Crutch Walking

A patient on crutches places them too far forward and bears weight on the axillae — nerve damage can happen in hours. Knowing the correct gaits and fitting prevents permanent injury.

Crutch walking requires precise fitting and gait selection based on the patient's weight-bearing status and upper body strength. Proper measurement: with the patient standing, crutch tips rest 4-6 inches (15 cm) lateral and 4-6 inches anterior to the feet, with 2-3 finger widths (about 1-1.5 inches) between the axillary pad and the axilla. Weight is borne on the hands and arms, never the axillae — axillary pressure compresses the brachial plexus, causing crutch palsy (numbness, tingling, weakness in hands/arms). Five standard gaits exist. Two-point gait: right crutch + left foot advance together, then alternate — used for partial weight-bearing with good balance. Three-point gait: both crutches + the affected leg advance first, then the unaffected leg follows — used for non-weight-bearing on one extremity. Four-point gait: right crutch, left foot, left crutch, right foot — slowest, most stable, requires weight-bearing on both legs. Swing-to gait: both crutches forward, then swing both legs to the crutches — for patients with paralysis. Swing-through gait: same start, but legs swing past the crutches — fastest, requires significant strength and balance. For stairs: going up, the strong leg leads ('up with the good'); going down, crutches and the affected leg go first ('down with the bad').

Key Distinctions

Don't confuse three-point gait (non-weight-bearing, both crutches move with affected leg) with two-point gait (partial weight-bearing, alternating crutch-opposite foot pattern). Students frequently mix up stair technique — remember the unaffected leg leads going UP, crutches and affected leg lead going DOWN. Crutch palsy is from axillary pressure, not from hand grip — the fix is hand weight-bearing, not padding.

Clinical Pearl

'Up with the good, down with the bad' — the strong leg climbs first, the crutches and weak leg descend first. Tattoo this to memory for stairs questions.