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Detailed information of FEMORAL ANTEVERSION
FEMORAL ANTEVERSION
DEFINITION:
A skeletal disorder characterized by excessive medial rotation of
the femur resulting in in-toeing.
EPIDEMIOLOGY:
- incidence: ?
- age of onset:
- at ambulation with peak in-toeing between 3-6 years of age
- risk factors:
PATHOGENESIS:
- torsion is a rotational deformity where there is a twisting
of a bone along its longitudinal axis
- the rotational deformitiy may be lateral or medial and in
the lower limbs may involve the femur or tibia
- Medial Femoral Torsion (Femoral Anteversion) and Medial
Tibial Torsion are two common causes of in-toeing in children
- age dependent foot progression angle, medial rotation, and
lateral rotation graphs are available (Nelsons, p.1699; Ped.
Clinics of North America 33: 1373 (1986)
2. Femoral Anteversion
- excessive femoral anteversion is a common cause of in-toeing
particularly in those older than 3 years of age
- may be associated with Medial Tibial Torsion
CLINICAL FEATURES:
- thighs, knees, patellae, and feet are rotated inward
2. Gait
- clumsy, in-toeing or "pigeon-toed"
3. Sitting
- "inverted W position" - child sits with hips flexed and
internally rotated
- this sitting posture does not cause or worsen the femoral
anteversion
2. Signs
- angle between the line of walking progression and the long
axis of the foot
- a positive value between 5-10 degrees is normal
- a negative value suggests in-toeing
2. Medial Rotation of the Hips
- examine the child in the prone position (on stomach) with
the knees bent or in the supine position (on back) with the
legs dangling off the edge of the examining table - push
ankles away from the midline:
- normal angle <70 degrees
- angle >70 degrees suggests excessive medial rotation of
the hips & is consistent with femoral anteversion
3. Lateral Rotation of the Hip
- position child as above
- push the ankles away from the midline:
- normal angle is >20 degrees
- angle <20 degrees suggests excessive medial rotation of
the hips & is consistent with femoral anteversion
3. Complications
- due to a compensatory lateral tibial torsion which
develops with increasing age resulting in a torsional
malalignment of the patellofemoral joint with the patellae
moving in and out of the intercondylar sulcus
INVESTIGATIONS:
- not necessary for the diagnosis
MANAGEMENT:
- shoe modifications, night splinting, Denis-Browne splint,
twister cables
- natural history of femoral anteversion is not altered by
passive stretching exercises or physical therapy
2. Surgery
- indicated if significant disability or femoral anteversion
is associated with a neuromuscular handicap, i.e. cerebral
palsy
- a major surgical procedure with risk of complications
- usually performed in adolescence because the compensatory
lateral tibial torsion may increase and become fixed
3. Prognosis
- usually resolves spontaneously between 7-8 years of age
- if femoral anteversion persists after 8 years of age it is
not likely to resolve
- there is no evidence that uncorrected femoral anteversion
produces degenerative arthritis of the hips or knees in adults
and should not interfere with walking or running
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Pediatric Database - FEMORAL ANTEVERSION
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