Crutches, Canes, and Walkers on the NCLEX
Crutch gaits, stairs, cane on the strong side, and how to check the fit of each device.
Assistive device questions are geometry: which side, which sequence, which angle.
Crutch fit and safety
2 to 3 finger widths between the axilla and the crutch pad. Elbows flexed about 20 to 30 degrees with hands on the grips. Weight goes through the hands, never the axillae: leaning on the pads compresses the radial nerve (crutch palsy). Rubber tips intact, no wet floors, no loose rugs.
Crutch gaits
Four-point: right crutch → left foot → left crutch → right foot. Slow, maximally stable, needs partial weight on both legs. Two-point: right crutch and left foot together, then the opposite pair. A faster four-point. Three-point: both crutches and the affected leg advance together, then the strong leg. For non-weight-bearing or partial-weight-bearing on one leg. Swing-to and swing-through: both crutches forward, swing the body to or past them; used with paralysis or bilateral involvement.
Stairs: up with the good
Up: strong leg first, then crutches and the affected leg. Down: crutches and the affected leg first, then the strong leg. The strong leg does the lifting on the way up and the controlled lowering on the way down. Same rule with a cane. A rail beats a second crutch when one is available: crutches on one side, hand on the rail.
Canes and walkers
Cane: held on the strong side. Advance the cane together with the weak leg, then the strong leg. Fit: handle at the wrist crease (about the greater trochanter) with the elbow flexed 15 to 30 degrees. Walker: lift or roll the walker a comfortable step ahead, step in with the weaker leg, then the stronger. Never pull up on the walker to stand: push up from the chair arms first. Same elbow flexion check as the cane.
Frequently asked
Why does the cane go on the strong side?
It widens the base of support and shares load with the weak leg during its stance phase, mimicking a normal arm swing.
Patient rests body weight on the crutch pads?
Reteach immediately. Axillary pressure causes radial nerve palsy. Weight belongs on the hands.
Which gait for a non-weight-bearing ankle fracture?
Three-point: both crutches plus the injured leg advance, then the strong leg.
Quick check
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