rheumatoid arthritis
Other arthritic conditions affecting hand grip
Partial weight-bearing situations

Gutter crutches provide additional forearm support, making them ideal for individuals with conditions that affect hand strength or cause joint pain in the hands and wrists.

Crutch Safety: Minimizing Risks and Maximizing Benefits

While crutches are invaluable mobility aids, their use does come with potential risks. How can users ensure safe and effective crutch use?

Ensure proper fit and adjustment
Learn and practice correct walking techniques
Maintain good posture while using crutches
Regularly inspect crutches for wear and damage
Use crutches on dry, non-slippery surfaces when possible
Follow healthcare provider instructions regarding weight-bearing limits

What are some potential risks associated with improper crutch use? Improper use or ill-fitting crutches can lead to:

Nerve damage in the armpit area
Shoulder or arm strain
Loss of balance and falls
Skin irritation or bruising

By following proper usage guidelines and maintaining their crutches, users can significantly reduce these risks and maximize the benefits of their mobility aid.

Alternatives to Traditional Crutches: Exploring Other Mobility Aids

While crutches are a common and effective mobility aid, they’re not the only option available. What other mobility aids might be considered depending on an individual’s needs?

Walkers

How do walkers differ from crutches? Walkers provide a wider base of support and can be ideal for individuals who:

Need more stability than crutches can provide
Have weakness or balance issues in both legs
Are at higher risk of falling

Canes

When might a cane be preferable to crutches? Canes can be suitable for individuals who:

Need minimal support for balance or stability
Have a condition affecting only one side of the body
Require a mobility aid for long-term use

Knee Scooters

What advantages do knee scooters offer over crutches? Knee scooters can be beneficial for individuals who:

Have lower leg or foot injuries
Need to keep weight off one leg for an extended period
Require a more comfortable alternative to crutches for longer distances

The choice between crutches and other mobility aids should be made in consultation with a healthcare provider, taking into account the individual’s specific condition, mobility needs, and overall health status.

Crutch Maintenance and Care: Ensuring Longevity and Safety

Proper maintenance of crutches is crucial for ensuring their longevity and continued safety. How can users effectively care for their crutches?

Regularly inspect all parts for wear or damage
Clean crutches with mild soap and water, avoiding harsh chemicals
Check and replace rubber tips as needed to maintain traction
Tighten any loose screws or bolts
Store crutches in a dry area to prevent rust or degradation

How often should crutches be inspected? It’s recommended to perform a thorough inspection at least once a week, or more frequently if the crutches are used extensively. Pay special attention to weight-bearing components and areas of frequent wear.

What signs indicate that crutches need replacement? Look out for:

Cracks or splits in the main body or handgrips
Excessive wear on rubber tips
Bent or misaligned components
Loose parts that can’t be tightened

By maintaining their crutches properly, users can ensure they remain a safe and effective mobility aid throughout their period of need.

Crutches – Physiopedia

When refering to evidence in academic writing, you should always try to reference the primary (original) source. That is usually the journal article where the information was first stated. In most cases Physiopedia articles are a secondary source and so should not be used as references. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article).

Axilla or underarm crutches: They should be positioned with 2 fingers of distance between the axilla and the axilla pad with the elbow flexed between 20-30 degrees.^[1] The design includes an axilla bar, a handpiece and double uprights joined distally by a single leg. They are adjustable in height; both the overall height and handgrip height can be adjusted (adjustable approximately 48 to 60 inches / 12 to 153 cm).^[2]

Two-point crutch gait: Please note the difference between two-point gait and two-point crutch gait. In two-point crutch gait, the crutches and the non-weight bearing / affected limb (due to fracture, amputation, joint replacement etc) make up one point and the uninvolved leg makes up the other point. The crutches and affected limb are advanced as one unit, and the uninvolved weight-bearing limb is brought forward to the crutches as the second unit. This gait pattern is less stable as only two points are in contact with floor. Thus, good balance is needed to achieve two-point crutch gait.

Three-point: this gait pattern is used when one of the lower extremities (LE) is unable to fully bear weight (due to fracture, amputation, joint replacement etc). There are three points of contact with the floor. The crutches serve as one point, the involved leg as the second point, and the uninvolved leg as the third point. Both crutches move forward, the affected limb then steps up to the crutches. This is followed by the weight-bearing limb which steps through, beyond the crutches. There are always three points of contact with the floor at any given time.^[6]
Four-point: this gait pattern is used when there is a lack of coordination, poor balance and muscle weakness in both LE. This is because it provides a slow and stable gait pattern with four points of support. Point one is the crutch on the involved side, point two is the uninvolved leg, point three is the involved leg, and point four is the crutch on the uninvolved side. The crutches and limbs are advanced separately, with three of the four points on the ground and bearing weight at any given time. ^[3]^[7]
Step-to: the fractured/injured limb is advanced, and then the intact limb is brought to the same position. When weight-bearing status is restricted to partial, toe-touch, or as tolerated, crutches or a walker are necessary. They help the patient step to the fractured/injured limb by pushing down with the upper extremities, thus transferring weight from the fractured/injured limb to the assistive device.

In cases where someone’s injury or disability only affects one leg, they might use a specialized crutch called a leg support crutch. A leg support crutch isn’t a traditional crutch. You don’t use your hands or arms with this crutch. Instead, the knee of your injured or affected leg is bent and rests on a knee pad. It’s secured with straps going up the thigh and around the calf. The bottom of the crutch extends to the ground and allows you to walk.

The crutches are one of the oldest inventions for walking support. They are used during the rehabilitation period after an injury to the lower extremities (fracture, sprain, dislocation, rupture of muscle tissue, etc.) or with permanent dysfunction of the musculoskeletal system. Crutches help the patient to be mobile, reduce the load on the legs by transferring body weight to the axillary region or forearm, maintain balance in case of impaired coordination when walking and standing.

According to the type of support, crutches are divided into two groups: axillary crutches and crutches under the elbow. Axillary crutches is a construction of two wooden or aluminum posts connected at the bottom into one with a rubber cap at the end. From above, the racks are connected by a platform, on which the patient rests with the armpit, transferring body weight to the shoulder area. Underarm crutches have handles that a person holds on to while walking. Most axillary crutches are height adjustable. They can be reinforced (with steel posts) for patients with a large weight, elongated for patients of large stature, for children, folding or collapsible. Axillary crutches are prescribed for patients with injuries of the lower extremities in the early period of rehabilitation, who find it difficult to maintain their own weight due to various reasons: advanced age, weakened arm muscles, fullness. Axillary crutches are used for a short time. Doctors do not recommend using axillary crutches on a permanent basis for more than 2 years, because prolonged support on the axillary bar of crutches often causes numbness in the arms and pain in the shoulder. If the patient needs to use crutches for a long time, then preference should be given to the elbow crutches.

Elbow Crutches or Canadian are adjustable length aluminum crutches with an approximately 30-degree top slope and are equipped with a plastic cuff (clip) and soft grip. The stand also has a rubber tip to prevent slipping. Canadians are prescribed to patients who can partially support their own weight, transferring the main load to the hands and elbow joint, but are not able to move completely independently. Typically, Canadians are not prescribed to patients with fractures and other injuries in the early period of rehabilitation. More often they are used for persistent disorders of the musculoskeletal system, when the patient has to spend most of the time on crutches. Canadian crutches provide more freedom and speed of movement than underarm crutches.

Both axillary and elbow crutches can be fitted with Anti-Slip Device (SAS) to improve traction on slippery surfaces. For patients who require an increased level of stability, the use of the Tri-Position Crutch or the Quad-Post Crutch may be recommended. They feature a low, wide base for maximum stability. This type of crutches is intended for people with impaired coordination of movements (including after a stroke), with neurological diseases, with osteoarthritis, with increased body weight, as well as for debilitated elderly people to facilitate climbing stairs.

When selecting axillary crutches, two parameters should be taken into account: the total height of the crutch from the tip to the axillary bar and the position of the bar to support the hand. If the patient cannot stand, then the total height of the crutches can be approximately calculated by subtracting 40 cm from his height. However, it is better if, during the selection and fitting of crutches to size, the patient stands and is shod in familiar shoes. Trying on the crutch, place it near the chest so that the tip is 15-20 cm from the foot. At the same time, 2-3 fingers should fit freely between the armpit and the crossbar (this is about 4-5 cm).

To determine the correct position of the palm crossbar , lower your free hand, bend it about 30 degrees and make a fist. In this case, the crossbar should be located at the level of the fist. If the user feels strong pressure in the armpits while walking, then the crutches are too long. If, when walking, the weight of the body is transferred more to the arms, and not to the shoulders, then the crutches are too short.

When selecting crutches with elbow support, two parameters must be taken into account: the position of the handle and the position of the restraint cuff . During the fitting, put your hand into the cuff and place the crutch at a distance of 15 cm from the foot. In this case, the elbow should be bent at an angle of 15-20 degrees. The correct position of the cuff is at a distance of 5-7 cm from the sharpest point of the elbow (with growth in the region of 170 cm). With a height of 182 cm and above, the cuff should be located at a distance of 10 cm from the edge of the elbow, but if the height is 150 cm and below, then this value is reduced to 4.5-5 cm. For the most accurate measurement, you should put the canadian on your arm, sit down on a chair, and direct the tip of the crutch to the ceiling, while bending the elbow 90 degrees.

Crutches are also classified according to the material from which they are made: metal and wood. Metal crutches are made of durable aluminum alloy, they are lighter. Wooden models are heavier, but they are never cold. Aluminum crutches are considered more durable. The weight of axillary crutches in a pair is on average from 1.5 to 2 kg, for underarm crutches – from 0.5 to 1 kg per piece. The permissible load on crutches can also be different: up to 100 kg, up to 120 kg and up to 150 kg, correlate these data with the user’s weight.

Axillary crutches make it possible to completely unload a sore or injured leg, transferring the load (weight of the human body) to the arms and shoulder girdle. They are used during the period of early rehabilitation after surgery or injury, when a solid support is needed. Using axillary crutches is easy enough, but it is not recommended to use them on a permanent long-term basis, as leaning on the axillary bar of crutches can cause numbness in the arms and pain in the shoulders. Optimal recommendations for the use of axillary crutches are 1.5 – 2 months, with the required constant walking – no more than 2 years (with a longer recovery period, it is further recommended to switch to canadian crutches).

Human height	Height (floor to armpit)
140 – 160 cm	from 83 to 116 cm
160 – 180 cm	from 116 to 133 cm
180 – 200 cm	133 to 153 cm

These crutches are smaller, lighter and more manoeuvrable. Suitable for use in the final stage of rehabilitation (as a light support), as well as for a long recovery period. The base of these underarm crutches can be in the form of a conventional tip (single bearing) or in the form of a pyramid, for higher stability. The handle on which the user rests with the brush is often standard, but it can also be anatomical, adjusted to the right or left hand.

If you have been recommended or have decided to opt for crutches with elbow support, then just order the model you like. All canadian crutches have adjustable height, on average, the height is adjustable from 140 to 195 cm. Therefore, in this case, an important point in the selection of canadians is to establish the correct height of the product for optimal load distribution. All models of elbow crutches have a telescopic design, with a fairly simple push-button adjustment. It is necessary to correctly adjust the position of the handle and the support cuff, that is, we adjust the height from the floor to the handle of the hand grip and from the handle to the support under the elbow.

Types of crutches for walking. Comprehensive Guide to Crutch Types, Measurement, and Walking Patterns

Types of Crutches: Enhancing Mobility and Support

Axilla or Underarm Crutches

Forearm Crutches

Gutter Crutches

Proper Crutch Measurement: Ensuring Comfort and Safety

Crutch Walking Patterns: Adapting to Individual Needs

Two-Point Crutch Gait

Three-Point Gait

Four-Point Gait

Indications for Crutch Use: Matching Aid to Need

Axilla Crutches

Forearm Crutches

Gutter Crutches

Crutch Safety: Minimizing Risks and Maximizing Benefits

Alternatives to Traditional Crutches: Exploring Other Mobility Aids

Walkers

Canes

Knee Scooters

Crutch Maintenance and Care: Ensuring Longevity and Safety

Crutches – Physiopedia

Contents

What Are the Different Types of Crutches?

How we reviewed this article:

Read this next

Types of crutches, their features to consider when choosing

When choosing crutches, an individual approach is important, it is necessary to take into account the parameters of a person in order for the rehabilitation process to be successful, without hindrance and with minimal time.

First of all, you need to find out what kind of crutches you need?

What parameters do we consider when choosing axillary crutches?

Canadian crutches (forearm support)

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