Forearm crutches are better for long-term use, offer more stability on uneven surfaces and stairs, and give you greater freedom of movement. But they aren’t universally superior. For short-term recovery from a surgery or injury, underarm (axillary) crutches actually require less energy to use and are easier to learn. The “better” crutch depends on how long you’ll need one and what you’ll be doing with it.
Energy and Effort: Underarm Crutches Win Short-Term
This surprises most people, but underarm crutches are actually less tiring to walk with. A prospective study published in the Malaysian Orthopaedic Journal measured heart rate changes after walking with each type and found that underarm crutches raised heart rate by an average of 12.5 beats per minute, while forearm crutches raised it by 15.85 beats per minute. That difference was statistically significant. About 65% of participants in the same study also reported feeling like underarm crutches used less energy.
The reason comes down to mechanics. Underarm crutches let you transfer weight through your torso and ribcage, distributing the load across a larger area. Forearm crutches concentrate more effort through your arms, wrists, and grip. Balance testing in the same study showed participants needed about 7% more effort to stabilize themselves during backward tilts with forearm crutches compared to underarm ones.
If you’re recovering from a broken ankle or a knee surgery and expect to be off crutches within a few weeks, underarm crutches are a perfectly reasonable choice, and they’re what most people in the U.S. are handed at discharge.
Why Forearm Crutches Are Better Long-Term
The energy advantage of underarm crutches comes with a serious tradeoff: nerve damage. Prolonged pressure on the upper arm and armpit can compress the radial nerve, causing a condition called compressive radial mononeuropathy. This results in weakness, numbness, or a “wrist drop” where you lose the ability to extend your hand. It happens from sustained direct pressure on the upper medial arm or axilla, and improperly used crutches are one of the most common causes.
Forearm crutches eliminate this risk entirely. The support wraps around your forearm with a cuff, keeping all pressure well below the shoulder and armpit. For anyone who needs crutches for months or years, whether due to conditions like multiple sclerosis, cerebral palsy, or permanent lower-limb impairment, this makes forearm crutches the clear choice. People with long-term disabilities who want to stay active or participate in sports typically choose forearm crutches for this reason.
Stability and Maneuverability
Forearm crutches are more stable and easier to use on stairs and uneven surfaces. The forearm cuff keeps the crutch attached to your arm even when you release your grip, which means you can reach for a handrail, open a door, or grab something off a shelf without setting the crutch down. With underarm crutches, letting go means the crutch falls or you have to lean it somewhere.
This hand freedom matters enormously in daily life. Cooking, carrying a bag, pressing an elevator button: forearm crutches let you do these things without a full stop-and-prop routine. They’re also less bulky, making them easier to maneuver in tight spaces like restaurant aisles, public transit, and cars. Throughout Europe, forearm crutches are the standard prescription for nearly all crutch users, while the U.S. has historically defaulted to underarm models, largely out of convention rather than clinical evidence.
Wrist Strain and Joint Pressure
One legitimate concern with forearm crutches is that they place more demand on your wrists and hands. Since you’re gripping and pushing through the handle with every step, long-term users can develop wrist pain or aggravate conditions related to nerve compression at the wrist. Holding something for prolonged periods with the wrist bent forward or backward is a known risk factor for this kind of discomfort.
Proper fitting reduces this risk significantly. When your forearm crutch is correctly adjusted, the handgrip should sit at the natural crease of your wrist when your arm hangs straight. Your elbow should bend about 30 degrees when you hold the grip. The forearm cuff should sit 1 to 2 inches below the bend of your elbow. If the crutch is too short, you’ll hunch and overload your wrists. Too tall, and your shoulders take unnecessary strain. Most crutches are adjustable, but it’s worth taking the time to set them precisely rather than guessing.
Weight and Material Differences
Standard aluminum forearm crutches weigh roughly 0.88 pounds each. Carbon fiber models cut that nearly in half, around 0.48 pounds per crutch. That 0.4-pound difference per crutch may sound small, but when you’re swinging them thousands of times a day, the cumulative effect on fatigue and shoulder strain adds up. Carbon fiber also dampens vibration better, which matters if you’re walking on concrete or rough pavement for extended periods. The tradeoff is cost: carbon fiber crutches run several times the price of aluminum ones.
For short-term users, standard aluminum is fine. If you’re a permanent or long-term crutch user, the lighter weight of carbon fiber can meaningfully reduce the energy cost of getting around, especially since forearm crutches already demand more effort per step than underarm models.
Which Type Should You Choose
For a temporary injury with a recovery window of a few weeks, underarm crutches are easier to learn, less tiring, and widely available at any pharmacy. They’re the practical default for short-term use as long as you avoid resting your weight on the armpit pad (push through the handgrips instead).
For anything longer than a month or two, forearm crutches are the better tool. They protect your nerves, give you more independence with your hands, handle stairs and uneven ground more safely, and are significantly less cumbersome in daily life. The slightly higher energy cost per step is a worthwhile tradeoff for avoiding nerve damage and gaining the kind of mobility that lets you actually live your life rather than just hobble through recovery. If you’re transitioning from underarm to forearm crutches, expect a learning curve of a few days to a week as your arms adjust to the different balance point and grip pattern.