The purpose of this video is to showcase an isolated distal tibial derotational osteotomy that is sufficient in ameliorating the effects of a tibial torsional abnormality alone or in conjunction with additional lower extremity malalignments in children. Furthermore, this video will explore the use of the term “miserable malalignment syndrome,” broadening the traditional classification to pursue a more flexible and standardized description. This video will examine a 12-year-old girl who exhibited tripping and clumsiness. A physical examination showed bilateral internal tibial torsion, bilateral femoral anteversion, genu valgum, and excessive intoeing on the right lower extremity causing tripping. Findings of initial radiographs of the tibia were normal. The patient was indicated for surgery to address her problem. A right distal tibial derotational osteotomy was performed and internally fixated using percutaneous Steinmann pins, which avoids revision surgery to remove hardware without compromising the quality of the osteotomy. This video questions the scope of the term “miserable malalignment syndrome” and presents an interesting perspective on the interaction between rotational and angular deformities.