How to Use Crutches, Canes, and Walkers

If you ever break a bone in your leg or foot, have a surgical procedure on your lower limb, or suffer a stroke, you may
need to use crutches, a cane, or a walker.
In the beginning, everything you do may seem difficult. But, with a few tips and some practice, you will gain
confidence and learn to use your walking aid safely.
General Guidelines
Remove scatter rugs, electrical cords, spills, and anything else that may cause you to fall.
In the bathroom, use nonslip bath mats, grab bars, a raised toilet seat, and a shower tub seat.
Simplify your household to keep the items you need handy and everything else out of the way.
Use a backpack, fanny pack, apron, or briefcase to help you carry things around.
Crutches

If an injury or surgical procedure requires you to keep your weight off your leg or foot, you
may have to use crutches.
Proper Positioning
The top of your crutches should reach between 1 and 1.5 inches below your armpits while
you stand up straight.
The handgrips of the crutches should be even with the top of your hip line.
Your elbows should bend a bit when you use the handgrips.
Hold the top of the crutches tightly to your sides, and use your hands to absorb the weight.
Don't let the tops of the crutches press into your armpits.
Walking
Lean forward slightly and put your crutches about one foot ahead of you. Begin your step as if you were going to use
the injured foot or leg, but shift your weight to the crutches instead of the injured foot. Your body swings forward
between the crutches. Finish the step normally with your non-injured leg. When the non-injured leg is on the ground,
move your crutches ahead in preparation for the next step. Keep focused on where you are walking, not on your feet.
Sitting
Back up to a sturdy chair. Put your injured foot in front of you and both crutches in one hand. Use the other hand to
feel for the seat of your chair. Slowly lower yourself into it. Lean your crutches upside down in a handy location.
(Crutches tend to fall over when they are stood on their tips.) To stand up, inch yourself to the front of the chair. Hold
both crutches in the hand on your good leg side. Push yourself up and stand on the good leg.
Stairs
To walk up and down stairs with crutches, you need to be both strong and flexible. Facing the stairway, hold the
handrail with one hand and tuck both crutches under your armpit on the other side. When you're going up, lead with
your good foot, keeping the injured foot raised behind you. When you're going down, hold your injured foot up in front,
and hop down each stair on your good foot. Take it one step at a time. You may want someone to help you, at least
at first. If you're facing a stairway with no handrails, use the crutches under both arms and hop up or down each step
on your good leg, using more strength. An easier way is to sit on the stairs and inch yourself up and down each step.
Start by sitting on the lowest stair with your injured leg out in front. Hold both crutches flat against the stairs in your
opposite hand. Scoot your bottom up to the next step, using your free hand and good leg for support. Face the same
direction when you go down the stairs this way.
Canes

You may find it helpful to use a cane if you have a small problem with balance or instability, some
weakness in your leg or trunk, an injury, or pain. If you are elderly, a single point cane may also help
you to keep living independently.
Proper Positioning
The top of your cane should reach to the crease in your wrist when you stand up straight. Your elbow
should bend a bit when you hold your cane. Hold the cane in the hand opposite the side that needs
support.
Walking
When you walk, the cane and your injured leg swing and strike the ground at the same time. To start, position your
cane about one small stride ahead and step off on your injured leg. Finish the step with your normal leg.
Stairs
To climb stairs, grasp the handrail (if possible) and step up on your good leg first, with your cane in the hand opposite
the injured leg. Then step up on the injured leg. To come down stairs, put your cane on the step first, then your
injured leg, and finally the good leg, which carries your body weight.
Top of page
Walkers

If you have had total knee or hip joint replacement surgery, or you have another
significant problem, you may need more help with balance and walking than you can
get with crutches or a cane. A pickup walker with four solid prongs on the bottom may
give you the most stability. The walker lets you keep all or some of your weight off of
your lower body as you take your steps. You use your arms to support some of the
weight. The top of your walker should match the crease in your wrist when you stand
up straight. Do not hurry when you use a walker. As your strength and endurance get
better, you may gradually be able to carry more weight in your legs.
Walking
First, put your walker about one step ahead of you, making sure the legs of your
walker are level to the ground. With both hands, grip the top of the walker for support
and walk into it, stepping off on your injured leg. Touch the heel of this foot to the
ground first, then flatten the foot and finally lift the toes off the ground as you complete
your step with your good leg. Don't step all the way to the front bar of your walker.
Take small steps when you turn.
Sitting
To sit, back up until your legs touch the chair. Reach back to feel the seat before you
sit. To get up from a chair, push yourself up and grasp the walker's grips. Make sure
the rubber tips on your walker's legs stay in good shape.
Stairs
Never try to climb stairs or use an escalator with your walker.



Definition
Crutches are artificial supports and assists patients who need aid in walking because of disease,
injury, or a birth defect.
Purposes
> To assist client who cannot bear any weight on one leg.
> To assist client who have full weight bearing on both legs.
> Prevent injury to client who has difficulty in ambulation.
Principles
> Assess clients physical limitations to determine safety and comfort.
> Take time to show patients how to walk with crutches for them to learn
> Maintain proper body mechanics.
Equipment
> Gait belt > Tape measure
> Crutches > Sturdy footwear, properly fitted
Crutch Walking
1. Inform the client you will be teaching crutch
ambulation.

Rationale: Reduces anxiety. Helps increase
comprehension and cooperation, promotes client
independence.

2. Assess the client for strength, mobility, ROM,
visual acuity, perceptual difficulties and balance.
Note: nurse and therapist often collaborate on
this assessment.

Rationale: Helps determine the clients
capabilities and amount of assistance required.

3. Adjust crutches to fit the client. With the client
supine, measure from the heel to the axilla. With
the client standing, set the crutch position at a 4-
5 inches lateral to the client and 4-6 inches in
front of the client. The crutch pad should fit 1.5
inches below the axilla (3 finger width). The hand
grip should be adjusted to allow for the client to
have elbows bent at 30 degree flexion.

Rationale: Provide broad base of support for the
client. Space between the crutch pad and axilla
prevents pressure on radial nerves. The elbow
flexion allows for space between the crutch pad
and axilla.

4. Lower the height of the bed. Rationale: Allows the client to sit with feet on the
floor for stability.
5. Have the client dangle legs. Assess for
vertigo.

Rationale: Allows for stabilization of blood
pressure, thus preventing orthostatic
hypotension.

6. Instruct the client to position crutches lateral to
and forward to feet. Demonstrate correct
positioning.

Rationale: Increases client comprehension and
cooperation.

7. Apply the gait belt around the clients waist if
needed.

Rationale: Provides support, promotes client
safety.

8. Assist the client to a standing position with
crutches.

Rationale: Standing for a few minutes will assist
in preventing orthostatic hypotension.

Four-Point Gait
9. a. Position crutches to the side and in front of
each foot.
b. Move the right crutch forward 4 to 6 inches.
c. Move the left foot forward, even with the left
crutch.
d. Move the left crutch forward 4 to 6 inches.
e. Move the right foot forward, even with the left
crutch.
f. Repeat the four-point gait.

Rationale: The four point gait provides greater
stability. Weight bearing is on three points at all
times. The client must be able to bear weight
with both legs.

Three-Point Gait
10. a. Advance both crutches and the weaker leg
forward together.
b. Move the stronger leg forward, even with
crutches.
c. Repeat three-point gait.



Two-Point Gait
11. a. Move left crutch and right leg forward 4 6
inches.
b. Move right crutch and left leg forward 4 6
inches.
c. Repeat two-point gait.

Rationale: The two pint gait provides a strong
base of support. The client must be able to bear
on both legs. This gait is faster than four-point
gait.

Walking UP stairs
12.a. Instruct the client to position the crutches
as if walking.
b. Place the strong leg on the first step.
c. Pull weak leg up and move the crutches up to
the first step.
d. Repeat for all steps

Rationale: Prevents weight bearing on the
weaker leg.

Walking DOWN stairs
13. a. Position the crutches as if walking.
b. Place weight on the strong leg.
c. Move crutches down the next lower step.
d. Place partial weight on hands and crutches.
e. Move the weak leg down to the step with
crutches.
f. Put the total weight on arms and crutches.
g. Move strong leg same step as weak leg and
crutches.
h. Repeat for all steps.

Rationale: Prevents weight bearing on weaker
leg.

14. Set realistic goals.

Rationale: Crutch walking takes up to 10 times
the energy required for unassisted ambulation
15. Consult with a physical therapist. Rationale: The physical therapist is the expert on
the health care team for crutch-walking
techniques.

16. Wash hands.

Rationale: Reduces the transmission of
microorganisms.
Reference:




Able to
perform
Able to
perform with
assist
Unable to
perform
Crutch Walking
1. Inform the client you will be teaching crutch
ambulation.


2. Assess the client for strength, mobility,
ROM, visual acuity, perceptual difficulties and
balance. Note: nurse and therapist often

collaborate on this assessment.

3. Adjust crutches to fit the client. With the
client supine, measure from the heel to the
axilla. With the client standing, set the crutch
position at a 4-5 inches lateral to the client
and 4-6 inches in front of the client. The
crutch pad should fit 1.5 inches below the
axilla (3 finger width). The hand grip should
be adjusted to allow for the client to have
elbows bent at 30 degree flexion.


4. Lower the height of the bed.
5. Have the client dangle legs. Assess for
vertigo.


6. Instruct the client to position crutches
lateral to and forward to feet. Demonstrate
correct positioning.


7. Apply the gait belt around the clients waist
if needed.


8. Assist the client to a standing position with
crutches.


Four-Point Gait
9. a. Position crutches to the side and in front
of each foot.
b. Move the right crutch forward 4 to 6 inches.
c. Move the left foot forward, even with the left
crutch.
d. Move the left crutch forward 4 to 6 inches.
e. Move the right foot forward, even with the

left crutch.
f. Repeat the four-point gait.

Three-Point Gait
10. a. Advance both crutches and the weaker
leg forward together.
b. Move the stronger leg forward, even with
crutches.
c. Repeat three-point gait.



Two-Point Gait
11. a. Move left crutch and right leg forward 4
6 inches.
b. Move right crutch and left leg forward 4 6
inches.
c. Repeat two-point gait.


Walking UP stairs
12.a. Instruct the client to position the
crutches as if walking.
b. Place the strong leg on the first step.
c. Pull weak leg up and move the crutches up
to the first step.
d. Repeat for all steps


Walking DOWN stairs
13. a. Position the crutches as if walking.
b. Place weight on the strong leg.
c. Move crutches down the next lower step.

d. Place partial weight on hands and crutches.
e. Move the weak leg down to the step with
crutches.
f. Put the total weight on arms and crutches.
g. Move strong leg same step as weak leg
and crutches.
h. Repeat for all steps.

14. Set realistic goals.


15. Consult with a physical therapist.


16. Wash hands.


Crutch Walking
1. Inform the client you will be teaching crutch
ambulation.