Paget disease of bone (osteitis deformans) is a disorder of bone remodelling causing abnormally accelerated bone turnover, resulting in bone that is larger, weaker, and more vascular than normal. The pelvis, lumbar spine, femur, skull, and tibia are the most commonly affected sites. Paget disease is most prevalent in people over 55. The walking cane implications arise from the bony deformity, pain, pathological fracture risk, and complications including secondary osteoarthritis of adjacent joints.
Paget Disease Features Affecting Walking
| Paget Feature | Walking Impact | Cane Role |
|---|---|---|
| Tibial or femoral bowing | Altered leg mechanics; fall risk; limb length discrepancy | Cane compensates for altered gait; may need shoe raise |
| Hip joint involvement | Secondary OA of hip; pain with weight-bearing | Contralateral cane reduces hip loading; same as hip OA |
| Lumbar spine involvement | Stenosis from enlarged vertebrae; neurogenic claudication | Cane for claudication; forward-lean rest position |
| Pathological fracture risk | Subacute fractures in bowing tibiae; pain; acute fracture risk | Cane reduces loading on affected bone; fall prevention critical |
| Bone pain (active Paget) | Deep bone pain; worse at night and with weight-bearing | Cane reduces weight-bearing through painful bone |
Bisphosphonate Therapy and Cane Need
Bisphosphonate therapy (zoledronic acid, risedronate) is the standard treatment for active Paget disease. Effective bisphosphonate therapy suppresses bone turnover markers, reduces pain, and may slow disease progression. Pain from Paget disease often improves significantly with treatment. Cane use should be reassessed after a full bisphosphonate treatment course -- pain reduction may eliminate the need for a cane that was used during active, symptomatic disease.
Incomplete Fracture in the Tibial Cortex
A characteristic complication of tibial Paget disease is an incomplete fracture on the convex surface of the bowed tibia -- a lateral cortex stress fracture visible on X-ray as a lucent cleft. This is a high-risk site for progression to complete fracture, particularly with loading. A cane reduces tibial loading during walking and is part of the conservative management strategy for incomplete Paget fractures. If the fracture site is at high risk of progressing, a period of crutch use may be more appropriate than a cane.
Explore DaiWalk walking canes. Related: Walking Cane for Stress Fracture | Walking Cane for Hip Osteoarthritis.
