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Chiropractic Care for Femoral Anteversion

Published Date: 
June 29, 2023
Pigeon toed adult

Femoral anteversion is a common and rarely serious congenital condition affecting young children. For some people, the condition persists into adulthood. It affects the lower body, including the hips, knees, and feet. 

People with femoral anteversion are out of alignment. There is rotation in their hips and legs, which can affect their everyday life, depending on the degree. Although there is no non-surgical cure for this condition, and it usually resolves itself with time, chiropractic care can align the entire body and make the situation manageable.

A Brief Explanation of Femoral Anteversion

Femoral anteversion typically develops due to intrauterine positioning increasing the femoral neck anteversion. Essentially, a baby’s position in the uterus causes their bones to bend a certain way. It’s more common for girls and usually affects both sides of the body. 

Officially, femoral anteversion means “leaning forward.” If the femoral neck leans forward concerning the femur, the leg will rotate internally, and the knee and foot will twist toward the body’s midline. 

If a child has in-toeing (pigeon-toed) and an increase in internal rotation of the hip of greater than 70 degrees and a decrease in external rotation of the hip of fewer than 20 degrees, a diagnosis of femoral anteversion is likely.

Treatment is often hands-off and includes only observation throughout a child’s early life. Most kids have some degree of femur rotation that resolves independently over time. If the condition doesn’t resolve by age 10, more aggressive treatments might be recommended. 

Common Symptoms and Impact on Daily Life

Femoral anteversion is most noticeable between the ages of four and six. Most people notice their children are pigeon-toed or their legs are bowed around this time. It might cause clumsiness, but it is rarely painful.

A young girl with femoral anteversion.

Specific symptoms of femoral anteversion include:

  • In-towing or pigeon toes
  • Bowlegs or bowed legs
  • Snapping sound from the hip when walking
  • Mild to moderate pain in the ankles, hips, and knees for some children
  • Child tends to sit in the W position
  • Awkward walking or running style
  • Frequent tripping, especially when running

Traditional Treatment Approaches

In many cases, there is no official treatment for femoral anteversion. Doctors and parents wait until the issue resolves, usually around age 10. Some instances of the condition aren’t even serious enough to intervene (if the rotation is less than 40 degrees).

In very rare cases, a surgical procedure known as derotation osteotomy is recommended. This usually doesn’t become an option until age eight or later and only occurs when the rotation is severe enough to interfere with walking or running. This type of surgery is high-risk and requires the surgeon to cut the femur bone, rotate it, and fix it into a more natural position.

Physical Therapy and Exercises for Femoral Anteversion

More common and less risky treatment includes physical therapy.

The goal of physical therapy is to help the child develop muscle strength. Physical therapy is also required after surgery. 

A mother helping her baby walk.

Range of Motion Exercises

Several exercises will help with femoral anteversion or internal hip rotation but do not correct the problem. Exercises used to help with the condition include:

  • Conscious walking: People typically walk without much thought, but kids with an internally rotated femur should focus on careful walking to avoid tripping and falling. The therapeutic exercise includes nothing more than slow, deliberate walking.
  • Bridging exercise: This torso stability exercise forces proper alignment of the femur. To do the exercise, lay on your back with knees bent and feet flat on the floor, about hip distance apart. Press the upper back into the floor and lift the hips off of the floor. Squeeze the buttocks muscles together while pressing your feet into the floor. Exhale, inhale, exhale, and then release. Do five repetitions of this therapeutic exercise daily.
  • Backward walking: You can begin practicing backward walking in toddlerhood. This is a variation of conscious walking because it forces the child to focus more on their actions. Backward walking also helps to strengthen the hip muscles and reduce the force exerted onto the femur bones. Practice walking ten steps forward, then reversing and walking nine steps backward. 

Strengthening Exercises 

The NASM Corrective Exercise protocol suggests inhibiting and lengthening the hip flexor and strengthening the gluteal muscles. This will help correct poor biomechanics and straighten out the thigh bone.

Surgical Intervention in Severe Cases

In rare cases, only about one percent, surgical correction is needed. These are typically severe cases that interfere with a child’s daily life and do not resolve by early adolescence.

The surgery is a high-risk procedure, although children tend to heal quickly. Before surgery is recommended, doctors take into account the following:

  • Child’s age (most of the time, a child who undergoes this type of surgery is over the age of eight or, if not eight, has a severe enough issue that it makes it impossible to walk properly)
  • Severity (more than 50 degrees of anteversion and more than 80 degrees of torsion)
  • Obvious deformity of more than three standard deviations beyond the mean
  • Serious functional disability with walking or running
  • Pain level

In addition to breaking and correcting the position of the bone using plates and screws, surgery also includes lengthening the groin muscles. Surgery aims to allow the child’s toes to point forward and allow for normal movement with decreased risk of tripping and falling.

The Role of Chiropractic Adjustments in Alignment Correction

Chiropractic care aims to improve spinal motion and the body’s physical function. Although it cannot directly cure an internally rotated femur, it ensures that the body performs optimally. It’s effective for treating back pain but also helps align the entire body. 

Dr. Darren Faherty D.C.

In 2004, Dr. Darren Faherty graduated with a Bachelors of Science degree in Biology from UWEC - University of Wisconsin Eau Claire. Dr. Darren continued education at the highly esteemed University of Western States (formerly Western States Chiropractic College) where he obtained his chiropractic degree in 2007. He has been helping people recover from injuries and return to their normal lifestyles ever since.

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