Walking Aids

Using a cane correctly will help to improve balance by widening the base of support and by providing additional sensory input. The usual base of support is the area under and between the two feet. This area of support is enlarged with the use of a cane. A cane can also reduce the amount of weight that must be borne by the legs, which can be important in people with arthritis or weakness of the legs. There is good evidence to support the use of a cane in elderly people with decreased vision, peripheral nerve problems, previous stroke, as well as those who have had surgery for a hip fracture. Some patients may be reluctant to start using a cane, as they fear it makes them look frail. Consistent encouragement and emphasizing that using the cane will allow them to walk farther and more safely can usually overcome this hurdle.

Single point wooden canes, while relatively inexpensive, must be carefully fitted to the correct size relative to the patient’s height and arm length. Lighter weight aluminum canes can easily be adjusted for proper height. The length of the cane should ideally result in between twenty and thirty degrees of elbow flexion. This can be achieved by measuring from the floor to the wrist crease, with the arm hanging loosely at the patient’s side. The cane should be held in the hand opposite to the impaired (weak or painful) leg, and moved forward with the impaired leg. By doing this, the amount of weight bearing experienced by that leg is reduced proportionate to the amount of weight put through the cane.

Canes should always be fitted with rubber tips, to prevent slipping. The standard cane has a smooth, curved handle. A built-up molded handle is used in people with impaired hand function, for example in severe arthritis. Multiple point canes, such as quadruped canes (commonly called quad canes), provide a greater base of support and thus even greater stability, and can stand by themselves. They are often prescribed in stroke patients. However, they are cumbersome and difficult to use on uneven surfaces or by people who move relatively quickly, as all four feet must be on the ground at the same time else the increased base of support is lost and the extra feet may get entangled in furniture. A straight cane has the advantage of being maneuverable in tight quarters.