UNIVERSITY OF CEBU – BANILAD

COLLEGE OF NURSING

CRUTCH WALKING

SUBMITTED BY:
PLASENCIA, CHELSEA ANGELA R.
BSN 3H

SUBMITTED TO:
MS. RACHEL A. BAJARIAS, MAN, RN
I. WHAT ARE CRUTCHES?
 Crutches are devices that may be a temporary or permanent necessity for some
clients who are unable to use their legs to support their weight for a variety of
reasons ranging from minor injuries to lifelong disabilities.
 Crutches allow a client to walk independently.

II. TYPES OF CRUTCHES

 Underarm Crutches (Axillary)

 Most commonly seen crutches around

 Are mainly made of either wood or aluminum
 This model can be adjusted easily with a patient’s overall height and hand
height
 While operating on an axillary crutch, you need to be able to flex your
elbow roughly about 30 degrees
 In any normal condition, the top of the crutch and armpit (axilla) should
have a distance of about two to three fingers and on the ground 6 to 8
inches from your foot
 Forearm Crutches (Loftstrand)

 Also known as elbow crutch

 The cuff of the crutch has to be at a distance of 1 to 1.5 inches from the
elbow
 Enables the patient to flex from 15 to 30 degrees
 The bottom tip of the crutch should stay 2 to 4 inches from the foot
sideways and 6 inches in front of your foot
 Commonly suggested to patients with cases of Polio or other lifelong
disabilities
 Gutter Crutches

 A simple modification of forearm crutches

 A gutter crutch will enable patients or older people to maintain balance
and distribute their weight if they need to rely on tools to accomplish such
a goal
 A gutter crutch is usually prescribed to rheumatoid arthritis patients
because of their weak grip due to joint pain
  Hands-free Crutches

 Hands-free crutches came into being from the adverse side effects of
underarm crutches
 Also known as knee crutches
 These crutches don’t have any function for hands or wrists rather they
can be strapped to the thigh and knee to provide support
 The base of the crutch is designed to sustain weight in one leg, so this
crutch is rather useful than underarm crutches

III. HOW TO USE CRUTCHES

1. Follow the plan of exercises developed for you to strengthen your arm muscles
before beginning crutch walking.
2. Have a health care professional establish the correct length for your crutches and
the correct placement of the handpieces. Crutches that are too long force your
shoulders upward and make it difficult for you to push your body off the ground.
Crutches that are too short will make you hunch over and develop an improper
body stance.
3. The weight of your body should be borne by the arms rather than the axillae
(armpits). Continual pressure on the axillae can injure the radial nerve and
eventually cause crutch palsy, a weakness of the muscles of the forearm, wrist,
and hand.
4. Maintain an erect posture as much as possible to prevent strain on muscles and
joints and to maintain balance.
5. Each step taken with crutches should be a comfortable distance for you. It is wise
to start with a small rather than large step.
6. Inspect the crutch tips regularly and replace them if worn.
7. Keep the crutch tips dry and clean to maintain their surface friction. If the tips
become wet, dry them well before use.
8. Wear a shoe with a low heel that grips the floor. Rubber soles decrease the
chances of slipping. Adjust shoelaces so they cannot come untied or reach the
floor where they might catch on the crutches. Consider shoes with alternative
forms of closure especially if you cannot easily bend to tie laces. Slip-on shoes
are acceptable only if they are snug and the heel does not come loose when the
foot is bent.

IV. CRUTCH GAITS

 The crutch gait is the gait a person assumes on crutches by alternating body
weight on one or both legs and the crutches.
 Five standard crutch gaits are the four-point gait, three-point gait, two-point gait,
swing-to gait, and swing-through gait.
 The gait used depends on the following individual factors:
a. the ability to take steps,
b. the ability to bear weight and keep balance in a standing position
on both legs or only one, and
c. the ability to hold the body erect.
V. CRUTCH STANCE (TRIPOD POSITION)

 Before crutch walking is attempted, the client needs to learn facts about posture
and balance.
 The proper standing position with crutches is called the tripod (triangle) position.
 The crutches are placed about 15 cm (6 in.) in front of the feet and out laterally
about 15 cm (6 in.), creating a wide base of support. The feet are slightly apart.
 A tall client requires a wider base than does a short client. Hips and knees are
extended, the back is straight, and the head is held straight and high.
 There should be no hunch to the shoulders and thus no weight borne by the
axillae.
 The elbows are extended sufficiently to allow weight bearing on the hands. If the
client is unsteady, the nurse places a gait/transfer belt around the client’s waist
and grasps the belt from above, not from below. A fall can be prevented more
effectively if the belt is held from above

VI. FOUR-POINT ALTERNATE GAIT

 This is the most elementary and safest gait, providing at least three points of
support at all times, but it requires coordination.
 Clients can use it when walking in crowds because it does not require much
space.
 To use this gait, the client needs to be able to bear weight on both legs.
 The nurse asks the client to:
1. Move the right crutch ahead a suitable distance, such as 10 to 15 cm (4
to 6 in).
2. Move the left front foot forward, preferably to the level of the left crutch.
3. Move the left crutch forward.
4. Move the right foot forward.
VII. THREE-POINT GAIT

 To use this gait, the client must be able to bear the entire body weight on the
unaffected leg.
 The two crutches and the unaffected leg bear weight alternately.
 The nurse asks the client to:
1. Move both crutches and the weaker leg forward.
2. Move the stronger leg forward.

VIII. TWO-POINT GAIT

 This gait is faster than the four-point gait.

 It requires more balance because only two points support the body at one time; it
also requires at least partial weight bearing on each foot.
 In this gait arm movements with the crutches are similar to the arm movements
during normal walking.
 The nurse asks the client to:
1. Move the left crutch and the right foot forward together.
2. Move the right crutch and the left foot ahead together.

IX. GETTING INTO A CHAIR

 Chairs that have armrests and are secure or braced against a wall are essential
for clients using crutches.
 For this procedure, the nurse instructs the client to:
1. Stand with the back of the unaffected leg centered against the chair.
The chair helps support the client during the next steps.
2. Transfer the crutches to the hand on the affected side and hold the
crutches by the hand bars. The client grasps the arm of the chair with
the hand on the unaffected side. This allows the client to support the
body weight on the arms and the unaffected leg.
3. Lean forward, flex the knees and hips, and lower into the chair.
 X. GETTING OUT OF A CHAIR
 For this procedure, the nurse instructs the client to:
1. Move forward to the edge of the chair and place the unaffected leg
slightly under or at the edge of the chair. This position helps the client
stand up from the chair and achieve balance, because the unaffected
leg is supported against the edge of the chair.
2. Grasp the crutches by the hand bars in the hand on the affected side
and grasp the arm of the chair by the hand on the unaffected side. The
body weight is placed on the crutches and the hand on the armrest to
support the unaffected leg when the client rises to stand.
3. Push down on the crutches and the chair armrest while elevating the
body out of the chair.
4. Assume the tripod position before moving.

XI. GOING UP STAIRS

 For this procedure, the nurse stands behind the client and slightly to the affected
side if needed.
 The nurse instructs the client to:
1. Assume the tripod position at the bottom of the stairs.
2. Transfer the body weight to the crutches and move the unaffected leg
onto the step.
3. Transfer the body weight to the unaffected leg on the step and move the
crutches and affected leg up to the step. The affected leg is always
supported by the crutches.
4. Repeat steps 2 and 3 until the client reaches the top of the stairs.

XII. GOING DOWN STAIRS

 For this procedure, the nurse stands one step below the client on the affected
side if needed.
 The nurse instructs the client to:
1. Assume the tripod position at the top of the stairs.
2. Shift the body weight to the unaffected leg and move the crutches and
affected leg down onto the next step.
3. Transfer the body weight to the crutches and move the unaffected leg to
that step. The affected leg is always supported by the crutches.
4. Repeat steps 2 and 3 until the client reaches the bottom of the stairs.

REFERENCES:

Berman, A., Snyder, S., Frandsen, G., & Berman, A. (2016). Study guide for kozier & erb's
fundamentals of nursing: Concepts, process, and practice, tenth edition by Berman,
Snyder. Pearson.

Sutton, D. K. (2022, August 7). 4 different types of crutches and their uses. Dxand. Retrieved
April 18, 2023, from https://dxand.com/types-of-crutches/#axillary-crutches

Wikimedia Foundation. (2023, February 21). Crutch. Wikipedia. Retrieved April 18, 2023, from
https://en.wikipedia.org/wiki/Crutch