Femoral Anteversion | Symptoms and Causes

LIke ThisLIke ThisLIke ThisLIke ThisLIke This

Contact the Lower Extremity Program

  • 617-355-6021
  • International: +1-617-355-5209
  • Visit our Locations

The normal hip joint

The hip joint is one of the body's most reliable structures, providing movement and support without pain or problems in most people for a lifetime. The hip’s simple ball-and-socket anatomy—with the ball-shaped femoral head rotating inside a cup-shaped socket called the acetabulum—usually works well with amazingly little friction, and little or no wear. In toddlers and young children, walking with pigeon-toes is a normal part of your baby's hip and walking development, even when it’s caused by femoral anteversion. The anteversion usually straightens itself out as a baby learns to walk.

Anatomy of the hip jointWhat is femoral anteversion?

Femoral anteversion is an in ward twisting of the thigh bone (called the femur—the bone located between the hip and the knee). The condition causes your child's knees and feet to turn inward and have a "pigeon-toed" appearance.

Because your child’s knees and feet turn in, her legs look like they’re bowed. This bowed leg stance actually helps her achieve greater balance as she stands. Her balance is unsteady when she tries to stand and walk with her feet close together or with her feet turned out, so she may trip and fall quite a lot.

When does femoral anteversion become obvious?

Femoral anteversion usually shows up when a child is between 2 to 4 years old, since inward rotation from the hip tends to increase during that time. The condition is at its most obvious when a child is age 5 to 6 years old.

What causes femoral anteversion?

Femoral anteversion is usually considered to be a developmental variant, and the reasons for excessive femoral anteversion in some are unknown. The majority of patients are normal.

What are the signs and symptoms of femoral anteversion?

   •   pigeon-toed walking—the child is unable to walk with her feet close together and legs straight 
   •   running with legs swinging out
   •   tripping and falling often
   •   sitting in a “W”-shaped position, with the child’s knees bent and her legs splayed out behind her

How common is femoral anteversion?

As the most common cause of kids walking with toes pointing inward (in-toeing) after age 3, femoral anteversion occurs in up to 10 percent of children.

How serious is femoral anteversion?

For the vast majority of children with femoral anteversion (some experts estimate as high as 99 percent), the condition usually self-corrects and normalizes by adolescence. Very few cases are severe enough to need surgery.

Do splints, braces or special shoes help correct femoral anteversion?

No, studies show that these devices don’t usually lead to faster improvement of this condition.

Who’s at risk for developing femoral anteversion?

   •   Most cases of femoral anteversion are sporadic (by chance) with no clear reason.
   •   There’s some evidence that femoral anteversion may be more common in girls than boys.
   •   Rarely some babies may be born with femoral anteversion (congenital).

For parents and patients

show_more_start

Should I be concerned with my baby's progress in walking?

Walking with pigeon-toes is a normal part of your baby's walking progress, even when caused by femoral anteversion, which should straighten itself out as your baby learns to walk. If it doesn't by the time she’s about 4 years old, consult your baby's doctor.

Is my child in pain?

No, femoral anteversion doesn’t usually cause a child any pain. 

What should I ask my child's doctor?

Some of the questions you may want to ask include:

   •   Could you describe what’s wrong with my child’s leg(s)?
   •   Are other tests needed to confirm this diagnosis?
   •   Is there, or could there be, damage to her tissues or blood vessels?
   •   Does my child need treatment? Does she need surgery? 
   •   Will femoral anteversion affect her growth plate or the normal growth of her leg?
   •   Could there be long-term effects? Pain? Arthritis? 
   •   Could this condition affect my child’s ability to walk, run or play sports?
   •   How long should my child be followed by her care team?

If my child has femoral anteversion in one femur, can she develop it on the other side, too?

Femoral anteversion often develops symmetrically in both thigh bones, although it can develop on just one side.

If my child has femoral anteversion, is she at risk for early arthritis?

No, femoral anteversion typically does not lead to arthritis or any other future health problems.

show_more_end

When to seek medical advice for femoral anteversion

Contact your child’s doctor if she:

   •   walks with a pigeon-toed gait
   •   can’t walk with her feet close together and legs straight 
   •   runs with her legs swinging out 
   •   trips and falls more often than her peers
   •   likes to sit in a “W”-shaped position, with her knees bent and her legs flung out behind her

Complications

Surgery for femoral anteversion is uncommon because most of the time it goes away on its own. But if it’s needed for severe cases, the vast majority of surgeries for femoral anteversion at Children’s are successful and occur without major complications. After surgery, patients are at a very small risk for infection, bleeding or poor bone healing (malunion).

Femoral anteversion glossary

show_more_start

   •   acetabulum: hip socket; a part of the pelvis

   •   arthritis (osteoarthritis): joint inflammation and damage, resulting in pain, swelling, stiffness and limited
       movement. Arthritis can occur when a joint’s cushioning cartilage wears away. Femoral anteversion doesn’t typically
       lead to arthritis. 

   •   Hale Family Center for Families: dedicated to helping families find the information, services
       and resources they need to understand their child’s medical condition and take part in their care

   •   cartilage: smooth, rubbery tissue that cushions the bones of a joint and other areas; allows the bones to move
       easily without pain

   •   congenital: present at birth

   •   CT scan: a diagnostic imaging test that uses x-ray equipment and powerful computers to create detailed,
       cross-sectional images of your child's body

   •   diagnosis, diagnostics: identifying disease or injury through examination, testing and observation

   •   femoral anteversion: an inward twisting of the thigh bone, causing a “pigeon-toed” gait

   •    femoral derotation osteotomy: a surgical procedure for severe cases of femoral anteversion, in which the
        surgeon cuts the femur, rotates the ball of the femur in the hip socket to a normal position, and reattaches the bone.

   •   femoral head: round-headed top of the thigh bone (femur)

   •   <><>the thigh bone, the longest and strongest of your child’s bones. The rounded top of the femur (femoral head)
       joins the hip socket (acetabulum) to form the hip joint<>

   •   in-toeing: walking with toes pointing inward; femoral anteversion is a the most common cause of a child’s
       in-toeing beyond the age of 3
 
   •   MRI (magnetic resonance imaging):a diagnostic imaging test that uses a combination of large magnets,
       radio frequencies, and a computer to produce detailed images of organs and structures within the body

   •   onset (of signs or symptoms): the first appearance of signs or symptoms 

   •   open reduction surgery: a procedure in which the doctor repositions the thigh bone through an incision into
       the patient’s body

   •   orthopedic surgeon, orthopedist: a doctor who specializes in surgical and non-surgical treatment of the
       skeletal system, spine and associated muscles, joints and ligaments

   •   orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders
       and injuries to the spine, skeletal system and associated muscles, joints and ligaments

   •   sporadic: by chance

   •   W" shaped sitting position:child sits with knees bent and legs spread out behind her; sitting position often
       adopted by children with femoral anteversion

   •   x-raysa diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues,
       bones, and organs onto film

See our extensive glossary of orthopedic terms. 

show_more_end

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

Close