Hi! I was actually wondering if you all could do a really in-depth post specifically on canes versus forearm crutches. I’ve noticed a couple of the recent asks pertain to it, and I think I myself still have one in the queue related to it, but in all of the posts y’all link us too in your answers to those asks, I have found the information is still very sparse and doesn’t directly compare the two in a lot of detail. I would really really love to see a specific dedicated post that breaks down the differences Between them directly, and goes into a lot more detail about what kind of person might prefer a cane and what kind of person might prefer forearm crutches. Differences in conditions, pain levels, fatigue levels, location of issue on their body, other symptoms, examples of disabilities that might more commonly default to one over the other, all that stuff. I’ve looked through basically all your posts on the subject I can find, and still feel like it’s really only scratching the surface, so if there’s a way y’all would be willing to do one big post on this topic specifically, I know at least I would really love it and I think others would as well! Most of the existing posts are a little too broad and surface level, and while I have found them super helpful as a starting point, I would love to see one that zooms in just on these two mobility aids rather than a broad overview of all types of mobility aids being compared like most of the existing resources y’all have. Seriously love what you all do and I would be extremely grateful for this!
Hey anon, just for you:
On Writing Characters Using Canes vs Crutches
[large text: On Writing Characters Using Canes vs Crutches]
This is a writing advice post that doesn't cover every single possibility because that's too impossible to try and do. It's simplified to be coherent for writers who have little to no experience with these sorts of mobility aids, and I encourage anyone who wants to write a character using either of these to treat this post as a small part of a larger research process. This post will contain generalizations for the purpose of me wanting to actually finish it. This is writing advice, not medical information, nor something you should be applying to real life.
Please keep in mind that a lot of the disability examples will only be shown in a single category because otherwise this would be a comical block of text. So yes, I know that a ton of conditions outside the "chronic pain" category also come with chronic pain, but I want this list to be actually easy to look through.
This will compare the cane (singular stick) to crutches (two sticks). Differences between a singular crutch and two canes will be at the end.
Canes
[large text: Canes]
The most primitive mobility aid that's out there. A wrist-height stick with a handle. An incredible invention. You hold it in your hand (at a rather natural angle) and that's mostly it—it's meant to follow a standard (left leg forward, right arm forward) gait and be a support meant for generally milder mobility issues. A cane can take up to 25% of body weight, so like half of what a leg does.
As a TLDR, here's what they could be:
One leg unable to bear the entire weight (but not completely unable)—this could be a result of a problem anywhere from the bottom of the foot all the way to the hip.
Milder balance problems—largely neurological, so either a condition that affects the brain, the spinal cord, or the nerves in the leg. There are also some autoimmune, respiratory, and cardiovascular causes as well, plus a few more.
Back/trunk problems, most commonly pain.
To use a cane you need two legs, most people who use canes for leg reasons will have a “good leg” and a “bad leg”. If this is the case, you'd typically hold the cane on the good leg side, as that redistributes the weight—and pain—between the bad leg and the cane.
The good leg needs to be able to bear the whole weight comfortably, the bad leg needs to be able to bear, at the very least, half of the weight. If the disability affects legs to the point where either:
both have problems weight-bearing;
one can't bear weight at all (e.g., amputation, flaccid paralysis, pain too severe);
then two crutches (or other mobility aid, like a wheelchair) would be the move. The cane doesn't replace an entire leg and is meant to be a minor support.
Examples of what would cause someone to use a cane:
Monoplegia or hemiplegia that is spastic (rigid) in the leg. This could be a result of stroke, traumatic brain injury, cerebral palsy, multiple sclerosis, nerve damage, Brown-Séquard syndrome, polio, encephalitis, transverse myelitis, progressive multifocal leukoencephalopathy, alternating hemiplegia of childhood, hemiplegic migraines, or being a hemispherectomy survivor. And many more things.
Chronic pain; arthritis, hypermobility spectrum disorders, chronic patellar instability, many types of EDS, neuropathy, peripheral artery disease, past injuries (e.g., broken foot that healed incorrectly), systemic lupus erythematosus, joint replacement, chronic bursitis, and a lot more.
Relatively minor fatigue—most fatigue disorders will be on a wide spectrum, and people's symptoms often vary a lot. But a cane could help with fibromyalgia, Charcot Marie Tooth disease, POTS, scoliosis, severe kyphosis/lordosis, COPD (and other respiratory conditions), or milder forms of CFS/ME. Someone undergoing chemotherapy (or taking some other fatigue-causing medication) could also use one.
Muscle conditions, which are an even bigger spectrum. Spinal muscular atrophy type 3 and 4, early Limb-Girdle muscular dystrophy, tibial MD, Becker MD, or early myotonic dystrophy type 2 can all be reasons to use a cane. Keep in mind that these have drastically different presentations from person to person, and it's not entirely unusual for two people with the same kind of muscular dystrophy to use very different mobility aids (e.g., a tilt-in-space powerchair vs ...no aid at all). These are just the ones where I'm aware of a person who 1) has it, 2) uses a cane, even if it's not the most common aid.
Prosthetic leg on one side; usually below knee (high level amputees will more often go for crutches, even if they use a prosthetic).
The second biggest reason why people use a cane is balance. For this the cane can be held in either hand; some people have a preference, generally for the non-dominant hand for convenience—although many people with balance problems will also have a coordination disorder that might make using their non-dominant hand too difficult. Some people will switch the side they hold it on.
For a lot of people with balance problems, a cane might be the aid they use at home, and use a rollator or a wheelchair outside.
A good cane for balance purposes is a quad cane—it has four legs at the bottom and offer more stability than the single point equivalent. However, the larger base might also mean that for some people it can be easier to hit it with their foot, which ranges from annoying to dangerous.
Examples of disabilities that affect balance;
Many of the things included in the first section—primarily those that directly affect the brain or nerves.
Conditions that cause vertigo—again, many of the same things as before because a lot of them tend to originate in the brain. So other than aforementioned meningitis or stroke and the like: Ramsay Hunt syndrome, migraines, basically any sort of brain damage, POTS, Meniere's disease, labyrinthitis.
Respiratory problems, like chronic obstructive pulmonary disease, severe asthma, or lupus.
Coordination disorders—again, a lot of overlap with aforementioned disabilities, so I'll skip to things I haven't mentioned yet. Ataxia could be caused by a lot of things; some include the Chiari malformation, ataxia-telangiectasia, Friedrich's ataxia, Parkinson's, brain tumors, or Niemann-Pick disease. Dystonia is usually a primary condition rather than being caused by other things (although it can be). Dyspraxia is also a coordination disorder generally milder than ataxia, and canes can be potentially helpful for it as well.
As mentioned before, some coordination disorders will affect the upper limbs as well, and it might be too difficult to use a cane. For disabilities like Huntington’s disease, or ataxia that significantly affects the hands, rollators and wheelchairs tend to be more helpful.
Anything that causes the person to fall. Fall risk is the primary reason people use canes.
A cane can also be used for back/trunk issues. One can lift off some weight of the body from above the Problem by putting the weight on the arm instead. I have really severe kyphosis as well as (partial) trunk muscle atrophy/coordination problems and quite literally can't straighten my back for more than a few minutes at most—my cane allows me to do that more easily and without needing to think about it as much.
Examples of some conditions that cause that include;
sciatica;
degenerative disk disease;
past spine injury;
scoliosis or severe kyphosis/lordosis.
In my experience, you need fairly good arm strength to use a cane comfortably. For people with more significant weakness in upper limbs, rollators tend to work better.
Grip strength is also important; there are canes designed to mitigate this (the platform cane/crutch comes to mind) but they're not the most common because often (not always) when someone has this issue they already require a larger mobility aid.
Canes are often a "starting" mobility aid, i.e., a person starts using it at first but later transitions to using something else as their disability progresses (or they realize that it wasn't adequate in the first place, it mostly happens with slowly progressive conditions—when they decide to get a cane, it's often just too late). A cane can be useful at the very start of an onset of amyotrophic lateral sclerosis, but it's basically worthless beyond that.
Similarly (kind of), a cane can be the "smaller" mobility aid for someone who uses multiple of them at the same time. Someone dealing with fatigue could use a cane at home, but need a rollator for going out, or a wheelchair for longer trips. Another person could use a cane when going out with a prosthetic leg on, but use a wheelchair or crutches at home when not wearing the prosthetic.
Crutches
[large text: Crutches]
These are more complex and provide more help. Crutches directly affect your gait depending on the exact disability, and take away both hands. They can potentially take up to 100% of body weight for parts of the walking cycle if you have good upper body strength and balance, and 50% otherwise (so, one good or two half-good legs still required).
Crutches are used for a lot of things (realistically too many to cover here) so I'll just go with the main categories that encompass most of them.
A) Both legs can't fully bear weight;
The same things as in the cane section, but present on both sides rather than one.
Hypotonia; can be caused by thousands of things. Some include Down syndrome, Tay-Sachs syndrome, achondroplasia, being born prematurely, brain damage, and congenital hypothyroidism.
Paraplegia that's low-level and/or incomplete, or quadriplegia that's incomplete. Quadriplegia is a huge spectrum as well, and it will depend on the amount of strength and flexibility that the individual person has in their arms and hands.
Bilateral amputation with prosthetics.
B) One leg can't bear any or a lot of weight;
The same things as in the cane section, they're basically all on a spectrum, so some people choose a cane and others choose crutches.
Unilateral amputation, or congenital limb difference.
Limb length discrepancy where it doesn't touch the ground or barely does so.
C) Significant balance issues;
Same things as for canes, but either more severe or just someone's personal preference.
D) Back/trunk pain;
Same as C).
Additional note based on things I have seen: you can't use crutches if you have no legs and no prosthetics. You can't walk literally just on crutches. You need at least a single leg or prosthetic.
(Yeah I'm aware that there's probably a guy somewhere who does tricks where he does exactly that for a short video. That's Crutches Georg and he should not be counted because 99.9% of crutches users won't be doing that ever.)
Crutches will provide much more stability and relieve more pressure than a cane, but there is a wide range of the amount of support depending on how they are utilized.
What the disability is can actually present itself in the person's gait—there are a few main ones that are associated with crutches;
Four-point. The two legs and two crutches work as four different points of support, and three of them are in contact with the ground at any time. A lot (not all) of people who use it will use crutches full-time and/or not be able to stand without them. The most stable and the slowest out of all of these.
Three-point. Probably the one most people have in mind when thinking crutches. The crutches both move at the same time along with the bad leg, then the good leg follows. This is the "broken leg in a cast" way of walking.
Two-point. The closest to how non-crutch users generally walk. It's like having a cane on each side; left crutch forward, right leg forward. Fairly fast.
Step-to. The crutches work as one point of contact, and the legs as the other - both of each will move forward at the same time. In the step-to, a person puts their feet at the crutches' height. Fairly fast as well.
and step-through. I'd say the most difficult, least stable, providing the least amount of support. The same as in step-to, both crutches go forward before both legs, however here the legs get swung through them while the person is only holding up on crutches. This is the fastest that it gets, and can definitely be faster than an abled person walking. You can run quickly like this.
If you have issues visualizing them, there are a lot of great demonstrations on YouTube that you can look up for clarification.
There are a lot of subtle differences in which one people end up using, but as a rule of thumb, the more balance they lack, the more points of support they need. To provide some examples;
a person with quadriplegic cerebral palsy might lack balance and coordination, so they might use a four-point gait.
A person with one-sided tarsal tunnel syndrome can walk with a three-point gait, as it can be used to mitigate weight-bearing fully or partially—if the pain gets worse, they can just not touch the ground with that leg.
A person with incomplete thoracic spinal cord injury could also work with a three point gait, though they would put both legs on the ground. If someone has good strength in the arms and trunk, they can get both crutches in the front along with one leg, then try to get the second one to go forward as well. This is how a lot of crutch users with a disability affecting two legs, but with decent balance and upper body strength, walk.
A person who had a traumatic brain injury and now experiences balance problems but not as much leg issues could opt for a two-point gait. It does help with weight redistribution, but primarily provides a lot of balance.
Both step-to and step-through are primarily used by single-leg problem havers (like unilateral amputees) in my experience, but I've seen people with diplegia or incomplete low-level spastic paraplegia use it too. You need very good balance and good upper body strength. I've seen dudes do backflips and ride skateboards on crutches like this. You can run as well and be way faster than you think.
The same as canes, crutches require arm strength. The more you're looking to take away from the legs, the more will go to the shoulders. If someone doesn't have the needed arm strength, a rollator will be more helpful. Walkers not so much as they still require some strength to turn.
More Direct Comparisons
[large text: More Direct Comparisons]
The differences between pain and fatigue levels might be somewhat evident from comparing the sections above—to generalize the subject as much as possible: the bigger the pain or the fatigue, the higher possibility of using crutches over a cane is. They provide more relief for both, as well as providing more balance.
Now, there's always exceptions. Someone might not be able to use two sticks, because of a disability affecting one of the arms—hemiplegia is a common example. In this case, the person could prefer to use a single crutch rather than two. They could opt for platform crutches, which don't require as secure of a grip. They might need a rollator instead. They might have a powerchair that they operate with their good arm.
Another thing is that some people will use crutches even if a cane would work just as well. Some people like the grip more, or find them easier to use. They could also like that crutches are seen as more medical than a cane, which could be seen as a fashion accessory. Maybe they can be faster on crutches than with a cane (e.g., if their disability is limited to a single leg, getting it out of the walk cycle might be more convenient) and that matters to them.
And to go with this, some people just don't like crutches. I personally don't like the forearm cuff because I tend to swing my wrist around with my cane rather than hold it perfectly straight, so the cuff seems annoying. For someone else that could be more than a preference, e.g. if they have a limb difference that affects the length of their forearms to be much shorter—a person like this could prefer two canes.
As to what mobility aids are better for which disabilities, it's highly individualized, but to heavily generalize again: canes tend to be more helpful for relatively milder disabilities, and crutches for relatively more significant ones based on the amount of support they provide. But that's an oversimplification so simple that it's not really useful.
Someone with neuropathy in parts of their foot might find a cane completely sufficient, but it wouldn't be as useful for someone with nerve damage that caused flaccid paralysis from the hip down; they would probably prefer crutches. But then again, someone with mild vertigo could use crutches because they prefer them (even if a cane would work just fine) while someone else might have incomplete C6 quadriplegia and use a cane with leg braces over crutches because they enjoy having a free hand.
For more similarities between the two; overuse injuries can happen to both cane and crutch users, generally in the shoulder(s). They're not very common unless you're putting more weight on them than you're supposed to. They're very annoying because it drastically tanks your mobility until they get better (unless you can walk without them just as much that is), but they're treatable with physical therapy.
Now for the two canes and a singular crutch.
Let's start with the fact that the latter is infinitely more popular than the former. It's basically the same as a single cane but more supportive; it's good for people who need more balance than a cane provides but can't use both hands. Two canes is very rare and I can't tell you what the actual pattern of choosing them over other options is outside of personal preference because I have no idea.
The general conclusion of the post is that crutches and canes really aren't that different, and are more of a spectrum of usable sticks by the amount of support they provide to the user. That's why often you'll see canes and crutches listed as the same thing when it comes to "management of XYZ disability" type resources—for a lot of them they're rather similar in practice, especially when compared to rollators, walkers, scooters, or wheelchairs.
I hope this was more in depth and therefore more helpful, if this still leaves you with some unanswered question feel free to reach out again.
mod Sasza
