Femoral anteversion is an inward twisting of the thigh bone, also known as the femur (the bone that is located between the hip and the knee). Femoral anteversion causes the child's knees and feet to turn inward, or have what is also known as a "pigeon-toed" appearance. Intoeing is often noticed by parents when their child begins to walk, but it may be present in different aged children for various reasons. The twist in the bone is also what allows children to W-sit.

What causes femoral anteversion?

Femoral anteversion can be the result of stiff hip muscles due to the position of the baby in the uterus or an anatomic twist in the bone that is normal. The bone typically untwists as the child grows but this is a very slow and gradual process.  Femoral anterversion has a tendency to run in families. Typically, a child's walking style looks like that of his or her parents.

When the child is first learning how to walk, femoral anteversion can create an intoeing appearance. As the knees and feet turn in, the legs look like they are bowed. The bowed leg stance actually helps the child achieve greater balance as they stand as it gives them a wider base of support. Balance is not as steady when they try to stand and walk with their feet close together or with their feet turned out. This may cause them to trip and fall.

How is femoral anteversion diagnosed?

The diagnosis of femoral anteversion is made by a history and physical examination by your child's doctor. During the examination, the doctor obtains a complete prenatal and birth history of the child and asks if other family members are known to have femoral anteversion. Generally, X-rays are not necessary.

Treatment for femoral anteversion

Specific treatment for femoral anteversion will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history
• The severity of the condition
• Your child's tolerance for procedures or therapies
• Expectations for the course of the condition

The twisting in of the thigh bone usually improves with time. As the child grows, normal walking patterns typically develop by 7 to 8 years of age.

Most studies have found that braces or special shoes do not help this condition.

Long-term outlook for a child with femoral anteversion

Femoral anteversion has a very good prognosis. Many cases correct themselves as the child grows but this is occurs over the course of several years. On rare occasions, femoral anteversion can be severe and surgery may be required to straighten the thigh bone.  Surgery is typically performed after 10 yeas of age as the femoral anteversion is unlikely to improve after this age.

It is important to know that femoral anteversion typically does not lead to arthritis or any other future health problems and in fact many professional and Olympic athletes have femoral anteversion.