Helena is from the old country -- Czechoslovakia, back when there was a Czechoslovakia. Helena does things her way, and has done so for over 70 years; she could out-stubborn a mule. When she left her home country, she brought her late mother's cane -- black cherry, with a hooked handle. For the past five years, Helena's been using the cane, but it doesn't seem to be enough -- she's wobbling. She asked me to take her shopping for a new one."You might want to check with a physician or therapist beforehand -- get some advice."
"No. I know what is best for me."
I decided to run some reconnaissance; maybe I could give the mule a nudge. Mary Engles, physical therapist and owner of Sports Arena Physical Therapy (619-226-4131), gave me some general advice. "There are several different kinds of canes. What Helena has now is called a single-point cane," which is the most common form. "It can have a little crook at the top, or it can have a flat custom handle -- that fits better in the hand." Some canes, she noted, might have offset handles -- the handle set behind the cane's point of contact. "There's a little jog in the shaft of the cane that sets the handle back. That has to do with weight-bearing."
Engles said that the single-point cane is used "when you want to reduce weight on one leg. This is a very important point: the cane goes opposite the side of the weakness. If you have a problem with your right foot, the cane needs to go in your left hand. It has to do with leverage -- you want to keep the cane as far from the weight-bearing point as you can. If it's right next to the injured leg, it's close to the weight-bearing point. If it's farther away, you have better leverage when you push on the cane. Remember the old formula, 'weight equals force times distance.' We're trying to increase distance, so you don't have to put so much force into it."
She laid out the mechanics of use for an injured right foot. "Your cane will be in your left hand, and you will bring the cane forward with your right foot as you're walking. Both the cane and your foot are going to be on the ground at the same time. The cane accompanies the injured foot wherever it's going. As your right foot and the cane come forward, push down on the cane and step through with your left foot. Don't just step up to the right foot, step past it -- unless you have an injury that doesn't permit your ankle to bend much."
Leverage also plays a part in fitting a cane. "A cane should be custom fit, because people's arms are of different lengths. Normally, the top of the cane would be even with the outside of your hip. But if a person has a very short or long arm, you should adjust it." What matters is the bending of the arm. "The elbow should be slightly bent when the hand is resting on the cane. If the arm is completely straight, you have no pushing power."
Engles likes adjustable canes, since they can be passed on if the injury is temporary, and because "they tend to be made from lighter materials" -- usually aluminum, as opposed to wood. And for someone like Helena, who's unsteady these days, she would recommend "a quadruped cane. The cane comes down to a platform with four little legs on it. There are large or small platforms -- for a little lady, I suggest a small platform."
Still scouting, I started calling around to medical supply stores. Connie at Pacific Mobility Center in San Marcos (760-471-8884) told me, "The majority of our canes are metal, and height adjustable. You push a little button on the side to raise or lower it. We have either black or brown metal [ $25 ] and a few with pretty little paisley prints [ $25 ]. We also have a Lucite cane [ $39.95 ], which is not adjustable -- you'd have to saw it off to the proper height. We can do it here, or you can take a handsaw and do it yourself. It's good to work off of a cane that's already adjusted to your height. Then you add a rubber tip. Tips wear out, so we sell replacements [ $2.50 -- $3 for a package of two]." The store sells a foldable, adjustable travel cane ( $26 ) and a nonadjustable cane with an attached seat ( $39.95 ).
Paul at Balboa Pharmacy in Clairemont (858-278-0111) discussed handles. "Our canes have basic hook handles or derby handles. The derby handle makes the cane look like a number seven. Some of the canes have ergonomic grips, and we can order them with either left- or right-hand orthopedic handles." Basic wood canes, which the store will cut to fit, range from $8 to $50 , depending on wood and handle type. Adjustable aluminum canes are $23 .
Other prices around town:
M&J Medical in La Mesa (619-644-2695): black or flowered adjustable aluminum cane, $37 ; quadruped cane, $37 .
Eric's Medical Supply in Linda Vista (619-298-9640): single-point canes, $19.95 -- $79.95 , depending on material and handle; quadruped cane, $29.95 .
Park Boulevard Pharmacy in Hillcrest (619-295-3109): aluminum adjustable canes starting at $20.99 .