Sports Medicine Book

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Canes

Aka: Canes, Standard Cane, Offset Cane, Multi-leg cane, Multiple Leg Cane, Quad Cane, Walk Cane, Hemi-Walker
  1. See Also
    1. Mobility Device
    2. Assistive Technology
    3. Crutches
    4. Walkers
  2. Indication
    1. Gait disturbance
    2. Weight redistribution from painful lower limb
    3. Stability when balance is impaired
  3. Types: Cane (in order of weight bearing support)
    1. Standard Cane (Stright cane)
      1. For balance only (not for weight bearing)
        1. For Ataxia, Vertigo or Decreased Visual Acuity
      2. Materials
        1. Wood (light and inexpensive)
        2. Aluminum (light and adjustable length, higher cost)
    2. Offset Cane (Crook or offset below handle)
      1. Aluminum cane with adjustable length
      2. Distributes patient's weight over cane shaft
      3. Allows for one-handed partial weight bearing
        1. For moderate hip or Knee Osteoarthritis
    3. Multiple Leg Cane (Quadripod cane, Quad Cane)
      1. Cane with 4 legs at base
      2. Indications
        1. Severe hip or Knee Osteoarthritis
        2. Hemiplegia (allows use of hands - not encumbered by always holding cane)
      3. Advantages
        1. Allows for greater weight bearing than Offset Cane
        2. Stands upright even when not being held
      4. Disadvantages
        1. All 4 legs must be in contact with floor
        2. Adjust cane base size for gait speed
          1. Fast paced gait: Smaller cane base
          2. Slow paced gait: Larger cane base
            1. Also needed for greater weight bearing
    4. Walk Cane (Hemi-Walker, one handed, four legged walker)
      1. For severe leg weakness (e.g. post-CVA Hemiparesis)
      2. Allows for greater weight bearing than Quad Cane
      3. Uses only 1 hand (contrast with Standard Walker)
  4. Technique: Cane use
    1. Cane should support 15-20% of patient's body weight
    2. Cane held by hand opposite deficient leg
      1. Weak right leg: Hold cane in left hand
      2. Weak left leg: Hold cane in right hand
    3. Advance cane while advancing deficient leg
      1. Resembles tripod with 3 points in contact with floor
      2. Weak right leg advances with left arm and cane
      3. Weak left leg advances with right arm and cane
  5. Preparation
    1. Fitting
      1. Patient stands upright with arm relaxed at side
      2. Keep elbow flexed at side to 15 to 30 degrees
      3. Cane length
        1. Wrist crease or
        2. Greater trochanter to floor (with shoes)
    2. Handles
      1. Umbrella handle
        1. Typical handle on a Standard Cane
        2. Risk of Carpal Tunnel due to pressure on palm
      2. Shotgun handle
        1. Flat handle similar in shape to a shotgun butt
        2. Distributes pressure across entire hand (not just palm)
        3. Less risk of secondary Carpal Tunnel
      3. Finger and thumb groove handle
        1. Forces use of the correct hand to hold the cane
  6. References
    1. Bradley (2011) Am Fam Physician 84(4): 405-11 [PubMed]
    2. Van Hook (2003) Am Fam Physician 67(8):1717-24 [PubMed]

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