Adjusting crutches correctly takes about five minutes and comes down to two key measurements: the gap between the crutch top and your armpit, and the height of the handgrip. Getting these wrong doesn’t just feel uncomfortable. It can cause nerve damage in your arms or make you unstable on your feet. Here’s how to set them up right.
Start With the Right Shoes
Before you measure anything, put on the shoes you’ll actually be wearing while using the crutches. Sole thickness changes your height enough to throw off the fit. If you switch between sneakers and sandals regularly, you may need to do a quick readjustment each time. Barefoot measurements won’t be accurate for walking around outside.
Setting the Overall Crutch Height
Stand upright with your arms relaxed at your sides. The top pad of an underarm (axillary) crutch should sit about 2.5 inches, roughly two finger-widths, below your armpit. This gap is non-negotiable. If the pad presses into your armpit, you risk compressing the bundle of nerves and blood vessels that run through that area, a condition called crutch palsy. In documented cases, patients have developed severe nerve damage affecting their ability to grip, extend their wrists, and feel sensation in their hands.
Most crutches have push-button or wing-nut adjustments on the lower shaft. Have someone help you check the gap while you’re standing in your normal posture, not hunching or stretching upward. Adjust the lower shaft until that two-finger gap feels consistent on both sides.
Positioning the Handgrip
The handgrip matters more than the top pad, because this is where all your weight should go. With the crutch at the correct overall height, let your arm hang straight down. The handgrip should line up roughly with your hip, at the crease of your wrist. When you grab it, your elbow should bend about 20 to 30 degrees.
This angle isn’t just about comfort. Research on crutch biomechanics found that raising the handle even 1 to 2 inches above the ideal position, pushing elbow bend past 30 degrees, doubled the force your elbow muscles had to generate with every step. Over days or weeks of use, that extra strain leads to significant arm fatigue and joint pain. If your elbows are bending too much when you walk, lower the handgrip. If your arms are almost straight, raise it.
Adjusting Forearm Crutches
Forearm (Lofstrand) crutches have a cuff that wraps around your forearm instead of a pad under the arm. The same handgrip rules apply: your elbow should bend about 20 to 30 degrees when gripping the handle. The forearm cuff should sit 1 to 2 inches below the bend of your elbow. If the cuff is too high, it digs into the elbow joint. Too low, and it won’t stabilize your arm properly. Most forearm crutches have separate adjustment points for total height, handgrip position, and cuff placement, so work through them in that order.
Where Your Weight Goes
This is the single most important thing to get right: your weight belongs on your hands, not your armpits. The top pads are there for guidance and light stabilization, not to bear load. Leaning into the armpit pads compresses the brachial plexus, the nerve network that controls your entire arm and hand. Crutch palsy can affect the radial, median, and ulnar nerves simultaneously, causing weakness or numbness from the shoulder to the fingertips. Some cases take months to recover.
If you find yourself leaning on the top pads, that usually means the handgrips are too low or you’re fatigued. Readjust, or take a rest.
How to Walk With Crutches
Start from what’s called the tripod stance: crutch tips about 6 inches in front and slightly to the side of each foot. Which walking pattern you use depends on how much weight you can put on your injured leg.
Non-weight-bearing (three-point swing-through): Place both crutches forward at about a 45-degree angle. Swing your good foot through, landing it in front of the crutches. Your injured leg stays off the ground entirely.
Partial weight-bearing (three-point gait): Place both crutches forward. Step your injured foot up to the crutches, putting only the allowed amount of weight on it. Then step your good foot past the crutches.
Weight-bearing with balance support (four-point gait): Move one crutch forward, then step with the opposite foot. Move the other crutch forward, then step with the other foot. Right crutch, left foot. Left crutch, right foot. This is the most stable pattern and works well when both legs can bear weight but you need extra balance.
How to Handle Stairs
Stairs are where most crutch-related falls happen. The rule is simple to remember: “up with the good, down with the bad.”
Going up with a railing: Hold both crutches together in the hand opposite the railing. Step up with your strong leg first. Then bring your injured leg and the crutches up to the same step. Repeat one step at a time.
Going down with a railing: Place the crutches on the step below first. Step down with your injured leg. Shift your weight onto the railing and crutches, then step down with your strong leg.
Without a railing: The sequence is the same, but you keep both crutches on either side of you. Going up, step with the strong leg and bring the crutches up after. Going down, place the crutches on the lower step first, then step down with the injured leg, then the strong leg. Move slowly and make sure both crutch tips are fully on the step before shifting your weight.
Checking for Wear
The rubber tips (ferrules) on the bottom of your crutches are the only thing between you and a slippery floor. Check them regularly for cracks, smooth spots, or uneven wear. A worn-out tip loses its grip, especially on wet or tiled surfaces. Replacement tips are inexpensive and available at most pharmacies. Also check that the push-button adjustments click firmly into their holes and don’t slip under load. If a crutch slowly telescopes shorter while you walk, the locking mechanism needs replacement.
Padding on the top and handgrip also compresses over time. If the armpit pad has flattened to the point where you can feel the metal frame underneath, replace the pad or wrap it with additional cushioning.