This document provides instructions for non-weight bearing and partial weight bearing walking using crutches after lower limb fractures. It discusses the importance of early mobility to avoid complications of prolonged bed rest and promote healing. Complications from prolonged bed rest that affect various body systems are described. Detailed instructions are provided for different types of crutch walking including non-weight bearing, touch down weight bearing, and partial weight bearing. Measurements for proper crutch fitting and instructions for using crutches to climb and descend stairs are also outlined.

1. NON AND PARTIAL WEIGHT
BEARING WALKING AFTER
FRACTURES OF LOWER LIMB

2. WHY EARLY MOBILITY OF PATIENT IS
TO BE ENCOURAGED?
- TO AVOID COMPLICATIONS OF PROLONGED
BED REST
- TO PROMOTE HEALING
- TO LESSEN THE NEED FOR HOSPITAL STAY

4. COMPLICATIONS OF PROLONGED BED
REST
EFFECTS ON VARIOUS SYSTEMS
1) MUSCULO SKELETAL
2) CARDIO VASCULAR
3) RESPIRATORY
4) SKIN
5) EXCRETORY
6) METABOLIC
7) PSYCHO SOMATIC

5. MUSCULO SKELETAL SYSTEM
- DISUSE MUSCLE ATROPHY & DECREASED
ENDURANCE OF MUSCLES.
- SOFT TISSUE CHANGES, TIGHTNESS AND
CONTRACTURES.
- DISUSE OSTEOPOROSIS.
- GENERALIZED MUSCLE WEAKNESS.

6. CARDIO VASCULAR
- INCREASED HEART RATE.
- DECREASED CARDIAC RESERVE.
- ORTHOSTATIC HYPOTENSION.
- VENOUS THROMBOEMBOLISM.

7. RESPIRATORY SYSTEM
- DECREASED VENTILATION
- COLLECTION OF SECRETIONS
- ATELECTASIS
- DECREASED AEROBIC FITNESS

8. EXCRETORY SYSTEM
- RETENTION OF URINE
- INFECTIONS
- RISK OF KIDNY AND BLADDER CALCULI
- CONSTIPATION

9. METABOLISM
- LOSS OF APPATITE
- DECREASED LEAN MASS TO BODY WEIGHT
- INCREASED CHANCES OF DEVELOPING
DIABETES

10. SKIN
- PRESSURE SORES

11. PSYCHO SOMATIC
- SLEEP DISTURBANCE
- ANXIETY
- DEPRESSION
- IRRITABILITY
- APATHY
- INCREASED DEPENDANCY ON CARE GIVER

13. MEASUREMENT OF CRUTCHES
• CRUTCH PAD DISTANCE FROM ARMPITS:
THE CRUTCH PADS (TOPS OF CRUTCHES) SHOULD BE 1½"
TO 2" (ABOUT TWO FINGER WIDTHS) BELOW THE
ARMPITS, WITH THE SHOULDERS RELAXED.
• HANDGRIP:
PLACE IT SO THAT THE ELBOW IS SLIGHTLY BENT –
ENOUGH SO ONE CAN FULLY EXTEND THE ELBOW WHEN
TAKING A STEP.
• CRUTCH LENGTH (TOP TO BOTTOM):
THE TOTAL CRUTCH LENGTH SHOULD EQUAL THE
DISTANCE FROM THE ARMPIT TO ABOUT 6" IN FRONT OF
THE SHOE.

15. TYPES OF CRUTCH WALKING
• NWB - NON WEIGHT BEARING
• TDWB (OR) TTWB - TOUCH DOWN WEIGHT
BEARING
(OR) TOE TOUCH WEIGHT
BEARING
• PWB - PARTIAL WEIGHT
BEARING
• WBTT - WEIGHT BEARING TO
(OR) TOLERENCE
• FWB - FULL WEIGHT BEARING

16. NON WEIGHT BEARING WALKING
INSTRUCTIONS
• PLACE NO WEIGHT ON THE AFFECTED LIMB
• DO NOT TOUCH THE GROUND WITH THE
AFFECTED LIMB WHILE STANDING OR
WALKING
• BEAR THE FULL WEIGHT THROUGH THE
NORMAL LIMB AND CRUTCHES WHILE
STANDING AND WALKING

17. TO START WALKING
BALENCED STANDING
(TRIPOD POSISTION)
• USE THIS POSITION WHEN AT START OR END
A GAIT OR WHEN STANDING FOR ANY
LENGTH OF TIME.
• MOVE CRUTCHES TO THE FRONT ABOUT 12
INCHES. FIND THE BALANCE.
• DON'T REST THE ARMPITS ON THE CRUTCH
PADS.
• BEAR WEIGHT THROUGH NORMAL LIMB AND
THE HAND GRIPS OF THE CRUTCHES

18. TRIPOD POSITION

19. NON WEIGHT BEARING
1. STAND ON UNAFFECTED
LEG, LIFT BOTH CRUTCHES
AT THE SAME TIME AND
PLACE THE CRUTCHES
ONE STEP’S LENGTH IN
THE FRONT

20. 2. PUSH DOWN ON THE
HANDGRIPS WITH HANDS
WHILE SQUEEZING THE TOP
OF THE CRUTCHES BETWEEN
THE CHEST AND UPPER
ARMS.
3. PUTTING THE WEIGHT
THROUGH THE HANDGRIPS,
HOP FORWARD WITH THE
UNAFFECTED LEG TO MEET
THE CRUTCHES.
- REPEAT THE ABOVE 3 STEPS.

21. TDWB (OR) TTWB
TOUCH DOWN WEIGHT BEARING (OR)
TOE TOUCH WEIGHT BEARING
WALKING
INSTRUCTION
LIGHTLY TOUCH THE AFFECTED LIMB’S FOOT TO
THE FLOOR, AND LET THE CRUTCHES BEAR MOST
OF THE WEIGHT. IMAGINE AS IF STEPPING ON A
RIPE TOMATO: STEP LIGHTLY, SO IT WON’T BE
SQUASHED.

22. 1. STANDING ON THE UNAFFECTED
LEG, LIFT BOTH CRUTCHES AT
THE SAME TIME AND PLACE THE
CRUTCHES ONE STEP’S LENGTH
IN FRONT
2. BRING THE AFFECTED LEG FORWARD
SO THAT IT IS IN LINE WITH THE
CRUTCHES. ONLY PUT TOES DOWN
ON THE GROUND UP TO A MAXIMUM
OF 4 Kg OF PRESSURE.

23. 3. PUSH DOWN ON THE HANDGRIPS
WITH HANDS WHILE SQUEEZING
THE TOP OF THE CRUTCHES BETWEEN
CHEST AND UPPER ARMS.
4. PUTTING WEIGHT THROUGH THE
HANDGRIPS, HOP FORWARD WITH
UNAFFECTED LEG TO MEET THE
CRUTCHES, OR SLIGHTLY AHEAD
OF THE CRUTCHES, MAKING SURE
THAT ONLY 4 Kg OF PRESSURE IS PUT
THROUGH THE AFFECTED LEG.
- REPEAT THE ABOVE 4 STEPS.

24. PARTIAL WEIGHT BEARING WALKING
INSTRUCTIONS
BEAR SOME WEIGHT ABOUT 50 PER CENT ON
AFFECTED LIMB AS ONEWALKS

25. 1. STANDING ON UNAFFECTED LEG,
LIFT BOTH CRUTCHES AT THE SAME
TIME AND PLACE THE CRUTCHES
ONE STEP’S LENGTH IN FRONT
2. BRING THE AFFECTED LEG FORWARD
SO THAT IT IS IN LINE WITH THE
CRUTCHES. ONLY PUT UP TO 50% OF
BODY WEIGHT ON THIS LEG AS PLACE
IT ON THE GROUND.

26. 3. PUSH DOWN ON THE HANDGRIPS
WITH HANDS WHILE SQUEEZING
THE TOP OF THE CRUTCHES BETWEEN
YOUR CHEST AND UPPER ARMS.
4. PUTTING YOUR WEIGHT THROUGH
THE HANDGRIPS, HOP FORWARD WITH
UNAFFECTED LEG TO MEET THE CRUTCHES,
OR SLIGHTLY AHEAD OF THE CRUTCHES,
MAKING SURE THAT ONLY 50% OF BODY
WEIGHT IS PUT THROUGH THE AFFECTED
LEG.
- REPEAT THE ABOVE STEPS.

27. FULL WEIGHT BEARING WALKING
INSTRUCTION
BEAR MOST OF TH WEIGHT ON AFFECTED LIMB
AS TOLERAED. PLACE ONLY A LITTLE REMAINING
WEIGHT ON CRUTCHES.

28. • STANDING ON BOTH
LEGS WITH CRUTCHES AT
THE SIDE FOR SUPPORT,
LIFT BOTH CRUTCHES AT
THE SAME TIME AND
PLACE THE CRUTCHES
ONE STEP’S LENGTH IN
FRONT
• BRING THE AFFECTED LEG
FORWARD SO THAT IT IS
IN LINE WITH THE
CRUTCHES.

29. • PUSH DOWN ON THE
HANDGRIPS WITH HANDS
WHILE SQUEEZING THE TOP
OF THE CRUTCHES
BETWEEN CHEST AND
UPPER ARMS.
• PUTTING SOME WEIGHT
THROUGH HANDGRIPS
AND AS MUCH WEIGHT AS
ONE CAN THROUGH THE
AFFECTED LEG, STEP
FORWARD WITH
UNAFFECTED LEG.
• REPEAT THE ABOVE STEPS.

30. ASCENDING THE STAIRS
• FACE THE STAIRS HOLDING ONTO
CRUTCHES AND STANDING ON
AFFECTED LEG. ONLY PUT AS MUCH
WEIGHT AS ALLOWED AS PER
ORDERS ON THE AFFECTED LEG. IF
NON WEIGHT-BEARING – ONE CAN
CHOSE TO KEEP KNEE IN BENT
POSITION AS SHOWN IN THE
DIAGRAM IF POSSIBLE.
• PUT PRESSURE THROUGH CRUTCH
HANDGRIPS AS HOP UP WITH YOUR
UNAFFECTED LEG ONTO THE NEXT
STEP.
• THEN BRING AFFECTED LEG AND
CRUTCH UP TO THAT STEP.
• REPEAT THE ABOVE STEPS UNTIL
ONE GETS TO THE TOP OF THE
STAIRS.

31. DESCENDING STAIRS
• STAND AT THE TOP OF THE STAIRS
WITH THE TOES OF UNAFFECTED LEG
CLOSE TO THE EDGE OF THE STEP
AND HOLDING ONTO TWO
CRUTCHES, ONE ON EITHER SIDE.
• PLACE CRUTCHES ONTO THE LOWER
STEP, BRINGING AFFECTED LEG
FORWARD AT THE SAME TIME. ONLY
PUT AFFECTED LEG DOWN ON THE
STEP IF ALLOWED
• PUTTING WEIGHT THROUGH YOUR
CRUTCHES, SLOWLY LOWER
UNAFFECTED LEG ONTO THE LOWER
STEP, REMEMBERING TO ONLY PUT
WEIGHT THROUGH AFFECTED LEG IF
ALLOWED AS PER DOCTOR’S ORDERS.
• REPEAT THE ABOVE STEPS UNTIL YOU
GET TO THE BOTTOM OF THE STAIRS.

32. GENERAL INSTRUCTIONS AND
PRECAUTIONS IN CRUTCH WALKING
• Take care on slick or wet surfaces (for example, the kitchen
and bathroom).
• Be careful of throw rugs; they should be taken up.
• Never hop around holding on to furniture; it may slide or
fall.
• Keep the crutches near you so they are always in reach.
• Wear low-heeled shoes that will not slip off (for example,
sneakers).
• For the first few days, a strong belt may be worn to allow
someone to assist
• Be careful of ramps or slopes, as it is a little harder to walk.

33. THANK YOU