When my elderly dad was nearing the end of his life, he spent some time in the hospital with heart problems. Lying in a hospital bed for days left him weak and unsteady. It was clear that he would need a cane to help him walk, but I had no idea if a quad cane or regular cane would be better.
Depending on the person’s needs, there may not be a clear-cut answer about whether a quad cane or a regular cane would be better. However, quad canes are best for those who need more balance stability than a standard cane can provide.
It turns out that quad canes are great options for someone like my dad. They give the user an extra measure of support. In his case, I ended up getting a standard cane with a quad tip. It was light in weight while still helping him walk more steadily.
Quad Cane Vs Regular Cane
Studies have shown that – contrary to what you might think – using a walking aid such as a cane can contribute to loss of balance and an increased risk of falling. That being said, a 2018 study by Bateni, et al, showed that “significant improvements in postural steadiness” were found when a multi-tipped cane was compared with using a straight cane. The study also notes that “all measured variables of postural steadiness [using any other cane tip]…were significantly below those of the quad cane.”
What Is A Quad Cane Used For?
Quad canes spread the user’s weight out over a greater area, so this type of cane give users more balance than a traditional cane.
A nice side benefit is that a quad cane stands up by itself. This means the user doesn’t have to bend over to retrieve it from the floor like often happens with standard canes. If you’ve ever tried to prop a traditional cane up somewhere, you know what I mean. They just don’t stay put!
That being said, there are disadvantages to quad canes:
- A large base quad cane can be a tripping hazard. It’s easier to get the wide base tangled up in your feet, which may result in a fall. A small base or a standard cane with a quad-tip can be less problematic if the person needs more support than a regular cane can give, but not as much as a large base provides.
- Because of a quad cane’s wide base, you can’t walk as fast.
- The large base quad cane won’t fit on stair treads, making this type of cane unusable if the person needs to use stairs. To fit on stairs, the cane’s base should measure no more than about 6” x 8” inches or it won’t fit on the steps. Be sure to measure the stairs before you buy a cane to ensure the cane will work for your loved one!
- A large base quad cane is generally heavier than other canes. Frailer seniors will do better with a small base quad cane or a standard cane with a quad tip if those types will meet their needs.
Common Reasons For Needing A Cane
Like with my dad, a cane is usually one of the first walking aids most people use. They might need one during recovery after surgery or an injury, or they might need one if they have balance issues from something like vertigo or a severe ear infection.
There is no “one size fits all” cause to get a cane, but there are many good reasons for using one.
Some of the best reasons are:
- You worry about losing your balance and falling while walking
- If you want to walk with less pain
- You have hip or knee pain during or after walking
- If you feel unstable while walking or have trouble going up and down stairs
- You find that you hold on to furniture or something supportive to steady yourself while walking
My dad initially resisted the idea of using a cane, despite the fact that he was in his late nineties. It was a source of pride to him that he was very steady on his feet and he didn’t want to be seen as “old” because he used one.
After he was hospitalized, though, he recognized that he wasn’t as stable as he had been before. I convinced him to let me get him a cane “temporarily, until you have your strength back” by appealing to his vanity. I pointed out that he didn’t want to fall and break a hip because he would look a whole lot older if he was in a wheelchair or using a walker.
How Does A Cane Help You Walk?
Using a single point cane helps make you more stable when walking. They work by increasing your base of support. This distributes your weight more evenly, giving you improved balance and more walking safety. I did some research and found that using a cane can decrease the pressure in the leg that is opposite the hand with which you hold a cane by up to 25 percent.
How Many Types Of Canes Are There?
When I got the cane for my dad, I had no idea that each type of cane provided a little different type of support. I just grabbed one with a quad-tip mini base because I knew it would be more stable than a standard, single-tip cane.
Basically, canes come in three main types:
- Standard (traditional, hook-shaped) canes
- Multi-tip (quad or tripod) canes
- Offset canes
Traditional (standard) canes have a single tip at the end. And, as their name implies, tripod canes have three tips and quad canes have four. For the best stability, a cane should have a tip that is made of rubber or another non-slip material.
There are also a variety of cane grips and handles:
- Ergonomic handles are right- or left-handed and are good if you need wrist support.
- A Fischer handle is a molded grip that fits the contour of your palm. This handle type is good for people with arthritis and for those with carpal tunnel syndrome.
- Fritz handles and Derby handles are also good for people with arthritis. They have an uneven t-shape that gives users a better grip.
- Metallic caps or ornamental knob handles are pretty, but they aren’t as functional.
- Palm grips are wider than average and help reduce arm strain.
- Contour grips are strictly right handed or left handed and can’t be used with the other hand.
- *Note: carpal tunnel syndrome can be aggravated by using a standard, umbrella-type handle. Horizontal palm grips with foam padding can be helpful for carpal tunnel.
Not to discourage you, but as you can see, there is a huge variety of canes and mobility devices out there today. Don’t do what I did and grab a random cane off the rack at a drug store. Back then I had no idea that getting an ill-fitting or inappropriate walking aid could do more harm than good.
It’s critical to get the correct mobility aid. A 2009 study about fall injuries and seniors was published in The Journal of the American Geriatrics Society. “Unintentional Fall Injuries Associated with Walkers and Canes in Older Adults Treated in U.S. Emergency Departments” noted that “47,312 older adult fall injuries associated with walking aids were treated annually” in U.S. emergency rooms. Of those, 12.3 percent were for falls while using canes.
“…two-thirds of patients who use a cane obtain it on their own, without any professional guidance about the proper type or sizing of the cane, or even about whether a cane is the appropriate walking aid for their needs. Even fewer, about one in five, receive proper education on how to use their cane.” – Arizona Center on Aging
Standard canes are the type most people think of first. This type of cane isn’t intended to be weight-bearing, though – it’s really just a balance aid. People who need a weight-bearing support should really use a walker instead of a cane.
For occasional, limited support, try an offset cane which has an angle in the handle. This bend positions your weight over the cane’s axis.
For example, someone with an arthritic knee might use an offset cane when walking in case their knee buckles or “gives out” on occasion. This type of cane will give them some degree of support for a few steps until their knee stabilizes.
If you use a cane, be sure to check the tips of the cane often. Eventually the tip will wear out and you’ll have to replace it. If it looks worn, it’s time to put on a new one. You can get replacement tips from a drug store or a pharmacy or even online which you can see here.
Cane tips fit snugly so they don’t come off when you walk. This means you might need to loosen it by using a blow dryer to heat the tip where it meets the cane. Also, you may need to work a bobby pin between the tip and the cane handle to break the suction before the tip will come off.
Multi-tip canes have either three or four “legs.” You can find standard canes with a multi-tip (like the one I got for my dad) or actual tri- or quad-tip canes that have metal bases with three or four legs.
Using A Cane
How Many Seniors Use Canes?
A 2015 study determined that about 24 percent of adults age 65 and older (an estimated 8.5 million seniors) use some type of mobility device. Canes are used by more than 16 percent of these seniors and more than 10 percent use multiple mobility aids. In general, women are more likely than men to use a mobility aid.
The least popular mobility device is the scooter, with just over 2 percent of use in this group.
Should My Parent Use A Cane?
If, like my dad, your senior loved one isn’t as steady on their feet as they used to be, you’re probably thinking about whether a cane is a good option for them.
They should consider getting a cane if:
- They can’t walk on uneven ground without assistance
- It’s not easy for them to climb or descend a flight of stairs
- They avoid certain activities because they have to walk are worried they might fall
- Walking causes joint or limb pain
- They worry about falling if they don’t hold on to something or they always seem to hold onto chair backs, the sofa, a railing, etc. when they walk
- Walking tires them out or takes a lot of physical effort
The bottom line for deciding whether it’s time for a cane is this: will they be safer if they use a cane?
If in doubt, speak with your doctor to see if they recommend that your loved one walk with a cane.
How Do I Choose The Right Cane?
Choosing the right cane for you or your parent depends on the amount of assistance you need and your function level.
“Using a cane that isn’t right for you can cause you to develop poor walking postures and may lead to injury from a fall.”
- Grip comfort is important. Contoured grips are more comfortable than standard grips. Foam covered grips give a better grip and your hand won’t slip as easily in hot weather.
- People with dexterity issues should look for canes with a Fritz or Derby handle.
- Offset canes can bear more weight than standard canes. Bariatric canes have heavier frames and can support up to 500 pounds.
- Tips – for more stability, get a cane with a rubber tip or another non-slip material.
- Seat canes are available for more comfort when standing in lines or if you’ll need to stand for a long time. Be aware that these canes are heavier and the tripod-style can tip over if you sit on it backwards.
Caregivers need to carefully assess their loved one before purchasing a cane.
Take into account the person’s ability to use the cane you choose (is it too heavy or cumbersome for them?). Are they mobile enough to use a cane or should they really be using a walker or wheelchair? In retrospect, I should have gotten my dad a walker because he was very confused after his hospital stay and had no concept of the correct way to use a cane as you’ll see further down in this article.
What Is The Correct Way To Use A Cane?
When I got Dad’s cane, I didn’t think to teach him how to use it. It seemed obvious to me – you just brace it on the floor in front of you, then lean your weight on it as you walk, right? Nope!
My assumption was very, very wrong, as I saw when I visited him and found him walking around his apartment with the cane slung over his forearm like a woman carries a purse.
“Dad? Why are you holding the cane like that?” I asked.
“Oh,” he said, in a very decisive voice. “See, I don’t need to use the cane much, but I’m carrying it around with me so I’ll have it when I do need it.”
Talk about an eye-opening moment. Dad truly thought he could just grab the cane off his arm and put it in front of him if he stumbled or lost his balance. He didn’t realize that he would never have time to grab it and get it into place fast enough to prevent a fall.
Not good – your cane needs to be easily accessible and you have to walk while using it or it won’t help you stay safe.
To use a STANDARD CANE properly:
- Try to stand upright – don’t lean forward. Also don’t lean to one side.
- Hold the cane in your hand on the “good” side – the one opposite from your painful or weak leg, hip, or knee.
- Put your weight on your good leg, then step forward with the bad leg (move the cane at the same time you move your weak or painful leg). Only move the cane forward about the length of your opposite foot. Don’t make the mistake of reaching too far out or to the side or you’ll increase your fall risk.
- Press down on the cane to transfer your weight to the cane and your bad leg.
- Move your good leg forward a short stride length.
To walk with a QUAD CANE properly:
- Hold the cane with your dominant hand. Or, if one leg is injured or weak, hold the cane in the hand opposite the weak leg. In other words, if you can’t bear weight on your right leg, hold the cane in your left hand.
- Step forward with your weak leg at the same time you move the quad cane forward about the length of the opposite foot. As with a standard cane, don’t make the mistake of reaching too far out or to one side or you increase the risk of falling.
- Place the cane tip on the floor, making sure that all four legs of the cane make contact with the ground.
- Press down on the cane handle while leaning forward and transferring your weight to the cane and weak leg.
- Move your good leg forward so both of your feet and the cane are in line with each other.
How Tall Should A Cane Be?
The top of your cane should be at your wrist level when you are standing upright with your arms relaxed and hanging loosely at your side. If your cane isn’t the correct height, it can lead to back and shoulder pain, not to mention increasing the potential for falling.
If you already have a cane, have someone watch you as you hold your cane. Your shoulders should be even as you hold it. If the shoulder of the arm holding the cane is higher than the shoulder of the other arm, your cane is too high. Conversely, if the shoulder of the arm that holds the cane is lower than the other shoulder, the cane is too short.
To determine how tall someone’s cane should be:
- Put on your regular walking shoes
- Stand up straight
- Let your arms fall loosely at your side in a natural position
- Have someone measure from the floor to your wrist, just before the wrist bone (where the wrist flexes). Note: the proper cane length is roughly half the user’s height, measured in inches while they are wearing shoes. For example: my dad was 69 inches tall (5 feet 9 inches) and wore shoes with a 1 inch heel, which equals 70 inches tall in shoes. Half of 70 inches = 35 inch tall cane.
- Your elbow should have about a 20-degree bend when your hand is on top of the cane.
If in doubt, ask your doctor or physical therapist to measure you for the proper cane height.
How To Use A Cane On Stairs
Climbing or descending stairs with a cane takes practice.
To go up a flight of stairs:
- Move your unaffected (or strongest) leg first. Place that foot up onto the first stair step. For example, if your right leg is weak, use your strong left leg to take the first step.
- Next, straighten your affected (weaker) leg at the same time you move your cane to the first stair step (the one you have your strong leg on).
- Repeat until you reach the top of the stairs.
Reverse this pattern when coming down the stairs:
- This time your weaker leg goes first.
- Put your weight on your stronger (unaffected) leg (example: if your left leg is stronger, put your weight on that leg).
- Move the cane down to the next step below you.
- Then move the weaker leg down to the step the cane is now balancing on.
- Last, step down with your stronger (unaffected) leg. Both legs and the cane should now all be on the same stair step.
- Repeat, step by step until you reach the bottom.
*Sometimes it is recommended to move the cane and weak leg simultaneously while descending stairs, but I think this makes you too unstable. When I used my dad’s cane while I was weak from getting chemo, I was much more balanced when I used the method I detailed above.
Here’s a video so you can see the best way to use a cane on the stairs:
How Do You Use A Quad Cane?
It takes time to get the hang of walking with a cane. Your doctor or physical therapist can tell you what type of cane will best suit you, your mobility requirements, and your physical ability. They also can watch you walk with it and provide advice to help you use it correctly.
You use a quad cane the same way you would use a standard cane:
- Hold it with the hand that is on the same side as your strongest leg
- The stronger (or unaffected) leg bears the most weight when you walk
- Move the cane forward at the same time you move your weaker leg forward
- If both legs are affected, hold the cane with the hand that is either unaffected or is the dominant hand
- When you stand up from a sitting position, don’t try to use a quad cane for support. Instead, stand first, then take hold of the cane.
How To Use A Quad Cane On Stairs
Just like learning to walk with a quad cane takes practice, so does climbing or descending stairs with one.
- Use the unaffected (or strongest) leg to step up onto the first stair step. For example, if your left leg is weak, use your strong right leg to step up first.
- Next, simultaneously move the affected (weaker) leg and the quad cane to the same stair step you are standing on.
- Repeat this pattern for each stair step
When coming down the stairs, it is the reverse – lead with your weaker leg:
- Stand on the stronger (unaffected) leg. So, if your right leg is stronger, put your weight on that leg.
- Move the cane down to the next step below you
- Then move the affected leg down to the step the cane is now balancing on
- Last, step down with your stronger (unaffected) leg. Both legs and the cane should now all be on the same stair step
- Repeat, stair step by stair step until you reach the bottom.
*To be extra safe, watch the video embedded in this article.
Quad Cane Tips
As with a standard cane, check the tips of your quad cane frequently. If it starts to look worn, change your cane tip out.
TIP: If you’re doing this yourself, you might need to loosen the tip where it meets the cane it by using a blow dryer to heat the tip. You also might have to break the suction by working a bobby pin between the tip and the cane handle before the tip will come off.
One thing I came across while doing research for this article is cane tips for walking on ice! I had no idea these existed, but they are awesome for people who live in areas that get snow and ice in the winter. They easily attach to the end of your cane via screws. Some models have tips that you can flip up when you are indoors, so they don’t damage the floor or get marred if you are walking on a day without snow.
Even though they are made for walking in the ice and snow, ice tips would also be a good idea for a senior who frequently walks on uneven ground (say, at a park when they are watching a grandchild’s soccer game).
Does Medicare pay for canes? Medicare Part B covers canes as Durable Medical Equipment (DME). Your doctor must write a prescription for the cane and you must purchase or rent it from a Medicare-certified medical equipment supplier. Medicare only covers the cane if your doctor and DME supplier are enrolled in Medicare.
What is the difference between a walking stick and a cane? Strictly speaking, a walking stick is used for balance (for example, when you hike a mountain path on rocky terrain). A cane extends your base of support and helps you balance, making it a good “crutch” or mobility aid.