If you feel insecure when you walk, experience weakness or pain, or have had a fall, then you may be considering getting a walking aid. This factsheet will provide 'first stop' information on the types of walking aids available and the useful features of some of the more standard pieces of equipment.
For information about our help services, or for a list of other useful organisations and information resources, please get intouch with the COS Equipment Support Team
Walking equipment is usually for one of two purposes: as part of a rehabilitation programme if you are recovering from an injury or operation, or as a long-term aid to mobility if you have ongoing difficulty with walking.
The rehabilitation process is a gradual progression towards independent and unassisted walking. It may start with the use of one kind of walking aid to give you confidence before progressing to another walking aid. The ultimate aim of a rehabilitation programme is for you to regain as much independence and safety as possible in your walking, preferably without walking equipment.
Sometimes complete recovery is not possible, or you may have an illness or disability that permanently affects your legs, balance or coordination. In these situations, mobility equipment may be required for long-term use.
To ensure that the appropriate device is selected, your needs, your lifestyle and your home environment should be assessed.
Walking equipment may perform one or more functions including:
The correct use of a walking aid is not always as straightforward as it seems. The ‘usual’ way of using an aid may need to be adapted to suit you and your particular condition or circumstances. If you, or the person you care for, have reduced cognitive functioning, it may also be more difficult to learn, or remember how to use a walking aid.
Walking equipment may improve your mobility but if an inappropriate walking device is used, if incorrect techniques are adopted, or if the device is not suitable for a particular environment, your independence and safety may be jeopardised. A physiotherapist or occupational therapist should be able to give you appropriate teaching and advice when you are assessed. Further information is also available from some of the organisations listed at the end of this factsheet.
There are a number of actions that you can take to minimise your risk of a fall whilst using a walking aid.
As traditional walking sticks only have a single point of contact with the floor they tend to be used by those with moderately reduced balance.
These traditionally have a crook handle and are cut to the correct height. They are available in various diameters and strengths which are designed to take different loads. They are not as adaptable as metal sticks.
These tend to be stronger than wooden walking sticks. Some are fixed length, others are height adjustable. Metal sticks are available with right angled handles, crook shaped handles or anatomically shaped handgrips. The ferrules of metal sticks must incorporate a metal disc to prevent the end of the stick cutting into the rubber of the ferrule.
These are lightweight metal sticks with sectioned shafts that enable them to be folded up for storage, for example in a handbag. Strong elastic runs inside the shaft to ensure that in its open position the stick remains stable.
Fixed height or adjustable height versions are available. Some are provided with a plastic, storage wallet.
Walking sticks with a seat
These are particularly useful for people who need to rest periodically - perhaps with breathing difficulties or a heart condition - or for people who find it difficult to stand whilst waiting in a queue. They are not recommended for people who need to take a lot of weight through the stick, as the addition of a seat alters the balance of the stick.
The weight of stick seats and the amount of strength needed to open and close the seat varies. The height of many of these sticks can be adjusted. It is important to ensure that the overall height is appropriate for the individual user so he/she gains walking support from it.
The seat size is often small and seat height varies between the models. The lower the seat, the more difficult it becomes to stand up. Most do not provide back support or armrests to push up from.
Those with three or four legs provide a broader base of support and are therefore more stable to sit on than the shooting stick type, which have only one leg. Seat sticks with a single point base must have a rubber ferrule. Traditional style shooting sticks with a single point and plate base, instead of a ferrule, do not provide sufficient stability.
The maximum user weight tolerated by stick seats varies according to their design. You are advised to check the manufacturer’s details for weight tolerance. It is also advisable to discuss the suitability if this type of stick with your GP or physiotherapist.
Walking sticks for blind or partially sighted users
White walking sticks are available as walking aids for those people who are blind, partially sighted or have difficulty mobilising. The white colour acts as an indicator to those around that the user is blind or partially sighted. White sticks with red stripes can be purchased for those who are both deaf and blind or alternatively, red tape can be wrapped around a white stick.
These walking sticks should not be confused with symbol canes which enable people who are blind or partially sighted to establish the nature of their immediate surroundings; or white guide canes which are used to locate obstacles in the path of the user.
The RNIB can help with finding appropriate mobility training for you if you are having difficulty resulting from sight loss.
A variety of different shaped handles are available including:
These may be less comfortable to hold than a right-angled handle, but can easily be hooked over the arm when not in use.
Right angled or T-shaped handles
These are often more comfortable to use than a crook handle. The addition of a wrist strap may be useful to secure the stick when it is not in use.
Swan necked shafts
Handles with swan necked shafts (pictured) are offset above the stick, which allows your weight to be evenly spread centrally over the base of the stick - this may be helpful if you require more stability.
Contoured handles, sometimes called Fischer sticks
These are anatomically shaped handles which spread the pressure over a wider area of the palm to improve comfort for permanent users or those with painful hands, perhaps due to arthritis (Elmamoun and Mulley 2007; Marston and Brookes, 2005). They are produced for left or right handed use, so if you are self purchasing make sure you buy the correct one.
These walking aids have a walking stick-style shaft and a three or four point base. They are therefore freestanding and are more stable than standard walking sticks. They are usually used singly rather than in pairs. If used in pairs, models with a narrow base occupy less floor space and are therefore more practical. They are more difficult to use on stairs than standard walking sticks (Elmamoun and Mulley, 2007).
All tripods and quadrupods are made of metal, usually aluminium or steel, and have a telescopic mechanism for adjusting height using spring-loaded catches. It is very important to have the tripod or quadrupod at the correct height for use.
As with other walking aids, the usual measurement to take is the distance between the wrist crease and the ground (read more on the correct height below).
Tripods and quadrupods are available in narrow and wide based versions, the wide base offering greater stability. All can be used right or left-handed; the handgrip can be rotated through 180 degrees so that the spread of the base is away from the user.
Some quadrupods incorporate an extension above the handgrip that terminates in an elbow cuff, similar to the cuff found on elbow crutches. This gives added security, by retaining the forearm in a position immediately above the handgrip.
It is very important to have the walking stick at the correct height for use. If the height is incorrect then the support will not be adequate, or may cause discomfort. For example, if the walking stick is too high, this will result in you raising (elevating) your shoulders, therefore reducing your balance and comfort. Remember that these are general guidelines. There may be reasons why you require a different height, so check with a healthcare professional.
The most effective method of checking the height is to stand in your regular footwear with your arms hanging relaxed with a slight natural bend at the elbow (flexed at 15 degrees). Have someone measure the distance between the wrist crease and the ground. This should be the height of your walking aid.
Over time your height measurements and posture will change, so if it has been several years since you were provided with your stick, you should check that it is still a suitable height for you (Marston and Brookes, 2005). Do not significantly change the height of a walking stick if you have had it for some time as you will have got used to it. If you need to change the height of a stick, perhaps because your overall height has reduced with increasing age, make a number of smaller changes over time. Please remember there may be a reason why a stick length was chosen, for example sometimes stick length is adjusted for individuals who have had a stroke.
Wooden sticks can be measured and cut with a saw to the correct height. In practice, when therapists are measuring wooden sticks, they turn the stick upside down and mark the point where the stick should be cut, keeping in mind the small addition to the overall height once a ferrule is attached.
Metal sticks are available in a variety of fixed heights - the nearest suitable height should be chosen. If they have a telescopic mechanism, this can be finely adjusted using the spring-loaded catches.
You should always get advice from a healthcare professional before choosing or using crutches. Crutches are designed to be used in pairs and you need good co-ordination to use them correctly (Ainslie 2012). Occasionally one crutch is used on its own, but this should only be done under the guidance of a physiotherapist.
These are the most common type of crutch and may be single or double adjustable. Both floor-to-handgrip height and the distance between the cuff and the handgrip are adjustable on double adjustable elbow crutches. Single adjustable elbow crutches allow floor-to-handgrip height adjustment only. Standard and anatomically moulded handgrips are available.
Elbow crutches are available with two styles of cuff: open or closed. An open cuff is semi-circular in shape and provides a support to brace the forearm against in the step-through phase of walking. A closed cuff is an incomplete ring which prevents the forearm slipping forwards out of place and holds the crutch on the arm if, for example, you need to take your hand off the crutch to open a door.
Axilla or underarm crutches
These have a single or double shaft, the height and the distance between the handgrip and the axilla pad are adjustable.
If you are using axilla crutches, do not lean on the underarm pad as this may interrupt the blood flow and put pressure on important nerves that run through the armpit. The handgrips should be positioned so that the elbows are slightly flexed.
Forearm crutches with gutter armrest
These are designed for people who need to weight bear through the length of their forearm rather than their hand and wrist, for example those who experience pain in their hands. The height of these can be adjusted and they have a trough or gutter armrest that supports and spreads the user's weight through his/her forearms. The length and angle of the handgrip can also usually be adjusted.
Some crutches can have contoured handles, shaped to follow the contours of the hand and spreading the pressure over a wider area of the palm, for more comfortable use. A gel handgrip can also help to improve comfort.
Elbow crutches can be supplied with gutter armrests. These allow people to bear weight through their forearms rather than through their hands. They have padded, vinyl covered, trough-shaped supports with vertical handgrips. The length and angle of some handgrips can be adjusted to achieve the most comfortable position.
Most crutches are made of metal, either aluminium or steel-reinforced aluminium for heavy-duty use. You may find some underarm crutches are still made of wood. Some metal crutches can have a coloured paint finish. All crutches must be fitted with an appropriate ferrule. The ferrules of metal crutches must incorporate a metal ring to prevent the base of the crutch cutting into the rubber of the ferrule.
Crutches must be at the correct height for use. Both axilla and elbow crutches usually have two adjustment points.
The overall height of axilla crutches can be adjusted. This should be measured by standing upright in appropriate and supportive footwear. The underarm pad should fit under the armpit with two finger widths of space above to ensure no pressure is applied through the armpit when the crutches are being used.
The handgrip adjusts along the upright side of the crutches and should be set at a height level with the protruding bone at the side of the wrist.
The overall height of elbow crutches can be adjusted. This is measured by lining up the handgrips with the wrist bone. Some elbow crutches also have an adjustment for the elbow cuff, which should cradle the forearm just below the elbow joint so that movement of the elbow is not impeded.
As walking frames have more points of contact with the floor they tend to be used by those with greater balance problems and/or weak legs. A walking stick can off-load 25% of the user’s weight compared to a frame which can transfer 64% of the user's weight through the arms. This weight re-distribution from legs to arms can also help reduce leg pain.
Non-wheeled standard pulpit frames (zimmer frames)
Standard walking or pulpit frames are commonly known as zimmer frames and are mostly used indoors. Zimmer frames have:
Although walking frames are useful because they provide a large area of support, they do not allow the user to walk using a flowing walking pattern. The user has to keep stopping and starting as the frame is picked up, moved forwards and stepped into. This means they may not be suitable for you if you get tired quickly or have difficulty starting movements (this is often a symptom of Parkinson's disease).
Consider the size of the frame base if it is going to be used in a domestic setting, as some may be too wide to go through small doorways. Frames with four legs that are spread widely apart will be the most stable but may be difficult to get through doorways. If the doorway is particularly narrow, the user may have to walk through sideways. Narrow four-legged frames are available, but are not as stable.
Folding pulpit frames
A folding frame can easily be stored within the home if it does not need to be used all the time. It also makes it easier to transport in a car boot. Folding frames with four legs have hinged sides, which can be folded flat against the front of the frame when catches are released.
There are a variety of catch mechanisms available to allow the frame to fold. You are advised to make sure you can operate the catch easily before you buy. It is suggested that some users often find it difficult to fold frames with press-button releases or levers.
Some pulpit shaped frames have a different folding mechanism. The frame is folded by pulling up a wooden ball, suspended between the top and bottom horizontal bars at the front of the frame, lifting the bottom bar upwards and closing the frame as it pivots at the point where the bottom bar meets the rear legs of the frame.
You may find this an easy mechanism to operate, but these frames are not as compact when folded as those with other folding mechanisms.
High or forearm walkers
These are also called 'gutter frames' and have forearm troughs or gutters which allow you to bear weight through your forearms rather than your hands. Thus gutter frames may be considered if you have arthritis in your hands or have broken your hand or wrist (Ainslie 2012).
The troughs and handgrips can be adjusted to find the most suitable and comfortable position. Alternatively, some walkers have a platform rather than individual gutter rests on which to rest the forearms and a vertical handgrip.
High or forearm walkers may be wheeled or non-wheeled.
These frames are hinged so that each side can be alternately placed forwards with each step to give a reciprocal action. They will go through tighter spaces than standard frames.
The advice of a physiotherapist should be sought when considering this equipment. Users often have difficulty learning to use reciprocal frames which makes them unpopular.
Frames with two wheels can be used in two ways:
Wheeled pulpit frames
Wheeled walking frames are basically the same as standard pulpit frames but instead of ferrules they have small wheels on the front legs. It may be possible to exchange the ferrules on a standard, non-mobile frame for wheeled extensions. The small wheels make them more suitable for indoor use but, as the wheels do not swivel, they can be difficult to manoeuvre.
Wheeled frames are usually chosen over non-wheeled frames when balance, instead of reduced weight-bearing ability, is the main concern (Elmamoun and Mulley 2007). They are also useful for people who find it difficult to use a traditional frame as they make a more continuous walking pattern possible, and do not need to be lifted clear off the ground to move forwards. The wheels on these frames do not pivot around a corner, so the frame needs to be lifted when turning.
These frames should not be used for people who put significant weight through the frame, as the frame can unintentionally move forward with a pushing down/forward movement. They can also be hazardous to individuals with a Parkinsonian gait (characterised by small shuffling steps which accelerate) so consult with your healthcare professional.
This style of walking equipment offers the user additional postural support for gait training and rehabilitation.
Mobile frames for one-handed use
These frames have a central handgrip that enables the frame to be held/moved using one hand. Care should be taken if using a one-handed frame as it does not offer as much support as gripping the frame with both hands. Advice should be sought from a physiotherapist as using this sort of frame may have an adverse effect on some rehabilitation programmes.
Reverse mobile walkers
These are wheeled walkers in which you stand and face outwards. The cross rails of the walker are therefore behind you as you move forwards.
Three-wheeled rollators (Delta frames)
Triangular frames are sometimes called 'Delta' or 'tri-wheeler frames'. They have a single front swivel castor and two uni-directional rear wheels. The larger wheels make them suitable for use outdoors. You may find them more manoeuvrable than four wheeled walkers, although not as stable. As they are so manoeuvrable, the use of the brakes when the person stops walking is important for safety. Like two wheeled rollators they may allow you to adopt a more flowing walking pattern than a non-wheeled walking frame. The height of the pushing handles can be adjusted.
As with all mobility equipment, it is essential that triangular walkers are inspected regularly with particular attention paid to the locking mechanism (usually consisting of a cross brace), which maintains the rollator in an open position. If the folding mechanism is not properly locked the frame may fold unexpectedly (Ainslie, 2012).
Four wheeled walkers, when used appropriately, will allow the person to adopt a more fluent walking pattern. Large wheels and/or large swivelling castors facilitate travel. However, they may be too mobile for people who need to lean or push against the frame for support - the frame may run away from them. The size of these walkers make them more suitable for outside use, but with adequate space, can be used inside.
Although many find their rollators very useful, some find them difficult to handle especially when out in the community, for example getting them on or off buses . Studies have suggested that users of rollators can walk faster and use less energy than users of zimmer frames.
It is very important to have the frame at the correct height for use.
Generally, to ensure that the pushing handles are in the best position for weight bearing, the height of the handgrips should be at the level of the wrist bone when the user’s elbows are very slightly bent (at an angle of about 15 degree flexion). Some models are available in a number of fixed heights - the nearest suitable height should be chosen. Others have telescopic handles, with spring-loaded catches, so that their height can be more finely adjusted.
Brakes on rollators
It is very important to ensure that a fully mobile frame has brakes and that they can be operated quickly and easily by the user, so that he/she always feels in control. These are the most common types:
Heavy frames tend to be more stable, but may be difficult for some people to lift. Heavy frames can also cause shoulder and neck discomfort. Walking equipment designed for heavy duty use may be steel reinforced, adding to its weight.
The majority of walking frames are made of aluminium. Some are made of steel which may be stronger for heavy duty use, but will weigh more. Some suppliers will offer a range of colours.
Small solid wheels or castors are really only suitable for use indoors and may require more effort to push over deep pile carpet or carpet bars than larger wheels.
Pneumatic wheels will require pumping up from time to time, but provide more suspension than solid rubber tyres. If you have painful hands that may be aggravated by jarring you may find this an advantage.
Swivel vs fixed wheels or castors
Frames with castors that swivel may be more manoeuvrable, but fixed wheels can help to make it easier to walk in a straight line. Larger wheels are more suitable for uneven/outdoor terrain. Some studies have suggested that four wheeled walkers are more stable than three wheeled.
These enable you to take a rest if you becomes tired whilst walking. You apply the brakes, turn around and sits down. Some rollators have a small backrest for support when sat and armrests to help when sitting and standing. Check on the size and the height of the seat; some are very narrow, others are very low. A seat does increase the weight of the frame.
The rollator must have its brakes on before you sit on it, to ensure that the frame remains steady when sitting down and standing up. There is a risk that the brakes may fail to hold the wheels in place, or that the brakes may hold but the wheels may slide along the ground. Consequently many healthcare professionals tell users to park the rollator against a wall before applying the brakes and sitting down. If you are purchasing your own rollator, compare the stability of different models when sitting down on their seat with an experienced member of staff. Factors such as the rollators weight, the material of the wheels and how far the seat is from the braked wheels will all affect its stability when you are sitting.
The rubber tip of a walking aid is called the ferrule. It reduces the risk of the stick slipping on slippery or wet surfaces. On ice, metal tips give more grip. Ferrules must be replaced as soon as they show signs of excessive wear and tear. Different sizes are available to fit different diameters of shaft.
Replacements are usually available from the issuing authority if the walking aid has been loaned to you, otherwise contact the retail outlet that supplied your walking aid.
These have a large, swivel base, which enable the walking stick or crutches to maintain full contact with the ground when used at an angle or on uneven surfaces (pictured above).
Shock absorbing ferrules
These incorporate a mechanism to absorb shock and may be particularly appropriate for people who are full-time users of crutches.
These have a metal spike which provides a firm grip on snow and ice. The spike can be flipped up and down when not needed.
Props and clips
It can be very annoying if your walking stick falls to the floor and you find it difficult to pick it up. Props can be clipped around walking sticks or crutches. Several styles are available but they are all designed to support a stick in an upright position against, for example a table edge. Alternatively U-shaped clips can be attached to wheelchairs or walking frames and are used to secure sticks or crutches when not in use.
These can be attached to the top of a walking stick and the loop can be placed around the person's wrist to keep the stick at hand.
These can be fitted over the top of standard walking sticks and crutches to make them more comfortable to hold. They may be made of fleece, foam, rubber, terry towelling or gel.
Bags, baskets and trays
A bag, basket or tray can be attached to some walking frames. Trays can be clipped onto the top of the frame and folded forward or detached when not in use. They are more useful on wheeled frames which do not need to be picked up to be moved.
Care should be taken when using accessories that attach to the front of a walking aid as they will alter the balance of the device and may make it less stable. Using specially designed net bags, apron style bags with pockets and wire baskets which have been designed to better maintain the balance of the walking aid is vital. Bags should not be attached to walking sticks or crutches. A shoulder bag worn diagonally across the shoulders may provide a solution to carrying less bulky items.
Walking stick holders hold a walking stick ready for use when it is not convenient to use the frame, for example in a tight space.
Household trolleys are not walking aids, but if your main difficulty is carrying items such as meals and hot drinks between rooms, then you may wish to try out a household trolley in an equipment demonstration centre. Household trolleys are sometimes available through local authority social services departments, but depending on availability and eligibility criteria you may need to self purchase.
Household trolleys are designed for indoor use and their main advantage is that they enable items to be carried safely from room to room. You push them in front of you and should consider them as an aid to confidence rather than for transference of body weight. Some are height adjustable to an extent, but may not be suitable for a taller person. They are not suitable for outside use.
Shopping trolleys are not walking aids, but if you are steady on your feet but lack walking stamina (for example a breathing difficulty or a heart condition, which may be made worse by carrying heavy loads) you may benefit from a shopping trolley that incorporates a seat. Some models fold so that they can be stored discreetly.
Difficulties in walking may be due to a variety of reasons including balance, movement and joint/skeletal problems. It is useful to understand the difficulties that you are experiencing, as it will influence the type of walking aid that is best for you.
If you are experiencing difficulties whilst walking, you feel insecure, or you have fallen, you are advised to see your GP initially. There may be an undiagnosed reason for your mobility problems. If there is, it is important that any illness, whether temporary or longer-term, is identified and treated where possible. Your GP will be able to refer you for a physiotherapy assessment if required, or you can organise a private assessment for yourself.
Physiotherapists are available in hospitals and community settings, through health and social services. The Chartered Society of Physiotherapy has some online advice on how to find a physio.
If you are experiencing walking difficulties because you have a particular condition, for example Parkinson’s, Motor Neurone Disease or Multiple Sclerosis, or you have had a stroke, you are advised to talk to your physiotherapist. Sometimes the use of a walking aid may only be recommended at a certain stage of the condition, or with a particular method of use. The contact details for various organisations is given at the end of this factsheet.
If you have a condition which affects your hands, and thereby your grip, you will need to consider the type of handles on the walking aids. There are some designs which may be better for you.
Following an assessment, the physiotherapist may provide you with advice about techniques, exercises and/or footwear, rather than a walking aid. If a walking aid is required, they will usually provide you with one, or you may be advised on equipment to purchase yourself.
It is vital that you obtain the right walking aid for you and your circumstances. You also need to know how to use the walking aid properly and safely. A physiotherapist can ensure that this happens. There are some key factors that need to be considered:
As with any repeated movement pattern, the long-term use of a walking aid can cause changes in your gait, posture, balance and muscle strength. These can all affect your ability to carry out certain tasks. It is important that:
It is a good idea to have a second walking aid, for example if you want one to keep at the home of a friend or relative, or keep one upstairs and one downstairs at home. You can safely purchase a second walking aid with the same features as one with which you have already been provided, without the advice of a professional.