Canes


Introduction[edit | edit source]

Walking stick 3.jpeg

Canes or walking sticks are designed to:


There are lots of canes for users to choose from. There are wood and metal canes, as well as state-of-the-art carbon fibre canes. They can be traditional or come in a range of modern colours and patterns. There are some sticks that fold up to fit in a carrying case or handbag and some are adjustable to make it easier to get the correct length.[7]

Other aspects, such as the handle, can also be customized for the individual user. A range of styles are available including t-shaped, offset, crook, swan neck and ergonomic (or arthritic) handles, which are designed to provide additional support under the palm.[3]

For those needing more support, four-point canes (also known as quad canes) provide a wider base, and can act as an intermediary between the single point cane and the walker. However, quad canes may not be appropriate for all as the user must have the ability to ensure, and a gait pattern that allows, all four points of the cane to be in contact with the ground while weight is put through the cane. If this is not possible, this type of cane may pose a safety risk.[3]

As with any assistive device, it is important to ensure that a patient is using it properly. Even for something as simple as a cane, proper gait should be practiced in the clinic, and education should be provided regarding points of safety and concerns regarding negotiation of certain riskier areas such as stairs. Canes are very commonly used incorrectly, and as such, practitioners should always take the time to address these particular aspects.[8]

Handgrips[edit | edit source]

A wide variety of handgrips are available, each with characteristics that may be beneficial to a given patient.

Type of Hand Grip Benefit[9]
Anatomical Handle Stable and comfortable; force through handle kept directly over shaft
Crook Handle Allows for fluid movement of cane; typically one piece construction offering great strength
Derby Handle Stable; similar to anatomical handle; often separate from shaft allowing customizability
Fritz Handle Flatter handle intended to be more comfortable for those with arthritis of the hand
Contour Handle Handle is contoured to the hand of the user offering stability and greater ease of holding
Palm Grip / Fisher Wide flat handle that offers greater comfort for those with pain or arthritis of the hand

Types of Canes[edit | edit source]

A detailed understanding of the different types of ambulatory assistive devices and their types, modifications, fitting, stability and indications is essential when prescribing a cane.[10] The type of cane that is best for a patient is often dependent upon the specific gait characteristics they present with. That being said, it is important to understand that no one type of cane is "best" for improving mobility and preventing falls, the best cane is one that is chosen specifically for the individual. [10]

Three major varieties of canes are available and offer a range of support.[11]

  • Standard cane
  • Offset cane
  • Quadriped cane

Single Point Canes[edit | edit source]

Of the three types of canes, two types are considered "single point" canes; the standard cane and the offset cane. Additionally, single point canes provide the least amount of stability, but are also the least restrictive assistive device.[11]

Standard Canes[edit | edit source]

Walking stick 2 .jpeg

Standard canes (also known as straight canes) are generally made of wood or aluminium. They are lightweight and inexpensive. The shaft of a standard cane is typically straight, meaning that depending on the type of handle, the force applied by the user may not be positioned directly over the tip. This, in turn, causes the line of force from the body to be at a very slight angle compared with the cane's shaft, reducing the overall stability of the standard cane.

Wooden standard canes can be fitted to the user by permanently removing length from the tip, while aluminium standard canes are often adjustable, utilizing a pin or ring system to allow the height to be easily changed without permanent modification.

Standard canes are useful for patients who need just an additional point of contact with the floor for balance, have minor lower extremity weakness, or who need a small amount of weight bearing reduction. This being said, standard canes provide only limited support.[11][12]

Offset Canes[edit | edit source]

Offset canes are usually made from aluminium. Their length is adjustable, so there is no need for custom fittings. The major advantage of the offset cane is a bend that allows the handle to be placed directly over the main shaft of the cane. By doing so, a straight line of force can be created through the cane that is positioned directly over its tip, thus creating greater stability.[11][12]

Individuals who would benefit from an offset cane are those who need slightly more stability than a standard cane or require an intermediate amount of weight bearing reduction. This may include those who have a diagnosis of hip or knee osteoarthritis, which creates a mild to moderate antalgic gait pattern.[3][11]

Multiple-Legged Canes[edit | edit source]

Quadruped (Quad) Cane[edit | edit source]

Quad stick.jpeg

Quadruped canes can have a structure similar to either a standard or offset cane, but their defining feature is their enlarged base that features not one, but four tips. This four legged design creates a larger contact area with the ground, allowing the quad cane to provide greater stability than a single point cane. [3][12]

Quad canes also permit greater weight bearing, as well as an increased base of support for the user. Their self-supporting design can also make them easier to manage, especially for those with limited use of the hand or upper extremity on one side.[12]

One disadvantage is that all four legs of a quad cane must be in contact with the floor during use in order to provide proper stability. From a practical standpoint, this can greatly limit gait speed, but it can also create a major safety concern for those who cannot, or inadvertently do not, use the cane correctly.[3] [11]

Quad canes can be prescribed for patients with hemiplegia, or those with a moderate to severe antalgic gait from osteoarthritis.[11]

Hemi Walker / Walk Cane[edit | edit source]

Hemi walkers are a unique type of walker that is intended for us by individuals who have weakness or loss of function on ONE side of the body. The traditional instance for hemi walker use is with patient's who have hemiplegia post stroke. Hemi walkers can also be considered a type of quadruped or mulit-leged cane with an extra wide base of support, hence the name walk cane. [12][13]

Hemi walkers provide a much broader base of support than even a quadruped cane. They are also uniquely designed to allow patients with weakness or loss of function of one upper extremity to maintain continuous weight bearing in a safe a stably manor.[13]

Measuring/Fitting Canes[edit | edit source]

To measure the height of any cane the following procedure should be used:[12]

  1. Have the patient stand upright, with a normal stance, arms at the sides, and shoulders relaxed
  2. The tip of the cane is positioned touching the floor, next to the small toe, OPPOSITE the involved or weaker side
  3. The height of the cane is adjusted so the handle sits at the level of the ulnar styloid process (fold of the wrist) with the arm still at the side

**When fitting a quad cane, be sure to orient it properly - the shorter legs are ALWAYS closer to the body to reduce tripping risk

[14]

How to use a Cane[edit | edit source]

Gait[edit | edit source]

Canes should be used on the unaffected/strongest side of the body, so that support can be provided while the weaker side is bearing weight. The one instance where this does not apply is if there is a specific therapy goal of promoting increased weight bearing on the weaker or affected side. This instance will be initiated and guided by a physical therapist.[12]

Basic gait pattern with a cane:[12]

  • Advance the cane approximately one step length
  • Advance the affected/weaker leg, placing it in line with the cane
  • Shift weight to the cane and affected/weaker leg, and then advance the unaffected/stronger leg
    • Begin with a step-to pattern, advancing the unaffected/stronger leg to a point in line with the cane and other leg
    • Progress to step-through pattern, where the unaffected/stronger leg is advanced past the cane and other leg

Stairs[edit | edit source]

Ascending stairs with a handrail:[12]

  • Grasp the handrail with the hand opposite the cane
  • Raise the unaffected/stronger leg to the next step
  • Step up, bringing the affected/weaker leg and cane up to the step with the other

Descending stairs with a handrail:[12]

  • Grasp the handrail with the hand opposite the cane
  • Place the cane on the next lower step
  • Lower the affected/weaker leg to the same step as the cane
  • Shift weight to the cane, affected/weaker leg, and handrail before bringing the remaining leg down to the lower step

Sit to Stand[edit | edit source]

From sitting to standing:[12][15]

  1. Position the cane on the unaffected side of the user
  2. Ask the user to move to the edge of the seat before
  3. One hand is placed on the armrest/seat and the other holds the cane
  4. Use the hand on the chair and the cane to provide support to come up to the standing position
  5. Make sure the cane is 2 inches in front of the affected leg and 6 inches to the side of the affected leg


Standing to sitting:[12][15]

  1. Instruct the user to approach the chair (or bed), and turn toward the stronger side until the back is facing the chair or bed
  2. Assist the user to back up to the chair until the chair can be felt against the back of their legs
  3. Instruct the user to reach for the armrest, chair seat, or bed with the free hand
  4. The user then lowers themselves into the chair in a controlled manner using the cane and chair/bed surface for support

[16]

Safety Tips[edit | edit source]

Inspect the cane on a regular basis. Make sure the cane has a rubber top for shock absorption and grip to prevent slipping. Always check the cane for worn tips and handles. Always make sure that the cane is at proper height to avoid imbalance and bad posture.[17]

Conclusion[edit | edit source]

Walking stick.jpeg

Many people have disabilities that require an ambulatory assistive device in order to ambulate independently. Some people may "self-treat" as canes are easily accessible and do not require a prescription before being purchased. This increases the risks of falls, especially in elderly patients. There is also a risk of musculoskeletal injuries or postural adaptations if individuals use / hold the assistive device incorrectly.[3][4]

Many of the pharmacies and stores selling canes / assistive devices do not employ health professionals equipped with the knowledge to choose the appropriate device or fit them properly for the user. One study has shown that pharmacists do not feel they have sufficient knowledge to fit a device for a patient.[17]

Ambulatory assistive devices should be sold where appropriate health professionals can advise the buyers on the proper way to use them. Health professionals like pharmacists can be trained in this area as they also sell such in their pharmacies. This would help to ensure that users learn the proper way to ambulate with these assistive devices.

References[edit | edit source]

  1. Haddas R, Villarreal J, Lieberman IH. Kinematic comparison of the use of walking sticks versus a rolling walker during gait in adult degenerative scoliosis patients. Spine deformity. 2020 Aug;8(4):717-23.
  2. Bradley SM, Hernandez CR. Geriatric assistive devices. American family physician. 2011 Aug 15;84(4):405-11.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Arefin, Paroma, et al. A comparison of mobility assistive devices for elderly and patients with lower limb injury: Narrative Review. Int J Aging Health Mov 2.1 (2020): 13-7.
  4. 4.0 4.1 4.2 4.3 Bateni H, Maki BE. Assistive devices for balance and mobility: benefits, demands, and adverse consequences. Arch Phys Med Rehabil. 2005 Jan;86(1):134-45
  5. Prajapati G, Sharmila K. Role of assistive devices in wellbeing of elderly: A review. Indian journal of Gerontology. 2020;34(3):394-402.
  6. Oxford health Walking Sticks Available from:https://www.oxfordhealth.nhs.uk/wp-content/uploads/2014/08/OP-103.15-Safety-information-leaflet-walking-sticks.pdf (accessed 9.4.2021)
  7. Home instead Walking sticks Available from:https://homeinstead.com.au/news/how-to-choose-and-use-a-walking-stick/ (accessed 9.4.2021)
  8. Sheehan NJ, Millicheap P. Talk the walk: the importance of teaching patients how to use their walking stick effectively and safely. Musculoskeletal care. 2008 Sep;6(3):150-4.
  9. Hovallo, O. Art Walking Sticks: Walking cane handle types. Available from: https://artwalkingsticks.com/blogs/blog/walking-cane-handle-types-1 (accessed 6/14/2023).
  10. 10.0 10.1 Faruqui SR, Jaeblon T. Ambulatory assistive devices in orthopaedics: uses and modifications. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2010 Jan 1;18(1):41-50.
  11. 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Sehgal M, Jacobs J, Biggs WS. Mobility Assistive Device Use in Older Adults. Am Fam Physician. 2021; 15;103(12): 737-744.
  12. 12.00 12.01 12.02 12.03 12.04 12.05 12.06 12.07 12.08 12.09 12.10 12.11 Minor MA, Minor SD. Patient Care Skills. 7th Edition. Boston. Pearson, 2010. p.289-419
  13. 13.0 13.1 Van Hook FW, Demonbreun D, Weiss BD. Ambulatory devices for chronic gait disorders in the elderly. American family physician. 2003 Apr 15;67(8):1717-24.
  14. physicaltherapyvideo. Walking Canes: How to choose, measure and use. Available from: http://www.youtube.com/watch?v=8nvPeXIglI8
  15. 15.0 15.1 Visiting Nurse Associations of American (VNAA) 2010-2011 Edition Nursing Procedure Manual (NPM) Rehabilitation Therapy - Ambulation with a cane. Section 26.01. Accessed 31 January 2019.
  16. CAREGIVERSTRAINING. How to use a cane. Available from: http://www.youtube.com/watch?v=fRn8ZZJMzno
  17. 17.0 17.1 Sadowski CA, Jones CA. Ambulatory assistive devices: how to appropriately measure and safely use canes, crutches and walkers. Pharmacy Practice. 2014;1:24-31.