Miserable malalignment is a specific combination of rotational deformities in the leg that may lead to patellar (kneecap) pain and instability.
What is miserable malalignment?
In this condition usually the femur is rotated outwards, but the tibia rotated inwards, and the kneecaps face towards one another (squinting or winking patellae). There is excessive force on the patella towards the lateral side. From the front, if the feet are aligned together the kneecaps appear to 'squint' towards one another, and if the kneecaps are aligned together, the feet are forced to turn outwards.
How is miserable malalignment managed?
Most cases are managed without surgery. Surgery, when indicated, is usually a de-rotation osteotomy of femur, tibia of both.
Bilateral double osteotomy in severe torsional malalignment syndrome: 16 years follow-up. Leonardi F, Rivera F, Zorzan A and Ali. SM J Orthop Traumatol. 2014 Jun; 15(2): 131–136.