Topic
How to use crutches
💡 What You Need to Know
- Purpose of Crutches: Crutches are essential mobility aids designed to reduce or eliminate weight-bearing on an injured or surgically repaired lower extremity, facilitating safe ambulation during recovery.
- Proper Fitting is Crucial: Ensure crutches are correctly sized; the top of the crutch pad should be 1.5 to 2 inches (about two finger-widths) below your armpit when standing upright. Your elbows should have a slight bend (approximately 15-30 degrees) when gripping the handholds.
- Weight-Bearing Status: Always adhere strictly to your surgeon's prescribed weight-bearing status (e.g., non-weight bearing, partial weight bearing, weight bearing as tolerated) to protect the surgical site and promote healing.
- Energy Expenditure: Using crutches requires significant upper body strength and energy. Expect to tire more easily and plan your activities accordingly.
🤒 Associated Symptoms
- Post-Surgical Pain: Crutches are indicated when ambulation causes pain or instability in the affected limb following surgery or injury.
- Instability or Weakness: If you experience a feeling of giving way or significant weakness in your leg, crutches provide necessary support to prevent falls.
- Numbness or Tingling in Hands/Arms: Improper crutch use, particularly leaning on the axillary pads, can compress nerves in the armpit, leading to numbness, tingling, or weakness in the hands and arms (axillary nerve palsy).
- Shoulder or Wrist Pain: Incorrect posture or excessive weight bearing through the wrists can lead to discomfort or injury in these joints.
🛡 Crucial Precautions
- Avoid Leaning on Armpits: Never rest your body weight on the crutch pads under your armpits. All weight should be borne through your hands on the handgrips to prevent nerve damage.
- Clear Your Environment: Ensure pathways are free of obstacles, loose rugs, electrical cords, and wet surfaces to minimize fall risks.
- Wear Appropriate Footwear: Choose sturdy, non-slip, low-heeled shoes that provide good support. Avoid sandals, high heels, or walking barefoot.
- Stair Navigation: Use the 'up with the good, down with the bad' rule for stairs. When going up, lead with your unaffected leg, then bring the crutches and affected leg up. When going down, place crutches and affected leg down first, then follow with your unaffected leg. Always use a handrail if available.
- Hydration and Rest: Stay well-hydrated and take frequent breaks to prevent fatigue, which can increase your risk of falling.
🍽 Dietary Directions & Restrictions
- Adequate Hydration: Maintain good fluid intake to support overall health, prevent constipation (common with reduced mobility and pain medications), and aid in tissue healing.
- Nutrient-Rich Diet: Focus on a balanced diet rich in protein (for tissue repair), vitamins (especially C and D), and minerals (like calcium and zinc) to support bone and soft tissue healing post-surgery.
- Fiber Intake: Increase dietary fiber from fruits, vegetables, and whole grains to promote regular bowel movements, counteracting the effects of immobility and certain medications.
- Energy for Ambulation: Ensure sufficient caloric intake to meet the increased energy demands associated with using crutches and physical therapy.
⚠️ Attendant Guidelines
- Assist with Obstacles: Be prepared to assist the patient with opening doors, navigating tight spaces, or clearing pathways.
- Monitor for Fatigue: Observe the patient for signs of fatigue, dizziness, or loss of balance, especially during longer distances or on uneven terrain.
- Fall Prevention: Be vigilant about fall risks, particularly on stairs or slippery surfaces. Offer a steadying arm if appropriate and safe.
- Reinforce Instructions: Gently remind the patient of proper crutch technique, such as not leaning on armpits and maintaining an upright posture.
🩺 Physician's Perspective
- Strict Adherence to Weight-Bearing: It is paramount to follow the prescribed weight-bearing status precisely to prevent re-injury or delayed healing of the surgical site.
- Pain Management: Effective pain control is crucial for comfortable and safe ambulation. Discuss any uncontrolled pain with your medical team.
- Physical Therapy Referral: Engage actively in prescribed physical therapy to regain strength, flexibility, and proper gait mechanics, which are vital for transitioning off crutches.
- Report Complications: Immediately report any new or worsening pain, swelling, numbness, tingling, skin breakdown under the crutch pads, or inability to safely use crutches to your physician.
🎓 Academic & Nursing Corner
- Patient Education: Provide comprehensive instruction on proper crutch fitting, gait patterns (e.g., 3-point gait for non-weight bearing), stair climbing, and fall prevention strategies.
- Gait Assessment: Observe the patient's gait for stability, balance, and correct technique, correcting any improper habits such such as leaning on axillary pads or shuffling.
- Skin Integrity Monitoring: Assess skin under the axillae and on the hands for signs of redness, irritation, or breakdown, especially with prolonged use.
- Reinforce Weight-Bearing Status: Consistently verify and reinforce the physician's orders regarding weight-bearing status with the patient and family.
🔬 Clinical Reference Index
- Axillary Nerve Compression: A potential complication from improper crutch use, leading to neuropathy of the radial, ulnar, and median nerves.
- Gait Patterns: Specific ambulation techniques including 2-point (partial weight bearing), 3-point (non-weight bearing), 4-point (maximal stability), and swing-to/swing-through gaits.
- Weight-Bearing Statuses: Clinical classifications include Non-Weight Bearing (NWB), Toe-Touch Weight Bearing (TTWB), Partial Weight Bearing (PWB), Weight Bearing As Tolerated (WBAT), and Full Weight Bearing (FWB).
- Crutch Ergonomics: Principles of design and use to maximize comfort, efficiency, and safety, including proper handgrip angle and material.