Choosing The Best Assistive Device: Walker, Cane, Or Crutches? Exploring your Options

I see it all the time – patients hobble into my clinic, struggling to walk because they’re using the wrong assistive device. Many of my elderly patients need an assistive device but are afraid to use one because they fear they’ll get dependent on it. Let’s go through a few devices and discuss why they are or are not appropriate.

Crutches are appropriate if you have good balance, and are decreasing load through one of your legs.

Following a surgery or injury to the hip/knee/foot, someone may need to be non-weight bearing through their lower extremity. If you have decent balance, this is appropriate for you. Most people in their 50s and lower do well with crutches. If you are only using one crutch, use it on the OPPOSITE side of your injury. This is because having the crutch on the same side as your injury will make you lean on your injured side even more.

A cane is an assistive device that is not meant for support.

Yes, you read that correctly. A cane is not a supportive assistive device – even if it is a quad cane (has four prongs on the bottom so it stands up on its own). I actually dislike quad canes because they’re really heavy, don’t really help with mobility, and are honestly really sketchy when people use them. The reason this type of cane has four prongs is so that someone can leave it standing upright, NOT so a person can lean on it more.

To understand the purpose of a cane let me first tell you this: When we walk, our feet give information to our brain about our environment. We can feel if we are on a hill, if the ground is unstable, and how squishy our walking surface is. The purpose of a cane is to enhance this signal – it’s just another point of contact with the ground. If you’re feeling a little off balance or unsteady, the light touch of a cane on the ground can help.

If you’re struggling with this concept, try this: Balance on one foot with your eyes closed, and put one finger on the wall. Feel nice and balanced? Great. Now take your finger off the wall and keep balancing with your eyes closed. Feels a lot harder, right? That’s because light touch gives our body a LOT of information. This is what a cane gives us.

A cane is NOT meant to lean on, or to reduce weight through one of your limbs. I often see the elderly using a four-point cane and leaning heavily on it. This person should not be using a cane. Their “cane” is actually slowing them down and putting them at an increased fall risk. The assistive device this person really needs is a walker.

A walker is helpful if crutches are too difficult to balance on.

For those who either struggle with crutches (think: 60+ year old with knee/hip/foot surgery) or have very poor balance, a walker is very helpful. I’ve seen people of all ages use this: usually it’s either the very young – like a child younger than 7 who struggles to use crutches – or someone over 60 years old. I have to say, this tends to be the most underutilized assistive device because most people don’t want to have to use a walker.

The thing is, just because you start to use a walker doesn’t mean you’ll have to use it forever. Also, some people may benefit from using it forever but it’s not because using a walker makes someone reliant or weaker in any way. What does a walker actually make people? SAFER. It makes them safer.

Now, there are walkers with either 4 wheels or 2 wheels in the front only. Which one should you choose?

I suggest the four-wheeled walker when you are not injured, but feel you need a little extra support when moving around. These models have hand breaks and often have a little seat on the front (please check with the manufacturer if it is actually safe to sit on this, because many are not).

I suggest a two-wheeled walker when:

1. You are injured or had a surgery to your lower extremity
2. There are severe balance issues – a four-wheeled walker will be too unstable in this situation

A couple of quick notes:

1. Sometimes the back of the two-wheeled walker can scratch the ground. This is the reason many people place tennis balls on the back.
2. You cannot use a walker (either type) on the stairs. You will either need someone to carry the walker up and down the stairs for you or have two walkers, one for each floor of the home.

Whether you are reading this for yourself or for a loved one, I hope this information helps you make the best decision for your needs. You can always reach out to your healthcare provider or a physical therapist if you are unsure. Assistive devices can feel very intimidating – you don’t have to navigate this alone.