Antiphospholipid syndrome (APS) is an autoimmune thrombophilia characterised by recurrent thrombosis (arterial or venous) or pregnancy morbidity in the presence of persistent antiphospholipid antibodies (aPL): lupus anticoagulant, anticardiolipin antibodies, and anti-beta2-glycoprotein I antibodies. APS causes walking difficulty through thrombotic events -- stroke, DVT, and pulmonary embolism are the most common. APS may occur alone (primary APS) or secondary to SLE or another autoimmune disease (secondary APS).
How APS Leads to Gait Impairment
- Ischaemic stroke: the most common arterial thrombotic event in APS. Results in hemiparesis, spasticity, or cerebellar ataxia depending on stroke location. Walking impairment after APS stroke follows the same pattern as atherosclerotic stroke.
- Deep vein thrombosis (DVT) and post-thrombotic syndrome: DVT of the lower limb causes acute leg pain, swelling, and difficulty walking. Post-thrombotic syndrome (chronic venous insufficiency after DVT) causes chronic limb pain, swelling, and skin changes that limit walking distance.
- Pulmonary embolism (PE): acute PE causes exertional breathlessness that limits walking. Chronic thromboembolic pulmonary hypertension (CTEPH) after PE causes progressive breathlessness and exercise limitation.
- Livedo reticularis and skin necrosis: in severe APS (catastrophic APS), skin necrosis of the lower limbs causes painful lesions that impair weight-bearing.
Walking Cane in APS: By Complication
| APS Complication | Gait Problem | Cane Role |
|---|---|---|
| Ischaemic stroke (hemiparesis) | Asymmetric weakness; spastic gait; foot drop | Contralateral cane; same as post-stroke protocol |
| DVT / post-thrombotic syndrome | Limb pain and swelling; reduced walking tolerance | Contralateral cane offloads affected limb; compression stockings essential |
| PE / CTEPH | Exertional breathlessness; reduced walking distance | Cane reduces metabolic cost per step; extends walking range |
| Catastrophic APS (lower limb involvement) | Skin necrosis; severe pain; weight-bearing limitation | Cane or crutches depending on severity; acute medical emergency takes priority |
Anticoagulation and Walking Safety in APS
All patients with thrombotic APS require lifelong anticoagulation (warfarin or direct oral anticoagulants, DOACs -- noting that DOACs are less well studied in APS). Anticoagulation does not increase fall risk at therapeutic levels, but the consequence of a fall is more significant (longer bleeding time, haematoma risk). A walking cane that reduces fall risk is particularly valuable in anticoagulated APS patients -- preventing falls is more important than in non-anticoagulated individuals.
Explore DaiWalk walking canes. Related: Walking Cane for SLE/Lupus | Walking Cane After Stroke.
