Topic
How to use crutches
💡 What You Need to Know
- Purpose of Crutches: Crutches are used to help a child walk by taking weight off an injured leg or foot, allowing it to heal properly.
- Proper Fitting is Key: Incorrectly fitted crutches can cause discomfort, skin irritation, or even nerve damage. Always ensure they are adjusted to the child's height.
- Adult Supervision: Young children require constant supervision when using crutches to prevent falls and ensure correct technique.
- Gradual Introduction: Introduce crutch use in a safe, open space with clear pathways before navigating more challenging environments.
🤒 Associated Symptoms
- Pain with Weight-Bearing: Significant pain in the leg, ankle, or foot when attempting to stand or walk.
- Swelling and Bruising: Visible swelling, bruising, or deformity following an injury such as a sprain, fracture, or muscle strain.
- Inability to Bear Weight: Complete inability or extreme difficulty for the child to put any weight on the affected limb.
- Limping or Gait Changes: A noticeable change in the child's walking pattern, indicating discomfort or instability.
🛡 Crucial Precautions
- Clear Pathways: Ensure all walking areas at home and school are free from rugs, toys, and other obstacles to prevent tripping.
- Non-Slip Footwear: The child should always wear well-fitting, non-slip shoes (e.g., sneakers) to maintain traction.
- Stair Safety: Avoid stairs initially. If unavoidable, teach the 'up with the good, down with the bad' technique with adult assistance.
- Crutch Tip Inspection: Regularly check the rubber tips on the bottom of the crutches for wear and tear; replace them if they are worn smooth.
- Axillary Padding: Ensure the crutch pads under the arms are not pressing directly into the armpits, which can cause nerve damage (crutch palsy). Weight should be borne through the hands.
🍽 Dietary Directions & Restrictions
- Hydration for Healing: Encourage ample fluid intake to support overall healing and prevent constipation, which can be common with reduced mobility and certain pain medications.
- Nutrient-Rich Diet: Provide a diet rich in calcium, Vitamin D, and protein to support bone repair and tissue regeneration.
- Fiber Intake: Increase dietary fiber through fruits, vegetables, and whole grains to maintain regular bowel movements due to decreased activity.
- Avoid Excessive Sugars: Limit highly processed foods and sugary drinks, which can contribute to inflammation and hinder the healing process.
⚠️ Attendant Guidelines
- Supervise Technique: Continuously observe the child's crutch technique to ensure they are using them correctly and safely.
- Assist with Stairs and Curbs: Provide direct physical assistance when the child needs to navigate stairs, curbs, or uneven surfaces.
- Monitor for Skin Irritation: Regularly check the child's armpits and hands for redness, blistering, or skin breakdown from crutch use.
- Reinforce Weight-Bearing Status: Consistently remind the child of their prescribed weight-bearing restrictions (e.g., non-weight bearing, touch-down weight bearing).
- Encourage Breaks: Advise the child to take frequent breaks to rest and prevent fatigue, especially during longer periods of mobility.
🩺 Physician's Perspective
- Adhere to Weight-Bearing Orders: Strictly follow the prescribed weight-bearing status to ensure proper healing and prevent re-injury.
- Pain Management: Administer prescribed pain medication as directed and report any uncontrolled pain to the medical team.
- Watch for Complications: Be vigilant for signs of complications such as increased pain, swelling, numbness, tingling, or changes in skin color in the affected limb.
- Follow-Up Appointments: Attend all scheduled follow-up appointments for reassessment of the injury and crutch use.
- Physical Therapy Referral: A referral to physical therapy may be necessary to teach proper crutch gait, strengthen muscles, and regain full function.
🎓 Academic & Nursing Corner
- Crutch Measurement & Fitting: Crucial to measure from the axilla to a point 6 inches lateral to the foot, ensuring 2-3 finger widths between the axillary pad and the armpit. Handgrips should allow for a 20-30 degree elbow bend.
- Gait Training: Educate on various crutch gaits (e.g., 2-point, 3-point, 4-point, swing-through) based on the child's weight-bearing status and strength.
- Skin Integrity Assessment: Regularly assess skin in the axillary region, palms, and wrists for pressure areas, redness, or breakdown.
- Pain Assessment & Management: Utilize age-appropriate pain scales (e.g., Wong-Baker FACES) to assess pain and evaluate the effectiveness of interventions.
- Patient & Family Education: Provide clear, concise instructions on crutch use, safety, activity restrictions, and signs of complications to both the child and caregivers.
🔬 Clinical Reference Index
- Types of Crutches: Axillary crutches (underarm) are common for short-term use; forearm (Lofstrand) crutches offer more independence for long-term use.
- Weight-Bearing Statuses: Non-Weight Bearing (NWB), Touch-Down Weight Bearing (TDWB), Partial Weight Bearing (PWB), Weight Bearing As Tolerated (WBAT).
- Crutch Palsy: Neuropathy of the radial or ulnar nerve caused by prolonged pressure on the axilla from improperly fitted crutches.
- Energy Expenditure: Crutch walking significantly increases energy expenditure compared to normal ambulation, especially in children.
- Rehabilitation Protocol: Crutch use is often part of a broader rehabilitation protocol that includes physical therapy for strengthening, flexibility, and balance training.