Femoral anteversion also known as in-toeing is not always a disability although it can be.
In severe enough cases the femoral anteversion could cause functional disability and limit activities like running walking due to frequent tripping as well as pain or even significant deformity, which could require surgery for correction of the in-toeing.
Most children though outgrow the femoral anteversion or in-toeing, but if it persists and causes significant issues and over 50 degrees anteversion, as well as frequent falls and substantial functional impairment.
In severe enough cases the femoral anteversion can be considered a significant condition that impacts mobility and can be classified as a functional disability.
Although most children outgrow the femoral anteversion condition and can work and do activities normally.
Femoral anteversion is not painful, especially in children and it often corrects itself in children.
However in some cases the femoral anteversion may persist and cause some pain in the lower back, hips and knees, especially when the person has other rotational issues.
However the pain that sometimes comes along with femoral anteversion is more likely to occur in adults and adolescents than young children and it can sometimes result in increased tripping, development of arthritis and falling.
The amount of femoral anteversion that is normal is 30 to 40 degrees in infants, 15 to 20 degrees in children and 8 to 14 degrees in adults.
Most cases of femoral anteversion will correct itself as the child ages although it may persist in some adults.
The degree of femoral anteversion that requires surgery is over 45 to 50 degrees of anteversion, which often causes frequent tripping, severe pain refractory to conservative treatments and other severe functional limitations.
For adults surgery for femoral anteversion might be considered for any excessive anteversion of >35 degrees which causes symptomatic femoral acetabular impingement with instability as well as pain, even if the person is symptomatic with the in-toeing.
The normal range for Anteversion is 10 to 20 degrees in adults and 30 to 40 degrees at birth and it should decrease with age.
Excessive anteversion is 20 degrees which can lead to an inward turning of the legs and feet which is called in-toeing, and less than 10 degrees is considered to be retroversion.
To test for femoral anteversion a doctor will perform a test called the Craig's test, which is a clinical assessment test that is used to evaluate the degree of the inward rotation, "anteversion" or outward rotation, "retroversion" of the femur bone.
The Craig's test helps to determine if your femur's alignment is within it's normal range or if there's an excessive angle of rotation, which can affect a persons gait and lead to other issues.
To perform the Craig's test, the person will lay prone on their stomach with their knee flexed to 90 degrees and the doctor will then palpate the greater trochanter, which is the bony prominence on the side of the hip.
Then the hip is gently moved through internal and external rotation and the doctor identifies the point where the greater trochanter is most prominent laterally, "sticks out the furthest".
And in this most prominent position, the doctor measures the angle between your tibia and the vertical axis.
A normal angle is considered to be between 8 to 15 degrees of internal rotation, which is when the tibia deviates inward from the vertical axis.
Any angles that are greater than 15 degrees suggest excessive femoral anteversion, "inward rotation" and angles less than 8 degrees suggest femoral retroversion, "outward rotation".
The test is often performed on both legs and the results are compared to assess for any asymmetry.
Femoral anteversion is the inward twisting of your femur or thighbone which can cause a "pigeon-toe appearance, in-toeing, or a "W" sitting position.
The femoral anteversion or inward twist of the thighbone can be a normal part of development which often corrects itself by adolescence.
Symptoms of femoral anteversion are often most noticeable when a child is 4 to 6 years old.
The symptoms of femoral anteversion often include a clumsy gait and tripping, although treatment for femoral anteversion is rarely required.
Although if the femoral anteversion is severe enough or persistent then surgery may be needed.
The surgery to fix severe or persistent cases of femoral anteversion is called a femoral derotation osteotomy.
Most cases of pigeon-toeing in children go away on their own as the child grows, but in rare cases it may persist into adulthood.
Being pigeon-toed is not a birth defect, but instead being pigeon-toed is a common condition in children called in-toeing and is a normal part of development in most cases.
Sometimes the pigeon-toed or in-toeing is also present from birth as a result of womb positioning or family tendency and most cases of in-toeing or pigeon-toed resolves on it's own as the child grows.
Although a congenital condition like metatarsus adductus can cause pigeon-toeing, many cases of pigeon-toeing are a result of internal tibial torsion or femoral anteversion, which often improve on their own naturally.
Some underlying medical conditions and even injuries can cause pigeon-toeing and those require medical attention.
The age that pigeon-toed should be corrected is by 8 to 10 years old.
Most cases of pigeon-toed or intoeing in children resolve on their own without any treatment by the time the child reaches age 8 to 10.
If the pigeon-toed or intoeing continues past 8 to 10 years old or if it's causing any difficulty walking or pain then it may need to be corrected.
Pigeon toed which is also called intoeing is a common condition in children where the child's feet turn inward when walking or running instead of pointing straight like they normally should.
Pigeon toed or intoeing can be caused by misaligned bones in the child's foot, lower leg, "tibial torsion", or thigh "femoral anteversion".
Most cases of pigeon toed or intoeing resolve on their own as the child grows, although if it causes any pain and or stiffness or the child has difficulty walking or it continues past age 10, then the child should be evaluated medically by a pediatrician or an orthopedic specialist.
The difference between internal and external tibial torsion is that internal tibial torsion is the inward twisting of the shinbone also called the tibia, which causes in-toeing and external tibial torsion is the outward twisting, which causes out-toeing and a more outward-rotated foot posture.
The internal torsion is most common and often resolves on it's own by age 5 and external torsion is less common and can manifest with out-toeing symptoms around ages 4 to 7 and can even sometimes result in problems with knee stability and mechanics.
Internal tibial torsion does not cause pain in children.
internal tibial torsion is a common cause of intoeing or pigeon toed appearance and pain may occur in rare and severe cases which persist into adulthood or if the intoeing is also accompanied by a limp, swelling or increase in falls.