Forearm crutches, sometimes called Loftstrand or Canadian crutches, are a type of mobility aid designed to assist individuals with walking difficulties or lower-limb injuries. These devices function by transferring a person’s body weight from their legs to their upper body, specifically the forearms. Unlike the more common underarm models, forearm crutches use a different mechanism to provide support and stability during movement. This design allows users to achieve greater independence and mobility.
Design and Function
The forearm crutch features two main points of contact: the handgrip and the forearm cuff. The aluminum or composite shaft extends from the ground to the handgrip, which is positioned for the user to grasp and apply downward force. This handgrip channels the primary weight-bearing force from the user’s hand and wrist into the crutch.
Above the handgrip is a cuff, typically made of plastic, which partially encircles the user’s forearm, often just below the elbow. This cuff provides lateral stability and prevents the crutch from falling away when the user temporarily releases the handgrip to perform simple tasks. Weight is distributed through the hands and wrists, but the cuff also engages the forearm to aid in balance and control.
This design shifts the support mechanism away from the armpit area, unlike axillary crutches. The weight transfer is focused on the skeletal structure of the forearm and the upper body strength of the user. This mechanism encourages a more upright posture and lessens the risk of complications associated with the underarm design.
Specific Medical Applications
Forearm crutches are used to address a broad range of temporary and permanent mobility limitations in the lower body. For short-term needs, they are often prescribed for injuries that require partial weight bearing on a limb, such as severe ankle sprains, complex fractures, or post-operative recovery following knee or foot surgery. They enable a patient to safely take some weight on the affected limb while moving, which is often required in the rehabilitation process.
The devices are particularly suited for long-term support for individuals with chronic conditions. Many people with neurological impairments that affect walking, such as cerebral palsy, multiple sclerosis, or spinal cord injuries, rely on these crutches daily. The stability and freedom offered by the cuff design make them a preferred choice for those who need indefinite partial weight bearing assistance, and they also benefit individuals who require general balance and stability assistance due to muscle weakness or coordination issues.
Key Advantages Over Axillary Crutches
A primary advantage of forearm crutches is the elimination of pressure on the axilla, or armpit, which reduces the risk of nerve damage. Traditional underarm crutches can compress the axillary nerves and blood vessels if used improperly, potentially leading to a condition known as crutch paralysis or axillary nerve palsy. Forearm crutches bypass this area entirely, making them safer for prolonged use.
The cuff provides a functional benefit by securing the crutch to the user’s arm. This allows the user to quickly use their hands for tasks like opening a door or reaching for an object without the crutch falling to the floor. This increased maneuverability and independence is valued by long-term users.
The design encourages a more erect posture, which can reduce strain on the back and shoulders over time. Studies also suggest that walking with forearm crutches requires less overall energy expenditure compared to the underarm style, which can be a deciding factor for people with chronic fatigue or limited endurance.
Proper Fitting and Gait Basics
Correct adjustment of the forearm crutch is necessary to ensure safety and comfort. The handgrip height should be set so that it aligns with the wrist crease when the user stands upright with arms relaxed at their sides. This positioning allows for a slight bend, approximately 15 to 30 degrees, at the elbow when gripping the handle, which is needed for effective push-off.
The forearm cuff should be positioned just below the elbow joint, typically 1 to 2 inches from the bony prominence of the elbow. This placement ensures the cuff provides stability without interfering with the natural movement of the elbow joint during ambulation.
Users learn gaits tailored to their weight-bearing status. The three-point gait is used for non-weight-bearing or partial-weight-bearing. In the three-point gait, both crutches and the affected leg move forward together, followed by the unaffected leg. More coordinated users may learn a swing-through gait, where the crutches are advanced, and the body is then swung past them, allowing for faster movement.