II. Epidemiology
- Femoral Anteversion is most common cause for In-Toeing for school aged children
- More common in girls (2:1)
- Most common onset ages 3-5 years (most severe for ages 4 to 7 years old)
III. Definitions
- Anteverted hip (Femoral Anteversion)
- Femoral head significantly anterior to Femoral neck
- Associated with Toeing-In (normal in young child)
- Antetorsion used to describe abnormal anteversion
- Normal hip
- Femoral head slightly anterior to Femoral neck
- Retroverted hip
- Femoral head posterior to Femoral neck
- Associated with Toeing-Out
IV. Mechanism
- Excessive medial rotation of the femur
- Normal Femoral Neck Anteversion angles
- Adults: 15-25 degrees
- Children
- Age 3-12 months: 39 degrees
- Age 1-2 years: 31 degrees
V. Symptoms
- Standing appearance: "Kissing Patellae"
- Clumsy gait
- Running appearance: "Egg-Beater"
- In-Toeing feet ("Pigeon-Toed")
- Sitting position: "Inverted W"
- Sitting with hips flexed and internally rotated (feet at either side of hips)
- Contrast with most children who would typically sit cross legged
- Does not worsen Femoral Anteversion
VI. Signs
- Observe lower extremity via tunnel view
- Observe child's gait
- See Foot Progression Angle (Gait Rotational Angle)
- Patellae and feet point inward (kissing Patellae)
- Results in a clumsy, Circumduction Gait
- Measure rotation of hip
- See Hip Rotation Evaluation in Children
- Increased internal hip rotation (60 to 90 degrees)
- Decreased external hip rotation (10 to 15 degrees)
VII. Differential Diagnosis
- See Toeing-In
- Infants
- Congenital Hip Dysplasia
- Cerebral Palsy or other neuromuscular disorder
- Toddlers
- Teen and pre-teen
VIII. Diagnosis
- Biplanar Radiography
- Used to Measure Femoral Anteversion
IX. Management
- Watchful waiting until age 8 years
- Avoid non-helpful measures
- Shoe Modifications
- Night splints
- Dennis-Browne splint
- Twister cables
- Passive StretchingExercises
- Physical Therapy
- Femoral Rotational Osteotomy Indications
- Comorbid neuromuscular disease (e.g. Cerebral Palsy) or
- Severe functional Disability at age > 8 (0.1% of cases)
- Femoral Anteversion >50 degrees
- Internal rotation >80 degrees
X. Complications
- Chondromalacia Patellae (Patellofemoral Syndrome)
- No known association with hip or knee Arthritis
- Does not significantly affect Running or walking
XI. Course
- Spontaneously resolves to normal range in 80% of cases by age years
- Unlikely to resolve after age 8 years
- Compensatory lateral tibial torsion may occur
XII. Patient Resources
- Hughston Sports Medicine Foundation
XIII. References
- Pediatric Database Homepage by Alan Gandy, MD
- Hoppenfeld (1976) Physical Exam, Appleton-Lange
- Bates (1991) Physical Exam, Lippincott
- Rerucha (2017) Am Fam Physician 96(4): 226-33 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Congenital Abnormality (T019) |
SnomedCT | 1239002 |
English | Cong anteversion femoral neck, femoral anteversion (___ degrees), femoral anteversion, congenital anteversion of femur (physical finding), congenital anteversion of femur, congenital anteversion of neck of femur, congenital anteversion of neck of femur (diagnosis), Congenital anteversion of femur, Congenital anteversion of femoral neck, Congenital anteversion of femur (disorder), femur; anteversion, anteversion; femur, Congenital anteversion of femur neck, Femoral anteversion |
Dutch | femorale anteversie, anteversie; femur, femur; anteversie |
French | Antéversion fémorale |
German | Anteversion des Femur |
Italian | Anteversione femorale |
Portuguese | Anteversão femoral |
Spanish | Anteversión femoral, anteversión congénita del cuello femoral, anteversión congénita del fémur (trastorno), anteversión congénita del fémur |
Japanese | 大腿骨前捻, ダイタイコツゼンネン |
Czech | Femorální anteverze |
Hungarian | Femoralis anteversio |