Crutches should be used by patients who can bear no weight at all on an injured lower extremity. Ideal crutch height is one hand width below the axillae. The grip bar should be adjusted to a height at which the elbows are still mildly flexed while supporting the body weight. The patient should be instructed to bear the pressure of the pads against the sides of the thorax rather than in the axillae, or brachial plexus injury might result (crutch palsy).
Any of several crutch gaits may be prescribed. With a two-point gait, the patient advances the crutches first, and then brings the well leg up to the crutches ("swing-to" gait) or just past the crutches ("swing-through" gait). With a three-point gait, the crutches and the injured extremity are all advanced together, and then the well extremity is advanced to meet them. The three-point gait results in slower forward progression than does the two-point gait, but requires less energy. Partial weight-bearing or no weight-bearing may be prescribed for the injured extremity, regardless of the gait used.
The method for negotiating stairs is similar for the two- and three-point gaits. Ascending stairs, the patient advances the well extremity up to the next step, followed by the crutches and the injured extremity. Descending stairs, the crutches are lowered first.
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