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Ask the Experts
Patellar malalignment is a translational or rotational deviation of the patella to any axis, associated with several soft-tissue and osteochondral abnormalities and mostly characterised by a tilted and lateral displaced patella 
Malalignment will show the lower leg bone rotating outward with little to no inward rotation; the upper portion of the leg rotates in, with little or no outward rotation. Dr. Williams may also order x-rays and an MRI to determine if there is an injury to the bone or soft tissue within the knee.
Symptoms of Malalignment
Symptoms of Miserable Malalignment Syndrome include
- Knee Pain.
- Pain under the patella.
- Knee Join stiffness.
- Excessive grinding, popping, and clicking sounds on knee flexion.
- Knee joint giving out painfully.
- Knee does not lock or catch.
- Lower back pain predominantly affecting one side.
- Medial ankle and arch pain.
Causes & Effects
Risks of wearing
- Discomfort wearing the brace. A knee brace can feel heavy, bulky and hot at first. Poor fit can cause it to slip.
- Skin irritation or swelling. The skin under the brace might become red and irritated if your knee brace fits poorly. Some people also have swelling around the joint.
- Lack of benefit. Studies of knee braces for people with osteoarthritis have been limited, and results have been mixed. Some people see no benefit. Others report diminished pain and increased function.
- Stiffness. Wearing a brace can cause the wearer to treat the braced knee as injured and favor the other knee, which could contribute to joint stiffness.
Malalignment Treatments of Dr. Raviprakash
Some of the advantages of malalignment include
- Less stress on the bone and implant- FEA model showed neutral alignment significantly decreases stress at the bone, compared with varus alignment. High stress at the tibial bone would be a risk for tibial collapse. Varus alignment also increases contact stresses on the polyethylene, increasing wear of polyethylene insert
- Decreasing lift-off motion- As lift-off motion of the femoral component possibly increases wear of the articular surface, it should be avoided after TKA. Joint laxity theoretically increases the risk of lift-off motion, but alignment is another important factor. Hamai et al evaluated the effect of static knee instability by stress radiography on dynamic lift-off motion in fluoroscopy; the static varus–valgus laxity on the stress radiograph did not influence lift-off.
- Acceptable postoperative symptoms- Nishida et al reported postoperative function with neutral alignment group was better than mild valgus and severe varus group (Knee Surg Sports Traumatol Arthrosc, 2016). Our recent computer analysis also showed abnormal kinematics in the valgus-aligned knees. In our clinical survey, varus postoperative alignment negatively correlated with the satisfaction.
Oftentimes, you’ll be able to see some sort of exterior mishapeness, like bowing of your ankle even when standing straight. Even if you can’t spot the inward slump, a keen-eyed podiatrist likely will. Other times, an x-ray is needed to see the trouble that’s forming beneath the surface.
Most of the time foot malalignment is the cause of genetics or overuse. If you have arthritis, for example, this can lead to alignment issues. Or, if you damaged your ankle or foot and it didn’t heal properly, a sprain or fracture could affect your gait. Even athletes without proper technique can cause chronic injuries that lead to malalignment issues within the foot and ankle— and consequently, throughout the entire body.
A podiatrist should be able to tell if you have misaligned feet with a quick MRI. Unfortunately, this isn’t a condition that can heal itself or get better with time— in fact, it’ll only get worse. Those who suffer from pain can use a temporary Band-Aid: Orthotics. These custom-fitted shoe inserts can help to stabilize your ankle bone, but at the end of the day, your sinus tarsi remain collapsed. For many, corrective surgery is the only option, where a stent is inserted to stabilize the ankle bone and grant you a normal range of motion. Most procedures are noninvasive and you’ll only need to rest for a few days before you’re back on your feet— literally.
Rest: If you’ve had an injury such as a sprain, you should stay off your feet for a while. Talk to your provider about how long you should rest. Crutches or a walking boot can help you get around without putting weight on your ankle.
Ice: To reduce swelling, apply ice or a cold compress to the area for 15 to 20 minutes every few hours.
Compression: Ask your provider about wrapping an elastic bandage around your ankle to reduce inflammation. Be careful not to wrap it too tight.
Elevation: Resting with your ankle elevated above your heart reduces swelling. You can also try to sleep with your foot elevated at night.
Supportive footwear: Make sure your shoes provide adequate support for your feet and ankles. Avoid flip-flops, sandals and shoes that are too loose. It’s especially important to wear proper footwear when playing sports. Activities such as basketball and volleyball can lead to ankle injuries, especially without the right footwear.