Value of a Grocery Cart and Walker in Identification and Management of Symptomatic Spinal Stenosis in Diabetic Patients Presenting With Peripheral Neuropathy or Claudication

Lumbar spinal stenosis (SS) may produce symptoms similar to and frequently mistaken for diabetic peripheral neuropathy (DPN). Both axial loading (1), as seen with walking, and spinal extension (2), seen in an erect position, decrease the diameter of both the central spinal canal and lateral recesses. Common extremity symptoms include neurogenic-induced claudication (of the legs) and neurogenic positional pedal neuritis (of the feet) (3), and are frequently reduced by flexion of the spine, facilitated by leaning forward on a grocery cart (4) or wheeled walker.

A “Grocery Cart Test” (3) (the comparison of walking distance and time with and without wheeled support) is utilized in our private practice to investigate possible SS in patients presenting with DPN (including walking limitation) or claudication. Of patients later confirmed to have SS, most over 5′4″ reported good improvement (>75%) in uninterrupted walking duration and distance using a grocery cart. Patients with SS under 5′4″ do not consistently improve with a grocery cart (42″ handle), and those under 5′2″ do not consistently improve with a standard-size walker (34″ handle), as they do not necessarily flex the spine to hold the handle. A shorter walker (cut down to a 30″ handle) provided improvement for shorter patients (4′10″ to 5′2″). We noted that to maximize flexion, some patients rest their forearms on the transverse bar of a grocery cart handle, something not possible with a walker with two separate handles. Our patients with classic arterial claudication symptoms, including relief of claudication by standing and the ability to stand erect without extremity symptoms, did not improve significantly (>50%) with the cart.

This appears to be a useful screening method to identify symptomatic SS in patients presenting with DPN or claudication. It is also an effective guide to educate patients regarding the effect of spinal mechanics on their activity level, and can assist in convincing appropriate patients to accept the use of a walker as part of their lifestyle. Many patients subsequently reported a greatly increased activity level and freedom of movement after using a three- or four-wheeled walker of an appropriate height, and some reported reduced neuritic pain. Clinical use of this information and further investigation is indicated.