Femoral anteversion

Femoral anteversion is the commonest cause of the intoe gait. It is excessive anteversion of the femoral neck, such that internal rotation of the hip is increased and external rotation is reduced.

• generally presents in children aged three to ten years
• the degree of anteversion of the femoral neck varies from about 40 degrees (when a baby is born) to the degree present in an adult (about 15 degrees). Thus there is a gradual transition from the angle of anteversion a child is born with towards the adult position. If there is a slow transition of this degree of anteversion and the greater degree of anteversion persists into childhood, then the child generally presents with an abnormal gait and symmetrical intoeing
  • the child wil have absent or reduced external rotation of the hip
  • although the gait may appear clumsy it is no barrier to athletic prowess
  • usually resolves with growth
  • a characteristic of children affected by this condition is that they often sit on the floor with their knees facing each other. They should instead adopt the Buddha i.e. cross -legged position
• in most cases there will be spontaneous resolution. However if there is complete absence of external rotation then this a poor prognostic sign and increases the likelihood for need for surgical intervention
• in a small minority of cases a rotational osteotomy will be needed when the child is in his/her teens
• note that some children will self-compensate via development of external rotation of the tibia so resulting in the child's feet pointing forward normally. In this situation there is a pointing intwards of the patellae (known as the squinting patella syndrome). This condition may be considered cosmetically unattractive but would necessitate extensive osteotomies to correct and may be considered that should not be treated

Reference:

1. GP (April 15th 2005), 67.