Canes

Original Editor - The Open Physio project.

Top Contributors - Abbey Wright, Naomi O'Reilly and Kim Jackson

Introduction[edit | edit source]

Walking stick 3.jpeg

Walking sticks are designed to:

  • provide balance support in standing and walking[1][2]
  • take some pressure off one or both legs
  • improve feeling of safety and security when walking[3]

There are lots to choose from, from wood and metal right up to state-of-the-art carbon fibre. 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 stick[4].

A range of handle 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.

Four-point sticks (also known as quad sticks) provide a wider base of support than the more common single point walking stick, however, they can also create a potential tripping hazard due to their increased side width[5].

Walking sticks are used widely reduce pain and improve stability and balance. However, they are frequently used incorrectly and can be dangerous if not properly maintained. It is important to educate patients on how to obtain greatest benefit from their walking stick and of the necessity to check it regularly for defects to ensure safe usage[6].

Handgrips[edit | edit source]

Type of hand grip Benefit
T- handle good grip and control
Crook handle useful for hanging up the stick
Swan neck handle Makes the stick feel more balanced
Ergonomic/fisher stick handle Fits your hand closely, good for stiff or painful hands

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 in prescribing one.[7] The type used is dependent on the type of gait disturbance.

Gait disturbances categories[8]:   

  • Balance (including sensory and cerebellar systems),
  • Motor (including cerebral initiation of walking and muscular strength)
  • Joint or skeletal problems (eg OA)

Single Point Walking Stick (SPS)[edit | edit source]

Walking stick 2 .jpeg

Standard canes[edit | edit source]

This can also be called a straight cane and it is generally made of wood or aluminium. They are lightweight and inexpensive.

The length of the wooden standard canes must be custom fitted to the specific patient while the aluminium standard cane have pins for length adjustment so there is no need for custom fitting.

These standard canes are useful for patients that need just an additional point of contact with the floor for balance with little or no weight bearing needed, therefore, increasing the base of support.

This cane can be used for patients with mild sensory or coordination problems found in visual, auditory, vestibular, peripheral proprioceptive, or central cerebellar disease.

Offset canes[edit | edit source]

These canes are usually made from aluminium and the lengths are also adjustable with no need for custom fittings. These canes allow for the patient's weight to be displaced over the shaft of the cane. This cane provides more stability and can be used for occasional weight bearing.

The type of patients in need of this cane are those with painful gait disorders like that of mild to moderate antalgic gait gotten from hip or knee osteoarthritis.

Multiple-legged canes[edit | edit source]

Quad stick.jpeg

Quadruped (quad) cane[edit | edit source]

This is a four-legged cane usually made of aluminium.

This cane permits more weight bearing, increases base of support and provides more stability for the patient. It can also stand by itself freeing the patient to use his or her hands.

A disadvantage is that all four legs of the cane must be in contact with the floor during gait to provide stability which hinders fast gait.

It can be prescribed for hemiplegic patients or patients with moderate to severe antalgic gait from osteoarthritis.

Hemi walker[edit | edit source]

This is also known as a walk cane[9]. It is made of aluminium and has a vertical component with a handle and two legs, and another component with two additional legs angled away from the patient.

This cane provides more broad based support than the other canes. It is used by patients requiring continuous weight bearing through one upper extremity like stroke patients with hemiparesis who have moderate to severe lower extremity disability.

[10]

Measuring Canes[edit | edit source]

To measure the height of any walking stick, the base of the stick should be placed approximately 15cm from the outside of the foot and the handle height should be set at the wrist crease height. The elbow should be bent slightly (generally between 15 and 30 degrees) when holding the stick and standing upright.

  • Put on the user's walking shoes.
  • Have the user stand naturally upright as much as possible.
  • Have their arms fall to the sides naturally with a normal relaxed bend at the elbow.
  • Using a tape measure, measure the distance from their wrist joint (bottom crease at the wrist) down to the floor. Round up to the nearest half cm[5].
  • Adjust the stick according to the measurement

How to use a Cane[edit | edit source]

Gait[edit | edit source]

Walking sticks are usually used on the unaffected/strongest side of the body (the “good leg”) but this may depend on individual preference and abilities. The stick should be placed forward at the same time as the affected leg and then the unaffected leg follows.

  • If using two sticks at the same time, a four-point gait may be used by bringing one stick forward, then the opposite leg, then the other stick, followed by the other opposite leg.
  • Four point sticks with an offset base should be positioned so that the straight side of the base is nearest to the body. All points of the stick should maintain contact with the ground when the stick is placed down.

Stairs[edit | edit source]

To negotiate going up steps and stairs, lift the unaffected leg up first, then the stick and the affected leg onto the same step. To travel down, the stick and the affected leg should be lowered first, then the unaffected leg down to the same step[5].

Sit to stand[edit | edit source]

From Sitting to Standing:[11]

  1. Position the cane on the unaffected side of the patient.
  2.  Advise the patient to move to the edge of the seat, hold the cane handle and bear weight on the unaffected leg and cane to come up to the standing position.
  3. Make sure the height of the cane is appropriate (level of greater trochanter), ensure elbow flexion is 20° to 30° and that the cane is 2” in front of the affected leg and 6” to the side of the affected leg.


Standing to Sitting

  1. Instruct the patient to approach the chair (or bed), and turn in small circles toward the stronger side till the back is facing the chair or bed.
  2. Assist the patient to back up to the chair until the chair can be felt against the back of the patient’s legs.
  3. Instruct the patient to reach for one arm rest at a time.
  4. The patient lowers to the chair in a controlled manner[11]
[12]

Safety tips[edit | edit source]

Inspect 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 cane is at proper height to avoid imbalance and bad postures[13]

Conclusion[edit | edit source]

Walking stick.jpeg

Many people have disabilities that require an ambulatory assistive device in order to ambulate independently. Some people are prone to 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, and risk of musculoskeletal injuries or adaptations due to bad posture from incorrect way of using or holding the assistive devices.

Many of the pharmacies and stores selling these equipment do not have health professionals that are equipped with the knowledge to choose the appropriate device, fit them properly and specifically to the patient. One study has shown that pharmacists do not feel equipped with the knowledge to fit a device for a patient[13].

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 aid in ensuring that people 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. 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)
  4. Home instead Walking sticks Available from:https://homeinstead.com.au/news/how-to-choose-and-use-a-walking-stick/ (accessed 9.4.2021)
  5. 5.0 5.1 5.2 Life mobility Walking sticks Available from:https://www.lifemobility.com.au/how-choose-walking-stick (accessed 9.4.2021)
  6. 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.
  7. 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.
  8. Robert Lam. Choosing the correct walking aid for patients. Can Fam Physician 2007;53(12):2115–2116
  9. 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.
  10. physicaltherapyvideo. Walking Canes: How to choose, measure and use. Available from: http://www.youtube.com/watch?v=8nvPeXIglI8
  11. 11.0 11.1 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.
  12. CAREGIVERSTRAINING. How to use a cane. Available from: http://www.youtube.com/watch?v=fRn8ZZJMzno
  13. 13.0 13.1 Sadowski CA, Jones CA. Ambulatory assistive devices: how to appropriately measure and safely use canes, crutches and walkers. Pharmacy Practice. 2014;1:24-31.