Functional, Spiroergometric, and Subjective Comparisons Between Forearm Crutches and Hands-Free Single Crutches in a Crossover Study

Abstract

Background: Following below-knee surgery, the optimal medical mobility device remains controversial as adequate nonweightbearing of the operated extremity is critical to ensure successful healing. The use of forearm crutches (FACs) is well established but requires using both upper extremities. The hands-free single orthosis (HFSO) is an alternative that spares the upper extremities. This pilot study compared functional, spiroergometric, and subjective parameters between HFSO and FAC. Methods: Ten healthy (5 females, 5 males) participants were asked to use HFSOs and FACs in a randomized order. Five functional tests were performed: climbing stairs (CS), an L-shaped indoor course (IC), an outdoor course (OC), a 10-meter walk test (10MWT), and a 6-minute walk test (6MWT). Tripping events were counted while performing IC, OC, and 6MWT. Spiroergometric measurements consisted of a 2-step treadmill test with speeds of 1.5 and 2 km/h, each for 3 minutes. Lastly, a VAS questionnaire was completed to collect data regarding comfort, safety, pain, and recommendations. Results: Significant differences between both aids were observed in CS and IC (HFSO: 29.3 seconds; FAC: 26.1 seconds, P < .03; and HFSO: 33.2 seconds, FAC: 18 seconds, P < .001, respectively). The other functional tests showed no significant differences. The trip events were not significantly different between the use of the 2 aids. Spiroergometric tests showed significant differences regarding heart rate (HFSO: 131.1 bpm at 1.5 km/h and 131 bpm at 2 km/h; FAC: 148.1 bpm at 1.5 km/h and 161.8 bpm at 2 km/h) and oxygen consumption (HFSO: 15.4 mL/min/kg at 1.5 km/h and 16 mL/min/kg at 2 km/h; FAC: 18.3 mL/min/kg at 1.5 km/h and 21.9 mL/min/kg at 2 km/h) at both speeds (all P < .01). In addition, significantly different ratings regarding the items comfort, pain, and recommendation were recorded. Both aids were equally rated for safety. Conclusion: HFSOs may be an alternative to FACs, especially in activities that require physical stamina. Further prospective studies in patients with below-knee surgical intervention concerning everyday clinical use would be interesting. Level of Evidence: Level IV pilot-study.

Walking with unilateral ankle-foot unloading: a comparative biomechanical analysis of three assistive devices

“…2 b). The CR and IW results are consistent with previous research [ 34 , 35 ]. Moreover, these results correspond well with the participants’ rated perceived exertion, which was significantly higher for CR, albeit comparable between IW and ZG.…”

“…To avoid any contact between the forefoot and the AFO base, we had to increase the height of the heel above the AFO base and support the forefoot with a strap, which contributed to the discomfort reported by a few participants. The CR and IW caused discomfort to fewer participants, mainly on the hands and shank, respectively, aligning with previous reports [ 5 , 23 , 35 ]. Moreover, it is important to note that AFOs such as the ZeroG require a significantly longer time, usually a few minutes, to be put on.…”

“…2 a). Similarly, previous studies reported significantly slower walking using IW compared to NG [ 24 , 34 ] and significantly faster walking with IW compared to CR [ 35 ]. Contrary to our findings, other studies found that participants walked slower with IW than with CR.…”

Prehabilitation for Patients Undergoing Elective Foot and Ankle Surgery: A Contemporary Review

“…From a prehabilitation standpoint, strengthening the quadriceps as well as the brachioradialis and deltoid muscles in the upper extremities may aid in controlling and using ambulatory devices even after foot and ankle surgery. 110 …”

“…From a prehabilitation standpoint, strengthening the quadriceps as well as the brachioradialis and deltoid muscles in the upper extremities may aid in controlling and using ambulatory devices even after foot and ankle surgery. 110 The strength and stability of the knee and hip on the affected side, in addition to that of the unaffected lower extremity, lumbopelvic region, and upper extremities should be also optimized to prepare for nonweightbearing status and ambulatory aid use, thus protecting the operative site and reducing the risk of falls (Table 2).…”