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Axial Malalignment – Causes, Symptoms and Treatment

Axial malalignment refers to an abnormal alignment of bones, joints, or the spine that can cause pain, restricted movement, and accelerated joint wear.

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Things worth knowing about "Axial Malalignment"

Axial malalignment refers to an abnormal alignment of bones, joints, or the spine that can cause pain, restricted movement, and accelerated joint wear.

What Is Axial Malalignment?

Axial malalignment describes an abnormal or deviated positioning of bones, joints, or body axes compared to their anatomically correct orientation. It can affect individual bones, entire limbs, the spine, or the pelvis. Malalignments may be congenital or acquired throughout life and can occur at any age.

Causes

The causes of axial malalignment are diverse:

Congenital deformities: Genetically determined skeletal development disorders, such as clubfoot or hip dysplasia.
Growth-related causes: In childhood, growth disorders such as rickets or uneven bone development can lead to malalignment.
Injuries: Poorly healed fractures can result in permanent malalignment.
Degenerative conditions: Osteoarthritis or osteoporosis can gradually alter bone and joint axes over time.
Inflammatory diseases: Conditions such as rheumatoid arthritis can permanently affect joint alignment.
Muscular imbalances: One-sided strain, lack of movement, or a weakened postural apparatus can promote malalignment of the spine and extremities.

Common Forms

Genu varum (bow legs): The knee joints deviate outward.
Genu valgum (knock knees): The knee joints deviate inward.
Scoliosis: Lateral curvature of the spine.
Kyphosis / Lordosis: Excessive forward or backward curvature of the spine.
Hallux valgus: Outward deviation of the big toe.
Pelvic tilt: Unequal height of the two halves of the pelvis.

Symptoms

Symptoms depend on the affected body region and the severity of the malalignment. Common complaints include:

Pain in joints, muscles, or the spine
Restricted range of motion
Increased joint stress and premature wear
Compensatory postures and movement patterns
Muscle tension and weakness
In advanced cases: nerve compression causing numbness or tingling

Diagnosis

Diagnosis of axial malalignment typically involves:

Clinical examination: Assessment of posture and gait by an orthopedic specialist or physiotherapist.
Imaging: X-rays for precise measurement of axis deviation. In complex cases, a CT scan or MRI may be required.
Gait analysis: Digital gait analysis to assess loading patterns and biomechanical deviations.

Treatment

Treatment depends on the type, severity, and underlying cause of the malalignment, as well as the age of the patient:

Conservative Treatment

Physiotherapy: Targeted exercises to strengthen muscles and correct postural imbalances.
Orthopedic aids: Insoles, orthoses, or specially designed footwear for relief and correction.
Pain management: Use of analgesics or anti-inflammatory medications to relieve symptoms.

Surgical Treatment

Corrective procedures: In severe cases, surgical interventions such as corrective osteotomies (controlled bone cutting and realignment) may be necessary.
Joint replacement: In advanced cases with significant joint degeneration, joint replacement surgery (endoprosthesis) may be required.

Prevention

While not all malalignments can be prevented, the following measures may reduce the risk:

Regular physical activity to strengthen postural muscles
Ergonomic working conditions and proper lifting technique
Appropriate footwear
Early treatment of injuries and growth disorders in childhood
Adequate intake of calcium and vitamin D to support bone health

References

Wirth, C. J. et al. (Eds.) - Praxis der Orthopädie und Unfallchirurgie, Thieme Verlag, 4th edition (2014).
German Society for Orthopaedics and Orthopaedic Surgery (DGOOC) - Guidelines for the Diagnosis and Treatment of Lower Limb Malalignment (2022).
Hefti, F. - Kinderorthopädie in der Praxis, Springer Verlag, 3rd edition (2015).

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