Pediatric orthopedic crutch walking

What can I expect when a provider prescribes the use of crutches for my child?

Your child’s therapeutic treatment and recovery for injuries or conditions affecting her musculoskeletal system (e.g., fractures, dysplasia, developmental dislocation of the hip, Legg-Calves-Perthes Disease, etc.) begins when the physician prescribes the use of crutches, which provide the necessary support during the healing process. Physicians like to see a patient moving about as soon as possible after an injury or surgery. A crutch is a mobility aid designed to transfer weight from the lower body to the upper body. It is used for those who cannot use one or both legs to support their weight.

Your child will first be fitted for crutches.

Proper measurement of crutches requires that:

• the top of the crutches should be about two finger widths below the armpit.
• the hand piece should be level with the wrists when arms are hanging straight down.

Your child will then receive training on how to move about with crutches, as proper use of crutches doesn’t always come easily to children. Children’s Health staff will train your child on how best to move around with these therapeutic aids. Also, our medical professionals will educate you, as a parent, on how to make your child’s crutch walking experience more positive and, in turn, provide him with the best possible treatment outcome.

Instructions for children will include how to:

• Hold the top part of the crutch firmly between the chest and the inside of the upper arm
• Prevent the top part of the crutch from pushing into the armpit, as constant pressure could damage nerves and blood vessels
• Support weight with hands on the padded hand rests
• Safely stand, walk, sit down, rise from a sitting position and go up and down stairs
• Best position, move and distribute weight upon the “bad” leg and the “good” leg

Both child and parent will be educated about risks and precautions involving:

• Slick or wet surfaces (e.g., in the kitchen or bathroom, or any environment -- indoor or outdoor -- where water is present)
• Throw rugs (they should be removed from the environment.)
• Furniture (never use items as support; they may slide or fall.)
• Clutter (keep passageways clear.)
• Footwear (sneakers are the best; never wear shoes with heels or leather soles.)
• Traversing ramps and slopes
• Falls
• Maintaining integrity of the crutch structure (don’t modify them in any way.)

Parents will also learn helpful hints:

• A bedside toilet may be used.
• Ask teachers in school to let your child out of class a little early to avoid crowds on the stairs and in hallways.
• Provide the child with a backpack to carry schoolbooks and lunch.

If you find that your child has trouble using crutches after several practice sessions, a physical therapist in the Children’s Health’s Rehabilitative Services Department will provide additional help.

We see to it that your child receives the most advanced and comprehensive care. Children’s Health Orthopedic Department treats children for a variety of orthopedic problems including Fractures in children, dysplasia, developmental dislocation of the hip and musculoskeletal infections, among others. We treat more children with bone fractures than any other medical center in the Dallas/Fort Worth region.

It’s critical that you find a health care center that has a comprehensive focus on orthopedics. Team members are experienced in complex surgeries and therapies. Our physicians are also faculty members of the orthopedic department at UT Southwestern, where they have access to and participate in research instrumental in developing treatments, therapies and greater understanding of pediatric conditions. At Children’s Health, your child will receive the most current and effective orthopedic treatments available.

What are the different types of crutches?

Following a diagnosis of your child’s condition, the physician will decide on the proper crutch to use. There are several different types of crutches, and their use typically depends on how the patient needs to bear his weight based on his physical condition.

Crutch types based on weight-bearing status include:

• Non-weight bearing (NWB) - which keeps the “bad” leg off the ground at all times
• Touchdown weight-bearing (TDWB) - where the foot of the “bad” leg may set on the ground but without weight placed upon it
• Partial weight-bearing (PWB) - where a small amount of weight can be placed on the foot of the “bad” leg (typically about 30 pounds)
• Weight-bearing as tolerated (WBAT) - where a patient can put as much weight on the “bad” leg as is comfortable; it all depends on him