Malalignment Syndrome

Malalignment syndrome refers to an asymmetrical alignment of the bones of the pelvis, trunk and extremities that can result in persistent pain in the lower back, hip and legs, with the patient experiencing immense difficulty in turning the body in a particular direction.

There is also asymmetrical tension observed in the muscles, tendons and ligaments followed by asymmetries in weightbearing patterns and in ranges of motion of the head, neck, trunk, pelvis and upper/lower extremity joints.

In the lower extremity, the prevalence of malalignment syndrome causes an asymmetrical orientation wherein one leg undergoes external rotation as the other rotates internally; this leads to a shift in weightbearing resulting in an asymmetry of forces in the lower extremities.

This increases the predisposition of the patient to injuries which are typically associated with pronation and supination; the leg demonstrating external rotation, for instance, has increased tension in structures related to the medial aspect of the leg.

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This also implies increased weightbearing on the medial aspect of the foot which can further aggravate foot conditions such as hallux valgus/rigidus/limitus or plantar fasciitis, on the basis of excess traction caused by calcaneal eversion and a medial arch collapse.

While discussing the aetiology of malalignment syndrome, Wolf Schamberger states it as a developmental problem related to subtle asymmetries in muscle tension that are determined at the level of the spinal tract, brain stem or cortex.

The author further emphasised on acquiring a basic knowledge of sacroiliac joint development, configuration and biomechanics in order to better understand and diagnose asymmetries of the pelvis and spine.

Treatment strategies need to target biomechanical inefficiencies created by malalignment syndrome in the lower extremity kinetic chain; this involves restoring normal structure and function of the spine and pelvis with the use of devices such as orthoses that are designed to realign the body.

The effects of biomechanical foot orthoses on the gait patterns of patients with malalignment syndrome were investigated in detail by Kim et al. using three-dimensional gait analysis on ten patients with the condition.

According to the pelvic kinematic data collected by the authors, foot orthoses were found to reduce pelvic-tilt sidedness in addition to pelvic rotation angle asymmetry, supporting the hypothesis that foot orthoses can correct pelvic asymmetry.

Increases in knee adduction moment and angle were also observed in the patients proving that foot orthoses also help in facilitating axial alignment at the knee and vertical balance over the limb.

Hyperpronation of one or both feet is frequently associated with pelvic instability since the collapse of the medial arch allows the unilateral ilium to rotate anteriorly causing an imbalance of the pelvis.

The resultant anatomical changes include internal rotation of unilateral tibia and femur, pelvic obliquity, increase of sacral base angle, hyperlordosis and spinal curvature.

Excessive pronation of the feet, which starts this abnormal kinetic chain event, can be treated with MASS4D® customised foot orthotics.

By supporting the feet in their optimally corrected posture, MASS4D® foot orthotics help to limit the tibial rotation, quickly reducing the further proximal aberrant arthokinematics that result in pelvic and spinal malalignments.

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