Femoral anteversion is an internal rotation of the femur that occurs within the acetabulum.  This results in the knees and feet being turn inward (pigeon-toed appearance)

  • Twice as likely to be seen in girls
  • Typically detected when the child is four to six years of age


Etiology of femoral anteversion

  • Stiff hip muscles due to the position of the baby in the uterus
  • Rothbarts Foot


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.

Diagnosing Femoral Anteversion
The Hip Rotation Test is used in the differential diagnosis. 

  • The hip joint is rotated through its internal - external range of motion (See Animation below). 
  • If the internal rotation is more than 5 degrees greater than the external rotation, femoral anteversion is diagnosed.

The angle formed between the superimposed longitudinal axis of the head, neck, and greater trochanter of the femur proximally and the transverse axisof the femoral condyles distally.  This angle represents the structural twist that occurs in femur.

Approximately 12 degrees in adults, but is considerably greater in infants.

(1)  Femoral Anteversion  (Positional Deformity)

References:

    Hertling, D., & Kessler, R. M. (1996). Management of common musculoskeletal disorders: Physical therapy principles and methods. (3rd ed.). Philadelphia: J.B. Lippincott.

    Rothbart BA (1972) Clinical treatise on transverse plane dysplasias of the femur and tibia. J Am Podiatirc Med Assoc 62:1-14.

Adducted (Pigeon-Toed) Gait

Structural and Positional Variances that Occur in the Femur

(1)   Femoral Antetorsion (Structural Deformity)

Hip Rotation Test   

  • Patient prone, knee bent 90 degrees
  • Rotate leg outwardly (internal leg rotation)
  • Rotate leg inwardly (external leg rotation) 
  • Note any discrepancy in the excursion of the leg.

Antetorsion angular orientation of the neck of the femur to a line that connects the femoral condyles (Rothbart, 1972; Hertling & Kessler, 1996, Fig 12-3, p. 286). As such, it describes a bony or structural torsion or twisting of the femoral shaft.

Intoeing secondary to Antetorsion (Internal Femoral Torsion)

Computing the Antetorsion Value