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Reciprocally linked orthoses used for paraplegic walking have some form of linkage between the two hip joints. It has been assumed that flexion of the swinging leg is driven by extension of the stance leg. The aims of this study were to investigate the moments generated around the hip joint by the two cables in a Louisiana State University Reciprocating Gait Orthosis (LSU-RGO). Six (6) subjects were recruited from the Regional Spinal Injuries Centre at Southport, who were experienced RGO users. The cables were fitted with strain gauged transducers to measure cable tension. Foot switches were used to divide the gait into swing and stance phases. A minimum of 20 steps were analysed for each subject. Moments about the hip joint for each phase of gait were calculated. There were no moments generated by the front cable in 4 of the subjects. In only 2 subjects did the cable generate a moment that could assist hip flexion during the swing phase. These moments were very low and at best could only have made a small contribution to limb flexion. The back cable generated moments that clearly prevented bilateral flexion. It was concluded that the front cable, as used by these experienced RGO users, did not aid flexion of the swinging limb.

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A 50-yr-old man arrived at our department for a rehabilitation prescription after a right knee medial collateral ligament sprain. Magnetic resonance imaging showed medial collateral ligament partial rupture and medial femoral condyle increased signal intensity indicating bone edema. After treatment, the patient still complained of weight-bearing knee medial compartment pain. A lateral wedged insole was prescribed to decrease medial compartment compression forces. Initial response to insole use was good, but soon after, the patient complained of severe worsening knee pain. On examination, the lateral joint line and condyle palpation were tender. Insole use discontinuation was recommended, and another magnetic resonance imaging scan was performed. It showed an high T2-weighted signal intensity, representing bone marrow edema comprising a volume of 5 x 5 x 4.5 cm of lateral femoral condyle. Discontinuation of orthosis use relieved the pain, and the edema disappeared. To our knowledge, lateral femoral condyle painful bone marrow edema after lateral wedged insole use has not been previously described. The findings of this case report indicate that lateral wedged insole prescription should be carefully evaluated.

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