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CRUTCHES

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Dr. M. RAJESH, PT, B.P.T, M.P.T(cardio-pulmonary)

 Introduction:



Crutches are a type of Walking Aids that serve to increase the size of an individuals Base of support. It transfers weight from the legs to the upper body and is often used by people who cannot use their legs to support their weight (i.e short-term injuries to lifelong disabilities).

There are three types of crutches; Axilla crutches, Elbow crutches and Gutter crutches.

  • Axilla or under arm crutches They should actually be positioned about 5 cm below the axilla with the elbow flexed 15 degrees, approximately. 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)
  • Forearm crutches (or lofstrand, elbow or Canadian crutches). Their design includes a single upright, a forearm cuff and a handgrip. The height of the forearm crutches are indicated from handgrip to the floor (adjustable from 29 to 35 inches or 74 to 89 cm).
  • Gutter Crutches (or adjustable arthritic crutches, forearm support crutches) These are additional types of crutches, which is composed of padded forearm support made up of metal, a strap and adjustable hand piece with a rubber ferrule. These crutches are used for patients who are on partial weight bearing like Rheumatoid disease.



CRUTCH TYPES AND MEASUREMENTS:

1. AXILLARY CRUTCHES:

    • These are light weight and can be made of wood or metal.
    • Axillary crutches consist of an axillary bar, hand piece, double uprights joined distally by a single leg covered with a rubber suction tip.
    • The single leg allows height variations, by alterations of screws and wing bolts in predrilled holes known as telescopic arrangements.
    • Hand grip variations can be done either by screws or push button mechanism.
    • These help to improve balance and lateral stability.
    • Provide functional ambulation and lateral stability.
    • Can be used for stair ascending and descending.

MEASUREMENT OF LENGTH :

A. IN LYING :

      • WITH SHOES OFF :
        • (most reliable method) measurement is with the help of inch tape from apex of axilla till the lower margin of medial malleolus.
      • WITH SHOES ON :
        • 5cm vertically down from apex of axilla till 20 cm lateral to the heel of the shoes.
      • Measurement from axillary pad to hand grip :
        • Elbow is flexed 15 degrees, mark a point 5 cm below the apex of axilla and measure till the ulnar styloid process.

B. IN STANDING :

      • 2” below the axilla to a point 2” lateral and 6” anterior to the foot.
      • With shoulder relaxed, the hand piece should be adjusted to provide 20-30 degress of elbow flexion.

2. ELBOW OR FOREARM CRUTCHES :

    • Usually made of aluminum.
    • The elbow crutch consists of a single upright, a forearm cuff, handgrip, and a rubber ferrule.
    • Can be adjusted both proximally to alter the position of the forearm cuff and distally to alter the height of the crutch.
    • Can come with push button mechanism.
    • Forearm cuffs allow use of hands without disengaging the crutch.
    • These are easily adjustable and allow functional stair climbing activity.
    • More cosmetic than other crutches.

DISADVANTAGES :

      • Provide less lateral support due to absence of axillary pad.
      • Cuffs may be difficult to remove.
      • These can be expensive.

MEASUREMENT OF CRUTCH LENGTH :

A. IN LYING : (shoes on)

      • Elbow is flexed to 15 degrees; measurement is taken from the ulnar styloid process to a point 20 cm lateral to the heel of the shoe.

B. IN STANDING :

      • 2” laterally and 6” anteriorly to the foot.
      • Height should be adjusted with relaxed shoulders to provide 20-30 degrees of elbow flexion.

Correct Arm Cuff Location :

      • The higher up on the forearm your arm cuff is the greater the mechanical advantage you get. However if it is too high up, the cuff will bite into your upper arm when you stoop over to pick something up from the ground.
      • Measurement should be at proximal third of the forearm i.e. 1-1.5 inches below the elbow.

DISTANCE “X” :

      • To measure the distance of the bar which attaches the cuff to the hand grip, take the distance from the cuff girth till the ulnar styloid process on the forearm.

DISTANCE “Y” :

      • To take the y measurement hook the end of the tape on the bottom of the crutch tip and measure to the top surface of the hand grip. Standing tall with your back against the wall and shoulders back, allow your hands to hang loosely against your side so that the elbows are flexed approximately at 15 degrees. Measure from the floor up to the deep crease between the palm of your hand and your wrist. It is recommended to take that measurement and add one inch to determine the Y measurement.

This measurement also can be taken in lying position by palpating the greater trochanter and taking the distance from this point till the end of lateral malleolus. (Less reliable method).

3. GUTTER CRUTCHES :

    • Made of metal, with padded forearm support and strap, has an adjustable hand piece and rubber ferrule.
    • Used for patients who require support but cannot take weight through hands, elbows and forearms due to pain and deformities.

MEASUREMENT :

A. IN LYING :

      • With shoes on: measure from the point of fixed elbow till 20 cm lateral to the heel.

 TYPES OF CRUTCH WALKING:

  • 2 point: the crutches and the fractured leg are one point and the uninvolved leg is the other point. The crutches and fractured 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 and good balance is needed to walk with 2 points crutch gait .
  • 3 point: this gait pattern is used when one side lower extremity (LE) is unable to bear weight (due to fracture, amputation, joint replacement etc). It involves three points 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. Each crutch and the weight-bearing limb are advanced separately, with two of the three points maintaining contact with the floor at any given time.
  • 4 point: this gait pattern is used when there's lack of coordination, poor balance and muscle weakness in both LE, as it provides slow and stable gait pattern with three points support on it, 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 any given time.
  • Gait to: the fractured limb is advanced, and then the intact limb brought to the same position. When weight-bearing status is restricted to partial, toe-touch, or as tolerated, crutches or a walker are necessary and help the patient step to the fractured limb by pushing down with the upper extremities, thus transferring weight from the fractured limb to the assistive device.
  • Gait through: the intact leg is advanced,and then the fractured leg is advanced past it. With restricted weight-bearing, crutches are used instead of the injured limb, and the patient steps past the crutches with the weight-bearing lower extremity; the gait assumes a two-point or three-point pattern.

USES:

The use of crutches may be indicated if a patient:

  • Has lost the use of a limb (it is either injured or amputated).
  • Is having problems with Balance and impaired strength.

THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND WEBSITES..

THANK YOU,

SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER
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