What is Femoral Anteversion?
The femur also called the thighbone, is the long bone present in your legs. It connects the hip and the knee joint. Femoral anteversion is a deformity of the lower limbs characterized by excessive bending of the femur inwards in relation to the hip. The femur rotates inwards (forward) leading to the development of twisted legs and knees. It typically affects kids and children in the age group of 3-6 years and is more common in girls. Femoral anteversion can occur in one or both legs.
What are the Causes of Femoral Anteversion?
The exact cause of femoral anteversion is not clear. However, it may occur due to:
- A genetic mutation or,
- A deviation from the normal head-down position of the fetus in the uterus such as breech or transverse position
What are the Signs and Symptoms of Femoral Anteversion?
Femoral anteversion may not be significant after the birth of your baby or in the initial years of their development. However, as the baby continues to grow, the twisted legs may either straighten or continue to bend. In case of the latter, you need to consult a bone and joint specialist or an orthopedic doctor to get timely treatment.
Some of the common signs and symptoms may include:
- Abnormal gait (walking style)
- Appearance of bowed legs
- Intoeing: each foot points slightly towards each other
- Child sits in a W position where the legs appear like the letter “w”
- Tripping during walking or running activities
- Snapping sound in the hip or knee joint while walking
- Pain in the hips, knees, and/or ankles
How is Femoral Anteversion Diagnosed?
You should consult an orthopedic surgeon specializing in knee, hip, or foot and ankle disorders. The doctor will review your child’s medical history, family history, and look for external symptoms such as bone deformity, abnormal gait, and intoeing. In addition, strength of the muscles in the lower limbs and range of motion will also be checked. Imaging tests such as X-ray, MRI (magnetic resonance imaging), or a CT (contrast tomography) scan may also be recommended to confirm the diagnosis and develop a treatment plan best suited for your child.
What are the Treatment Options for Femoral Anteversion?
Your child’s doctor can treat femoral anteversion through a range of treatments. The first choice of treatment is usually the conservative approach. If the condition doesn’t resolve on its own or non-surgical methods fail, your doctor will suggest surgery.
Non-Surgical Treatments
- Oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) to suppress pain and inflammation
- Orthotic devices such as insoles, knee braces, and crutches to provide walking support
- Physical therapy in the form of massage and exercises
- Pain relief injections into the affected joint to suppress the pain and inflammation
- Immobilization by a cast or splint to allow the affected leg to rest
Surgical Treatment
Surgery is recommended for severe femoral anteversion and those cases which fail to heal despite conservative therapy. The surgical procedure for the treatment of femoral anteversion is called a femoral derotational osteotomy.
Femoral Derotational Osteotomy (FDO)
The main objective of FDO is to correct intoeing while walking and rotational deformities in the thigh. In general, the procedure involves the following steps:
- General or regional anesthesia is administered to the patient.
- Your surgeon makes a surgical incision on the outside of the thigh area to visualize the head of the femur (bony ball).
- The thigh bone is cut and the head of the femur in the hip socket is repositioned to attain a perfect angle.
- In some cases, the socket is also suitably trimmed to facilitate a better fit for the femoral head inside the socket.
- When the desired position is achieved, metal plates and screws are placed to hold the bone in this new position, until it is completely healed.
- These plates and screws may need to be taken out once complete healing is accomplished in a year or two.
- The surgical incisions are closed in layers and a sterile dressing is applied.
