Walking Aids Guide: Crutches, Canes, and Walkers Explained

Walking aids—crutches, canes, and walkers—help millions of people maintain mobility during injury recovery, manage chronic conditions, and preserve independence. Yet most people receive minimal instruction on proper use, leading to discomfort, falls, and delayed recovery.

This guide covers the major categories of walking aids, proper fitting, correct technique, and how to progress safely.

Understanding Weight-Bearing Restrictions

Before selecting a walking aid, understand your weight-bearing status as prescribed by your physician or surgeon.

Weight-Bearing Levels

Non-weight bearing (NWB): No weight on the affected leg. The foot should not touch the ground. Requires crutches or walker.

Toe-touch weight bearing (TTWB): Toe touches ground for balance only—essentially NWB with toe contact. Minimal actual weight transfer.

Partial weight bearing (PWB): Specific percentage of body weight allowed (e.g., 25%, 50%). Often progresses over time.

Weight bearing as tolerated (WBAT): Put as much weight as comfortable. Pain guides progression.

Full weight bearing (FWB): No restrictions. May still use assistive device for safety or balance.

Matching Device to Restriction

NWB/TTWB: Crutches or walker required. Cannot use cane alone.

PWB (25-50%): Crutches or walker. Cane insufficient for significant offloading.

WBAT/PWB (75%+): Can often transition to cane when balance adequate.

FWB with balance issues: Cane or walker depending on stability needs.

Crutches

Types of Crutches

Axillary (underarm) crutches:

• Most common type in US
• Rest under armpits with hand grips
• Require good upper body strength and coordination
• Best for: temporary use, younger patients, athletic injuries

Forearm (Lofstrand) crutches:

• Cuff around forearm with hand grip
• Allow hand use without dropping crutch
• Require less upper body strength than axillary
• Best for: long-term use, greater independence, experienced users

Platform crutches:

• Forearm rests on horizontal platform
• Minimizes wrist and hand stress
• Best for: arthritis, wrist/hand injuries, weakness

Proper Fitting: Axillary Crutches

Height adjustment:

1. Stand upright with shoes on
2. Position crutch tip 4-6 inches to side and 4-6 inches in front of foot
3. Top of crutch should be 1-2 inches (about 2 finger-widths) below armpit
4. Never rest body weight on armpit—this causes nerve damage

Hand grip position:

1. With arms at sides, hand grip should align with wrist crease
2. Elbows should bend 20-30 degrees when gripping handles
3. Weight transfers through hands, not armpits

Proper Fitting: Forearm Crutches

Cuff position:

1. Cuff sits 1-1.5 inches below elbow when arm is straight
2. Should be snug but allow forearm movement

Handle height:

1. Same as axillary: elbow bent 20-30 degrees when gripping
2. Wrist should be in neutral position

Walking Techniques

Three-point gait (NWB):

1. Move both crutches forward together
2. Swing affected leg forward (foot doesn't touch or barely touches)
3. Push through hands, bring unaffected leg through
4. Repeat

Two-point gait (PWB/WBAT):

1. Move left crutch and right leg together
2. Move right crutch and left leg together
3. Creates natural walking rhythm
4. More advanced, requires better balance

Swing-through gait:

1. Move both crutches forward
2. Swing both legs through (past crutches)
3. Fast but requires significant strength and coordination
4. Used by experienced users, especially with bilateral involvement

Stairs with Crutches

Going up: "Up with the good"

1. Good leg steps up first
2. Bring crutches and affected leg up together
3. Use railing when available (one crutch under opposite arm)

Going down: "Down with the bad"

1. Crutches and affected leg go down first
2. Good leg follows
3. Take one step at a time

Common Crutch Mistakes

Resting on armpits: Causes "crutch palsy"—nerve damage leading to weakness and numbness. Weight goes through hands only.

Crutches too tall: Forces shoulders up, causes neck and shoulder pain.

Crutches too short: Requires leaning forward, causes back pain and instability.

Looking down: Compromises balance. Look forward while walking.

Worn crutch tips: Slippery and dangerous. Replace when worn smooth.

Canes

Types of Canes

Single-point cane:

• Standard cane with single tip
• Lightest and most common
• Best for: mild balance issues, minor offloading, confidence

Quad cane (small base):

• Four small tips in rectangular pattern
• More stability than single-point
• Best for: moderate balance deficits, hemiplegia

Quad cane (large base):

• Wider four-tip base
• Maximum stability but bulkier
• Best for: significant balance issues, stroke recovery
• Can stand independently

Offset cane:

• Handle offset over shaft
• Better weight distribution
• Best for: arthritic hands, comfort

Forearm cane (cane crutch):

• Forearm support added to cane
• More support than standard cane
• Best for: need more support than cane, less than crutches

Proper Fitting

Height adjustment:

1. Stand upright with shoes on
2. Arm relaxed at side
3. Top of cane should align with wrist crease
4. Elbow bends 20-30 degrees when gripping handle
5. Cane tip sits 6 inches to side of foot

Testing fit:

• Shoulder should not hike up when using cane
• No excessive leaning to either side
• Comfortable reach without overextension

Which Side?

General rule: Cane goes in the hand OPPOSITE the affected leg.

Why: When you step with the affected leg, the cane provides support on the opposite side, mimicking natural arm swing and distributing forces across the pelvis.

Exception: Some neurological conditions or specific instructions may differ. Follow your therapist's guidance.

Walking Technique

Basic pattern:

1. Move cane and affected leg forward together
2. Push down on cane while stepping onto affected leg
3. Bring unaffected leg forward
4. Repeat

On stairs:

Going up: Good leg first, then cane and affected leg together. ("Up with the good")

Going down: Cane and affected leg first, then good leg. ("Down with the bad")

Common Cane Mistakes

Wrong side: Using cane on same side as affected leg. Always opposite side.

Cane too long: Causes shoulder hiking and inefficient gait.

Cane too short: Causes leaning and back strain.

Moving cane ahead of feet: Creates instability. Cane and affected leg move together.

Gripping too hard: Causes hand fatigue. Relaxed but secure grip.

Walkers

Types of Walkers

Standard walker (pick-up walker):

• Four legs, no wheels
• Must be lifted to advance
• Maximum stability
• Best for: significant balance issues, non-weight bearing, very cautious patients

Two-wheel walker (front-wheeled):

• Wheels on front legs only
• Glides forward, back legs provide braking
• Good balance of mobility and stability
• Best for: patients who can't lift standard walker, moderate balance issues

Four-wheel walker (rollator):

• All wheels with hand brakes
• Often includes seat and basket
• Fastest and most functional
• Best for: endurance issues, community mobility, patients with adequate balance

Knee walker (knee scooter):

• Platform for affected leg, handlebar steering
• Wheels for mobility
• Best for: foot/ankle injuries that prevent weight bearing, younger active patients

Proper Fitting: Standard and Two-Wheel Walkers

Height adjustment:

1. Stand inside walker with normal posture
2. Hands on grips, arms relaxed
3. Elbows should bend 20-30 degrees
4. Walker top should align with wrist crease when arms at sides

Width:

• Should fit through doorways in your home (standard 24" width fits most)
• Enough room to stand comfortably inside frame

Proper Fitting: Rollators

Handle height:

• Same 20-30 degree elbow bend principle
• Most rollators have wide adjustment range

Brake reach:

• Should easily reach brakes while gripping handles
• Test squeeze—adequate strength to stop effectively?

Seat height (if applicable):

• When sitting, feet should rest flat on floor
• Knees at approximately 90 degrees

Walking Techniques

Standard walker:

1. Lift walker, place all four legs down 6-12 inches ahead
2. Step affected leg into walker
3. Step unaffected leg into walker
4. Repeat—don't try to walk past the walker

Two-wheel walker:

1. Push walker forward (back legs slide)
2. Step affected leg forward
3. Step unaffected leg forward
4. Keep back legs in contact with ground for stability

Rollator:

1. Push forward with controlled speed
2. Walk with natural gait pattern
3. Use brakes when stopping, sitting, or on slopes
4. Never sit without locking brakes first

Stairs with Walkers

Standard/two-wheel walkers: Generally not safe for stairs. Use railing plus cane or crutch for stairs, walker for flat surfaces only.

Rollators: Not designed for stairs. Park rollator, use railing for stairs.

Alternative: Stair-specific solutions (chairlifts, platform lifts) for regular stair navigation.

Common Walker Mistakes

Walking ahead of walker: Stepping past the walker causes falls. Stay inside the frame.

Not using brakes (rollators): Always engage brakes before sitting or standing.

Walker too low: Causes forward lean and back strain.

Walker too high: Arms reach up, reducing control.

Lifting walker too high (standard): Wastes energy, creates instability. Small advances only.

Progressing Through Walking Aids

Typical Progression

Post-surgical/injury typical path:

1. Walker or crutches (NWB/TTWB phase)
2. Crutches with partial weight bearing
3. Single crutch or cane (WBAT phase)
4. No device (full weight bearing with good balance)

Timeline varies by:

• Surgery/injury type
• Healing rate
• Balance and strength
• Surgeon/therapist guidance

When to Progress

Progress to less supportive device when:

• Weight-bearing restrictions allow
• Pain is controlled during ambulation
• Balance is adequate for next level
• Confidence is sufficient
• Therapist/surgeon approves

Don't rush: Using a walking aid longer than necessary is preferable to falling.

When to Step Back

Return to more supportive device if:

• New pain or increased pain
• Balance concerns arise
• Fatigue affects safety
• Swelling or other symptoms return
• Fear of falling increases

Safety Tips

General Safety

1. Remove throw rugs and loose cords from walkways
2. Good lighting especially at night (nightlights in hallways)
3. Non-slip surfaces in bathroom (grab bars, bath mat)
4. Clear pathways before moving—know your route
5. Wear supportive shoes (no flip-flops or slippery socks)
6. Keep one hand free when possible (backpack vs. handbag)

Wet and Slippery Surfaces

• Slow down significantly
• Take smaller steps
• Consider rubber tip covers for crutches/canes
• Walker wheels may slide on wet surfaces
• Avoid freshly mopped floors when possible

Outdoor Use

• Watch for uneven surfaces, curbs, cracks
• Avoid grass when possible (stability issues)
• Extra caution on slopes
• Ice and snow require extreme caution or avoidance
• Consider ice tips for crutches in winter

Getting Up After a Fall

1. Assess for injury before moving
2. Roll to hands and knees if able
3. Crawl to sturdy furniture
4. Place hands on furniture, bring one leg up (foot flat)
5. Push up to standing
6. Rest before resuming walking

Practice this when not fallen: Know the technique before you need it.

Special Situations

Pregnancy

• Balance changes as pregnancy progresses
• Joint laxity affects stability
• May need walker even for conditions that typically use crutches
• Extra caution on stairs
• Plan for postpartum when infant care adds complexity

Obesity

• Weight limits on standard equipment (check specifications)
• Bariatric walking aids available
• May require more supportive device than typical
• Energy expenditure higher—more rest breaks needed

Arthritis

• Hand arthritis: Consider platform crutches, ergonomic cane handles
• Lower extremity arthritis: May need ongoing walking aid
• Fatigue considerations: Rollator with seat helpful

Neurological Conditions

• Stroke: Often quad cane on stronger side (may differ from typical)
• Parkinson's: Rolling walker may worsen festination; consider standard walker
• MS: Fatigue requires planning; rollator seat helpful
• Follow neurological specialist recommendations

Acquiring Walking Aids

Sources

Medical supply stores: Largest selection, professional fitting, typically higher cost.

Pharmacies: Limited selection, basic options, convenient.

Online retailers: Wide selection, variable quality, no fitting assistance.

Healthcare providers: May provide or loan, especially post-surgery.

Insurance/Medicare: May cover with prescription; check coverage.

Thrift stores/used: Lower cost but ensure safety (check for damage, proper tips).

What to Spend

Budget options:

• Basic cane: $15-30
• Basic crutches: $25-50
• Basic walker: $40-80

Quality options:

• Ergonomic cane: $30-80
• Forearm crutches: $50-150
• Four-wheel rollator: $100-300+

Consider: Daily use devices deserve investment in quality and proper fitting.

Maintenance

Crutches and Canes

• Check tips regularly: Replace when worn smooth
• Inspect adjustment mechanisms: Should lock securely
• Clean hand grips: Wash with mild soap
• Check for cracks or damage: Don't use damaged equipment

Walkers

• Wheel function: Should roll smoothly
• Brake function (rollators): Must stop completely when engaged
• Height locks: Should hold position securely
• Frame integrity: Check for cracks, bent components

When to Replace

• Rubber tips worn flat/smooth
• Adjustment mechanisms don't lock
• Visible cracks or damage
• Brakes don't function properly
• Significant wear affecting function

Conclusion

Walking aids are tools for maintaining mobility and safety—not signs of weakness. Proper selection, fitting, and technique make the difference between an aid that helps healing and one that causes problems.

Take time to learn proper use. Work with physical therapists for instruction. Don't rush progression. The goal is safe, confident mobility that supports your recovery and independence.

Whether you need a cane for a few weeks or a walker for the long term, understanding your walking aid empowers you to use it effectively and safely.