Malalignment Syndrome

Unexplained pain in the spine, hip, knee and/or foot pain may be attributed to a condition called malalignment syndrome. Symptoms can include uneven shoulders, and it often leads to discomfort and instability in various parts of the body. If you're experiencing such symptoms, seeking professional evaluation is crucial for accurate diagnosis and tailored intervention.

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Malalignment Syndrome is a common condition often observed in Singaporean patients, colloquially referred to as ‘miserable malalignment syndrome’ due to its recurrent nature and discomfort. This condition spans across various age groups, with a significant number of patients below the age of 18 seeking to address this concern. If it is addressed at a young age, this condition can be eliminated entirely through correct guidance and care. In adults, the symptoms can be effectively managed, leading to massive improvement in the quality of life and potentially avoiding the need for surgical intervention.

Symptoms and Risk Factors

  • Anterior rotation of the hip, causing spinal imbalance that may lead to scoliosis in growing children
  • Internal rotation of the femur (thigh bone) at the knee joint level
  • Inward facing patella/kneecap
  • Upper leg and knee in a "knock-knee" position, the lower leg (tibia and fibula) rotate outward
  • Feet flatten on the medial arch because of the excessive medial forces

These changes significantly affect the position, movement, and function of the knee joint. The longer the condition is left unaddressed, the more pain and discomfort patients may experience. Prolonged repetitive motion in this misaligned position creates uneven pressures on the knee joint, resulting in irreversible damage to the underlying articular cartilage.

As a result, pain becomes more pronounced after years of walking in this misaligned position.

Malalignment syndrome can occur in one or both knees and has a progressive effect from the feet to the spine. It can affect both less physically active individuals and those with highly active lifestyles. People with uneven muscle tightness across their body or those exposed to repetitive forces on the knee joint, such as during lunges and squats, are at a higher risk of developing this condition.

Left unaddressed, the likelihood of ongoing patellar joint dislocation and arthritic deterioration of the joint increases. Injuries to the knee joint resulting from conditions like meniscus tears, patellar tendonitis, patellar degeneration, or osteoarthritis can also contribute to malalignment syndrome, as the body adjusts its natural gait to compensate and offload the injured area.


Malalignment syndrome is diagnosed through a comprehensive evaluation that includes a detailed symptom history, clinical examination, and gait assessment. If there is a suspicion of joint damage, x-rays may be ordered to assess the specific extent of damage, particularly in the knee, ankle, mid-foot, or big toe joints.

How can it be managed?

Podiatric interventions are specifically designed to stabilise the lower limbs through the use of custom foot orthotics or ankle-foot orthotic devices. Therapies and podiatric modalities used to reduce pain, calcifications/spurring and to increase the healing of joints to help improve the patient’s quality of life.

For individuals wishing to continue sports or maintain a high level of physical activity, it is vital to note that making a few minor changes combined with conscious efforts during the workout, can significantly aid in the recovery process.

In cases where therapy and conservative options fail to alleviate pain or improve the overall condition, surgical intervention may be recommended as a last resort.

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Common Symptoms

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
Numbness, tingling, shooting or burning pains in the leg or foot
Bunion formation on one foot

How It Looks Like

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"I had warts on my feet which spreaded to my fingers and I came here to get them managed. It didn’t take very long for them to go away, which I’m thankful for. Towards the end of my management, I also found out that I had flat feet. I thought the pain I experienced before was normal from working long hours in the retail industry, but it really wasn’t. I also discovered that my legs were of different lengths, which affected my walking and could potentially cause problems for other parts of my body such as my spine. It was quite worrying for me, but the podiatrists were very educative and assuring towards the issues. I got my first pair of insoles and after I wore them over a few days, I came to realize that I didn’t experience pain and my feet didn’t feel super sore after a long day of walking. It has been a year since I got them, and till this day, I haven’t experienced any major problems in my feet and in my walking. Thankfully, this place was suggested to me to fix my warts and help me acknowledge that I also had flat feet instead of going to clinics or hospitals to get them managed. They are very informative and can guarantee quality products and services to help you live comfortably. It was a great experience and a fruitful journey towards recovery for me, and I hope that many who are not well-informed about pain of any sort in their feet will come down to East Coast Podiatry."


Our Podiatry Care Strategy

100% non-invasive methods

A lower limb specialist, such as a podiatrist, will be able to perform a thorough foot assessment using diagnostic tools, such as a musculoskeletal diagnostic ultrasound to determine the source of your foot pain. If surgery is required, your podiatrist will refer you to a trusted foot and ankle doctor for surgical solutions.

A thorough assessment

Immobilising the area with splints

Utilising technological therapies

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Georgina Tay
Senior Podiatrist & Head of Department

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