Choosing a Walker or Cane

Cane or walker?

Whether you use a cane or walker depends on how much support you need and whether you need it for one or both limbs. Hoenig says mobility problems tend to fall into one or more of these three categories: weight-bearing (due to weakness or pain); balance (due to a coordination or sensory problem, such as numbness or low vision); and endurance (due to heart or lung problems). The category that describes your issue influences the best type of gait aid.

If you have mild leg weakness — say, a creaky knee — a cane can give you one-sided support by reducing the weight on the joint. A cane is also appropriate in dealing with mild sensory changes, such as changes in vision, hearing or balance. For example, a cane might be more helpful for someone with a mild balance problem due to peripheral neuropathy or low vision, says Hoenig, because they can pick up where the floor is by feeling it through the arm holding the cane.

Features to consider in a cane

The base

Single-point base: The single contact with the ground helps those with early balance problems, who need just a little support to steady themselves and don't need to push down a lot on the cane.

Quad base: The quad cane, with its four-pronged base, is for those who need a wider base of support for balance. “It offers a little more stability on that side,” says Palm. “For example, someone who has had a stroke and needs to be able to lean farther in that direction to clear their leg.” But there's a trade-off. For one thing, a quad base is heavier and clunkier to use. Also, notes Palm, “it usually requires a slower gait pattern because you need to make sure that all four points of that quad cane hit the ground with each step.” On other hand, it can stand on its own — a nice feature if you need to put it down while sitting at a restaurant or in a restroom.

The handle

With any handle, you'll want the right height. “With your elbow bent at a 10- to 30-degree angle, the top of the cane would come to your wrist. If it's taller than that or a lot lower, it can throw off the mechanics of how you're walking,” Yourman explains.

Two more considerations when deciding on your type of grip: comfort and the amount of weight you're going to be putting on it.

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Rounded (or tourist) handle

Someone who isn't putting a lot of weight on the cane will do fine with this type, Hoenig says. (It's also a plus to be able to hang it over your arm when you're opening a door.) But if you have to really grip and lean hard, this curved handle is going to hurt your hand.

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T-shape handle

There are a lot of variations, including a Fritz or derby handle. The horizontal grip allows for even distribution of weight across the palm and is especially kind to those who have arthritic hands or fingers.

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Offset handle

With its unique shape — similar to a question mark or shepherd's staff, with the area just beneath the handle sticking out slightly — “the transmission of force is directly perpendicular to the ground,” says Susan Rocha, lead physical therapist at the University of California San Diego Health Koman Family Outpatient Pavilion. That puts your weight directly over the cane shaft for more comfort when walking.

Features to consider in a walker

If your balance is poor, or if you have weakness or arthritic pain in both legs or hips, you're going to get a much larger base of support from a walker. (Some can support up to half your weight.)

"The decision on the type of walker a person obtains may have to do with their upper extremity strength and ability, the location that they will be using it in, and personal preference,” says Barbara Resnick, professor of organizational systems and adult health at the University of Maryland School of Nursing. Standard walkers, without wheels, which need to be picked up and moved forward, are seldom used anymore. Today's options have two, three or four wheels.

Two-wheel (or front-wheel) walkers are the most common, with wheels in the front and posts in the back. The benefit here: It's really stable. “A two-wheel walker could be a good choice for a person who's got a more severe balance problem, such as Parkinson's, because it won't run away from you,” Hoenig says.

Rollators can be easier to use because they have wheels at the bottom of each leg. They usually have brakes on the handles — squeeze them and they lock — similar to a bicycle, though, notes Palm, good coordination is key: “Some people aren't quick enough to lock the brakes and the walker can get away from them.”

Three-wheeler walkers are a little like a tricycle, with one wheel in front and two in back. They're pretty easy to maneuver but less stable than two-wheel walkers, and don't provide as much support for overall balance or weakness. “Some people who have a smaller apartment or narrow doorways like them because they're easier to fit through smaller spaces,” says Palm. A drawback? They cause you to lean farther forward.

Four-wheeler walkers are wider than three-wheelers and are usually easier to push over uneven surfaces, such as sidewalks. “A four-wheel walker is easy to propel and gives some support,” says Hoenig. “But it's not as good as a two-wheel walker for people with major balance problems.” They usually have a seat with a basket underneath to hold groceries or personal items. “The seat makes them ideal for patients who have decreased endurance or are easily fatigued or get short of breath,” says Rocha. “A lot of cardiac patients use them so they can take a break and rest, especially when walking long distances.”