Ankylosing spondylitis (AS), now more commonly classified as axial spondyloarthritis (axSpA) when including the non-radiographic form, is a chronic inflammatory arthritis primarily affecting the sacroiliac joints and spine. Over time, persistent inflammation leads to new bone formation and progressive fusion of the spinal vertebrae -- the process called ankylosis. The resulting spinal rigidity and postural changes have specific implications for walking aid selection that differ from most other arthritis conditions.
How Ankylosing Spondylitis Affects Gait
AS affects walking through structural spinal changes and associated features:
- Thoracic kyphosis: Progressive forward stooping of the thoracic spine is a classic AS feature. As the thoracic spine fuses in a kyphotic position, the patient leans increasingly forward, shifting the centre of gravity and altering balance
- Reduced lumbar mobility: The lumbar spine loses its normal flexibility. Activities that require lumbar extension or rotation -- including many natural gait compensations -- are restricted
- Hip involvement: Hip arthritis (coxitis) occurs in a significant proportion of AS patients and can severely impair gait. Hip involvement in AS is associated with worse functional outcomes
- Enthesitis: Inflammation at tendon insertions (heel, Achilles, plantar fascia) causes foot and ankle pain that directly affects push-off and standing tolerance
- Fatigue: Chronic systemic inflammation causes significant fatigue
Postural Change and Cane Height in AS
The progressive thoracic kyphosis in AS creates a specific cane height challenge. As the patient leans increasingly forward, the vertical distance from the wrist to the floor changes relative to height. A cane calibrated for normal standing posture may be too long for the patient actual functional standing position.
Recommendation: in AS with significant kyphosis, cane length should be measured with the patient in their actual standing posture (kyphotic, forward-lean), not the upright posture assumed in standard cane length tables. The DaiWalk cane length calculator uses wrist crease measurement -- this is the correct approach for AS.
Biologics and AS Walking Improvement
TNF inhibitors (adalimumab, etanercept, infliximab) and IL-17 inhibitors (secukinumab, ixekizumab) have transformed AS management. In patients with significant inflammatory activity, biologic therapy can substantially reduce pain, fatigue, and morning stiffness -- improving walking capacity. However, structural changes (existing spinal fusion, hip damage) do not reverse with biologic treatment. Walking aid need may reduce in the inflammatory component but persist for the structural component.
AS and Cane Use: Summary
| AS Feature | Walking Impact | Cane Consideration |
|---|---|---|
| Thoracic kyphosis | Forward posture, balance shift | Cane length measured in functional posture, not upright |
| Hip coxitis | Severe gait impairment, limping | Contralateral cane; hip replacement common in severe cases |
| Enthesitis (heel, plantar) | Foot pain, reduced push-off | Cane reduces push-off demand; footwear primary |
| Fatigue | Reduced walking endurance | Energy economy over distance |
| Biologic-controlled inflammation | Reduced pain and morning stiffness | Cane need may reduce; structural damage component persists |
Explore the DaiWalk cane collection or use the cane length calculator. Related: Walking Cane for Rheumatoid Arthritis | Walking Cane for Psoriatic Arthritis
