The Department of Orthopaedic Surgery

Pediatrics

Femoral anteversion angle shown above. An excessive angle is found in the condition called "femoral anteversion." The graph shows that this angle decreases in normal children as they grow older.

Patient Guide to Femoral Anteversion

What is "femoral anteversion?"

The femur is the long bone that goes from the hip to the knee. "Anteversion" literally means "leaning forward." Femoral Anterversion is therefore a condition in which the femoral neck leans forward with respect to the rest of the femur (see diagram). This causes the lower extremity on the affected side to rotate internally (i.e. the knee and foot twists towards the midline of the body). Because some degree of rotation of the femur is always present as kids grow, it is considered abnormal only if it is significantly different from the average value of a patient of the same age.

How common is femoral anteversion?
It is very common and can occur in up to 10% of children. Femoral anteversion is the most common cause of children walking with their toes inward (in-toeing) in children older than 3 years of age.

What are the signs and symptoms of femoral anteversion?

A parent might notice that his or her child is walking with the toes turned inward. A child might also trip or fall more commonly than normal children. Parents are usually most worried about the appearance of the child's leg while walking or running. A child rarely has pain.

A doctor can be helped in diagnosing femoral anteversion if there is another family member who is or was affected by the condition. The doctor also looks to see if the patella is turned inward (toward the midline of the body). He or she will also watch to see if the child walks with the toes inward.
What causes femoral anteversion?

It is a developmental abnormality. This means that when the affected limb is growing in the fetus, the femur develops with an abnormal rotation. The exact mechanism is not known, but it is thought that genetic factors and the position of the fetus in the uterus can cause incorrect rotation.

What is the treatment of femoral anteversion?

The normal child is born with 40 degrees of femoral anteversion. This gradually decreases to 10 to 15 degrees at adolescence and generally improves with further growth. Therefore, no treatment is necessary if the anteversion is within this normal range. A doctor will explain the condition very carefully to parents who have a child with an abnormal amount of anteversion. He or she also will explain why it causes in-toeing and that this usually normalizes with time. Studies have shown that night splints and special shoes do not help in this condition.

Is surgery ever needed?

Surgery is only indicated if the anterversion is over 50 degrees and the child is at last 8 years of age. Waiting allows the family and dotors to see if the anteversion decreases naturally. This occurs in 99% of cases.

The only surgical treatment currently used is called a "femoral derotation osteotomy." The pediatric orthopaedic surgeon intentionally cuts the femur, rotates it, and then fixes it in a more correct anatomical position. The surgery should only be used in the more severe cases and in the older child.

How will my child with Femoral Anteversion do long term?

As stated above, the anteversion usually corrects itself by early adolescence. The prognosis is generally good. There is good evidence to show that these children do not have an increased risk of hip or knee arthritis or athletic difficulty later in life.

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