Treating a patient for a foot or leg injury? Being unable to bear weight due to a sprained or broken ankle, foot injury, knee or lower leg issue, or because a patient is recovering from surgery, often requires a prescription for crutches from the doctor.

An estimated 7+ million people use crutches every year for short and longer term mobility issues, making them one of, if not the most, prescribed orthotic aid. Rates of crutch injuries aren’t well quantified, but a 2014 systematic literature review revealed that over 70% of crutch complications develop from the use of axillary crutches.

Types of Crutches

Axillary - axillary (or underarm) crutches are the most well-known type of crutch mobility aid. Height adjustable, and typically made of wood or aluminum, axillary crutches are placed under the armpit with the top padded part placed against the rib cage and the hand holding the grip below parallel to the top.

Forearm - a forearm (or Lofstrand or elbow crutch) crutch is typically utilized by a patient with longer term ambulatory issues. It features a cuff through which the forearm slides through to a grip the patient holds.

Platform - much less common and more often used for patients with diminished hand grip, platform crutches feature a horizontal platform which a patient’s arm can rest and be stabilized in place with straps.

Strutter - strutter crutches are a variation on the underarm crutch that offer a wide, flat platform base (instead of a tip) that touches the floor as well as an articulating foot. The top portions curve to rest under the arms without rubbing or irritating, like axillary crutches might.

Leg support - this type of mobility aid combines a crutch with a support frame attached or on wheels where the injured leg is bent backwards and set up to rest completely clear of the ground. Best for patients with lower leg injuries that don’t affect the bending of the knee, leg supports may also come in hands-free variations.

Dangers of Crutches

Crutch paralysis - Damage to nerve endings in the armpit (axilla) can result from constant pressure placed on them when using axillary crutches.

Skin irritation - additional irritation and rubbing of the skin when using underarm crutches, especially without padding, can be annoying and painful. Best pads for crutches reviews the best  crutch pad options.

Slipping - the smaller point tips of some crutches and the lack of non-slip grip can lead to slipping and falling (especially on slick and uneven surfaces), which may exacerbate an existing weight-bearing injury.

Catching tip and falling - trip hazards on walking surfaces like cords may cause a patient to catch the tip of their crutch and lose their balance leading to a fall. Navigating stairways can also be extremely difficult with crutches.

Joint or muscle pain - less serious joint pain (arthralgia) or muscle pain (myalgia) may occur from the use of crutches as patients engage different muscle groups and incur many more awkward body movements and positions than they otherwise might. Neck, shoulder, back, and even elbow pain may occur.

What Should Clinicians Do

When prescribing crutches, it’s important for clinicians to go over proper gait (way of walking with crutches) as well as key reminders like using crutch pads to avoid nerve damage, how to adjust for height, and proper use of the hand grips to bear weight but avoid injuring the wrists.

For lower leg injuries, discuss crutch alternatives like hands-free leg platforms or knee scooters. Knee scooters are 3 or 4-wheeled devices with a raised leg platform and handlebars for easier maneuvering. Review how to navigate stairways and make recommendations for using help to traverse longer distances or go up and down stairs or inclines.

Avoiding injury from crutch use is possible, but it requires helpful guidance and instruction from clinicians (doctors, nurses, physical therapists, etc) to equip patients with the tools they need to practice good form and avoid falling.

 

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