Vasculitis encompasses a heterogeneous group of conditions characterised by inflammation of blood vessel walls. When vasculitis affects vessels supplying the lower limbs or the peripheral nervous system, it can cause gait impairment and fall risk requiring walking aid support. This article covers systemic vasculitides with musculoskeletal or neurological limb involvement -- specifically polyarteritis nodosa (PAN) and granulomatosis with polyangiitis (GPA, formerly Wegener granulomatosis).
How Vasculitis Affects Walking
Vasculitis impairs walking through several distinct mechanisms:
- Mononeuritis multiplex: A characteristic neurological complication of vasculitis (especially PAN) in which multiple individual peripheral nerves are damaged by ischaemia from small vessel inflammation. The result is patchy motor and sensory loss -- one foot may have a foot drop, another area may have reduced sensation, creating an asymmetric and unpredictable deficit pattern
- Lower limb ischaemia: Larger vessel vasculitis can reduce blood flow to the leg muscles and feet, causing claudication-like pain and weakness on walking
- Arthritis: Many vasculitides include joint inflammation as a component -- GPA, for example, can cause arthralgia and arthritis
- Medication effects: High-dose corticosteroids used to treat vasculitis cause proximal muscle weakness (steroid myopathy), further impeding gait. See the dedicated article on steroid-related walking changes
- Fatigue: Systemic inflammation in active vasculitis causes profound fatigue that limits walking endurance independently of pain or weakness
Mononeuritis Multiplex and Cane Use
Mononeuritis multiplex deserves specific attention because its pattern is asymmetric and variable. One patient may have a left peroneal nerve palsy (foot drop on the left) and reduced sensation in the right calf -- a combination that creates an unusual gait requiring individual physiotherapy assessment.
Key points for cane use in mononeuritis multiplex:
- Foot drop from peroneal nerve involvement requires high foot clearance -- the cane tip should be placed before the affected foot comes forward to provide stability during the swing phase when the foot cannot dorsiflex
- Sensory loss affects proprioception -- the cane provides a supplementary ground-contact proprioceptive signal
- The pattern can change as vasculitis is treated (or as new vascular events occur) -- cane technique may need regular reassessment
GPA (Granulomatosis with Polyangiitis) and Walking
GPA (formerly Wegener granulomatosis) is an ANCA-associated vasculitis primarily affecting the upper and lower respiratory tract and kidneys. Musculoskeletal involvement in GPA includes:
- Arthralgia and arthritis -- joint pain impairs walking
- Peripheral neuropathy from vasculitic nerve involvement
- Significant fatigue during active disease and during immunosuppressive treatment
- Subglottic stenosis may cause exercise intolerance that limits walking endurance regardless of limb function
Vasculitis Conditions and Cane Use Summary
| Vasculitis Type | Primary Walking Impairment | Cane Indication |
|---|---|---|
| Polyarteritis nodosa (PAN) | Mononeuritis multiplex, ischaemia | Asymmetric deficit, foot drop |
| GPA (Wegener) | Arthritis, neuropathy, fatigue | Pain, balance during active disease |
| Eosinophilic GPA (Churg-Strauss) | Peripheral neuropathy, fatigue | Sensory loss, balance support |
| All vasculitides on high-dose steroids | Proximal myopathy | Leg weakness support, fall prevention |
Explore the DaiWalk cane collection. Related: Walking Cane and Steroids | Walking Cane for Peripheral Neuropathy
