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🛏️ Basic Care & Comfort · Lesson 3 of 6 · 6 min

Canes, Crutches and Walkers: Which Side, Which Leg, Which Step

🩼 'Up with the good, down with the bad.' Every nurse can recite it. Half of them put the cane on the wrong side. The exam asks about both, and about the two-finger gap that keeps crutches from paralyzing an arm.

💡 Key idea

Cane on the strong side, moving with the weak leg. Crutches bear weight on the hands. Stairs: up with the strong leg first, down with the weak leg and crutches first.

🧠 Why it matters

CANE: hold it on the STRONG side, move the cane and the WEAK leg together, then the strong leg; the handle should reach the wrist crease with the elbow slightly bent. CRUTCHES: the pads sit 2 to 3 finger widths below the axilla and the weight is borne on the HANDS, never the armpits, to prevent brachial plexus injury. Common gaits: four-point (both legs bear weight, most stable), three-point (one leg cannot bear weight: both crutches and the affected leg move together), two-point, and swing-through. STAIRS with crutches or a cane: going UP, the strong leg goes first and the crutches follow with the weak leg; going DOWN, the crutches and weak leg go first. WALKER: lift or roll it forward about 6 to 8 inches, then step the weak leg, then the strong leg; elbows bent about 15 to 30 degrees. For all devices, non-skid shoes, clear floors and a gait belt during early training.

🏥 In the real world

🪜 A client with a fractured left ankle is learning stairs with crutches. Up: right (strong) leg first, then crutches and left leg. Down: crutches and left leg first, then right leg. He also complains of tingling fingers after a long walk; the nurse finds the crutches too tall and the client leaning on the pads. Two inches of adjustment prevents a nerve injury.

📌 Takeaways

  • Cane: strong side, moves with the weak leg
  • Crutches: two to three finger widths below the axilla; weight on the hands
  • Up with the good, down with the bad

✅ Test yourself

A client with right-sided weakness after a stroke is learning to use a cane. Which instruction is correct?
  1. Move the cane with the left leg
  2. Keep the cane 12 inches from the body
  3. Hold the cane in the left hand
  4. Hold the cane in the right hand

Answer: C · Hold the cane in the left hand

The cane is held on the strong (left) side and advances together with the weak (right) leg to widen the base of support.

A client reports numbness and tingling in the hands and forearms after using crutches. What is the most likely cause?
  1. The hand grips are too low
  2. Crutches that are too short, forcing a forward lean
  3. Axillary pressure from crutches that are too long
  4. A normal adjustment to crutch use that resolves within a week

Answer: C · Axillary pressure from crutches that are too long

Pressure on the axilla compresses the brachial plexus. The pads should sit two to three finger widths below the armpit with weight on the hands.

How should a client using a walker move?
  1. Move the walker forward, step with the weak leg, then the strong leg
  2. Step forward with the strong leg, then the weak leg, then move the walker
  3. Carry the walker while walking
  4. Lean the full body weight on the walker while stepping

Answer: A · Move the walker forward, step with the weak leg, then the strong leg

Walker first, then the weak leg, then the strong leg, keeping the body inside the frame.

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