Yes, for most people who need crutches for more than a few weeks, forearm crutches are better than underarm crutches. They put roughly 60 to 80 percent less pressure on the armpit nerve bundle, free both hands for stairs and doors, and reduce the energy cost of walking by an estimated 10 to 20 percent. Underarm crutches remain better for short-term non-weight-bearing recovery and for people with weak grip or poor shoulder stability. The right answer depends on how long you will use them, how much weight your arms can carry, and whether you need your hands free.
How Each Crutch Transfers Force Into Your Body
Both crutch types move load from your legs to your arms, but they do it through different anatomy. With underarm crutches, the top pad sits in the axilla, the hollow under the shoulder joint. The pad should not bear weight; body weight passes through the hands and the strut of the crutch. When users rest on the pad anyway, they compress the radial nerve and the axillary artery against the rib cage. That compression is the mechanism behind "crutch palsy," a wrist-drop weakness documented since World War I.
Forearm crutches, also called Lofstrand crutches, wrap a cuff around the proximal forearm, about 2 to 3 inches below the elbow. Weight travels through the handgrip into the shaft and cuff, then up the forearm rather than into the armpit. The cuff acts as a pivot, not a load platform. Because the cuff is anchored to the forearm, the crutch swings with the arm instead of falling away, which is why the design allows a more natural reciprocal gait.
In plain terms: underarm crutches hang from your armpits and rely on your hands; forearm crutches strap to your arms and spread load along the forearm.
The gait pattern also differs. Underarm crutch users typically adopt a swing-through or three-point gait with a wide base, roughly 12 to 18 inches between crutch tips. Forearm users can use a more upright, narrow-based gait with a step length closer to normal, around 20 to 24 inches per cycle when partial weight-bearing. A narrower base and reciprocating arm swing lower the vertical oscillation of the center of mass, which is where the energy savings come from.
Quantified Comparison: Pressure, Energy, and Cost
The numbers separate the two designs more than marketing does. A 2015 biomechanics study of axillary crutch users found mean peak axillary pressure of 120 to 180 mmHg when users leaned on the pad, well above the 30 to 40 mmHg capillary closing pressure. Forearm cuff pressure in comparable trials runs 20 to 50 mmHg, near or below capillary closing threshold. That 60 to 80 percent reduction is the single strongest argument for forearm crutches in long-term use.
Energy cost is the second differentiator. Treadmill studies of partial weight-bearing gait show underarm crutch walking costs about 30 to 50 percent more metabolic energy than normal walking. Forearm crutch walking costs roughly 15 to 35 percent more. The gap widens with speed and duration and matters most for anyone walking more than 500 meters per day.
| Feature | Forearm crutches | Underarm crutches |
|---|---|---|
| Axillary/cuff pressure | 20-50 mmHg cuff | 120-180 mmHg axillary peak |
| Extra energy vs. normal walking | 15-35% | 30-50% |
| Hands free for doors/stairs | Yes (cuff holds crutch) | No |
| Maximum weight-bearing support | Moderate | High (short-term) |
| Learning curve | 1-2 weeks | 1-3 days |
| Typical retail price | USD 40-120 per pair | USD 25-70 per pair |
| Best use duration | Long-term, 6+ weeks | Short-term, under 6 weeks |
| Stair technique | One crutch, one rail | Two crutches, side-step |
| Common failure mode | Wrist/elbow overuse | Nerve compression, falls |
Cost favors underarm crutches at entry, but replacement cadence closes the gap. Forearm crutches with adjustable cuffs typically last 3 to 5 years with tip replacement every 6 to 12 months. Underarm crutches are often borrowed or rented at near zero cost for a 6 to 12 week recovery. For anyone expecting to use crutches beyond 12 weeks, the total 3-year cost of forearm crutches (USD 60-150 including tips) is usually lower than repeated underarm replacement and missed work from armpit soreness.
When Underarm Crutches Are the Better Choice
The comparison is not one-sided. Underarm crutches win in specific clinical situations. After major lower-limb surgery with strict non-weight-bearing orders, the taller frame and wider base give more stability and tolerate a higher proportion of body weight through the arms. A 2020 review of postoperative mobility protocols found underarm crutches remained standard for the first 2 to 6 weeks after total knee replacement in most US centers.
People with weak grip strength, below roughly 20 kg on a hand dynamometer, often find forearm cuffs hard to control during swing phase. People with limited elbow extension, shoulder instability, or significant upper-limb arthritis may also do better with underarm crutches because the load path is shorter and the hand position is more forgiving.
Short-term users also benefit from the 1 to 3 day learning curve. Forearm crutches require 1 to 2 weeks to master the cuff swing, and falls during that window are a real risk. If your recovery is 4 to 6 weeks and you live in a single-level home, underarm crutches are simpler and cheaper.
Edge Cases and Misconceptions Worth Correcting
The most common misconception is that underarm pads are meant to bear weight. They are not. The pad exists to stabilize the crutch against the chest wall, not to support the body. Relying on the pad is the mechanism that produces crutch palsy, and it happens faster than most people expect: symptoms can appear within 2 to 4 weeks of habitual leaning.
A second misconception is that forearm crutches are always safer. The cuff can cause forearm nerve irritation, particularly the superficial radial nerve, if fitted too tight. Cuff circumference should allow one finger, about 0.5 to 0.75 inch, between cuff and skin. A 2018 fitting study found 40 percent of forearm crutch users wore cuffs that were too tight.
Three edge cases change the calculus:
- Bilateral below-knee amputation: forearm crutches allow a more natural gait and are standard in prosthetic training.
- Severe bilateral carpal tunnel: neither design is comfortable; platform crutches or a walker may be safer.
- High body mass index above 35: underarm crutches tolerate higher loads but heighten nerve risk; forearm crutches with weight-rated shafts (rated to 300 lb) are usually preferred long-term.
A counterintuitive detail: forearm crutches are often described as harder on the wrists, but pressure studies show the opposite for long-duration use. The cuff shares load with the hand, lowering peak wrist pressure by roughly 20 to 30 percent compared with underarm crutches, where the entire load passes through the palm.
Fitting and Learning Timeline
Fit determines outcomes more than design. Underarm crutch height should place the top pad 2 to 3 finger-widths, about 1.5 to 2 inches, below the axilla when standing. Forearm crutch height should place the handgrip at wrist crease level with the elbow bent 15 to 30 degrees.
| Time point | What to expect | Fitting check |
|---|---|---|
| Day 0 | Initial fitting, first steps | Pad 2 inches below armpit; grip at wrist crease |
| Day 1-3 | Soreness in hands and forearms | Elbow angle 15-30 degrees |
| Week 1 | Gait rhythm emerging | Cuff gap 0.5-0.75 inch |
| Week 2 | Stair technique practiced | Tip wear under 1/8 inch |
| Week 3-4 | Endurance improves | No armpit numbness or tingling |
| Week 6 | Reassess if still needed | Ferrule/tip replacement if worn |
| Week 12+ | Long-term decision point | Consider forearm if continuing |
By week 3 to 4, most users know whether the design suits them. Persistent armpit tingling, numbness in the ring and pinky fingers, or wrist pain that limits daily activity are signals to switch designs or seek a fitting review.
What to Actually Do
Start by asking your clinician how long you will need crutches and whether you will be non-weight-bearing or partial weight-bearing. Those two answers determine the design more than anything else.
Then take these steps:
- Request a fitting by a physical therapist rather than self-adjusting at home. A 10-minute fitting reduces fall risk measurably.
- If you expect more than 6 weeks of use, choose forearm crutches with adjustable cuffs and weight-rated shafts.
- Check cuff and pad gaps weekly for the first month; swelling changes fit.
- Replace rubber tips when the tread groove disappears, typically every 6 to 12 months.
- Stop and seek care for armpit numbness, finger tingling, or wrist pain that does not resolve within 48 hours.
- Practice stairs with a rail before you need them; forearm crutches let you keep one hand free.
Limitations of the Evidence
Most comparative studies are small, with 20 to 60 participants, and use healthy volunteers rather than patients. Metabolic cost estimates vary by 10 to 15 percentage points across labs because of treadmill versus overground protocols. Pressure measurements depend heavily on sensor placement, so the 60 to 80 percent reduction is a range, not a fixed value. No large randomized trial has compared fall rates between the two designs over 12 months, so the safety claims rest on biomechanics and observational data, not on head-to-head trials. Treat the numbers as strong directional evidence, and let your clinician's assessment of your specific weight-bearing status, grip strength, and home layout decide the final choice.