From the Guidelines
Femoral antiversion is considered normal up to the age of 8 years. This is based on the understanding that most infants are born with a significant degree of femoral anteversion, which gradually corrects as the child grows and develops [no direct evidence from 1 supports this specific age, but it is a widely accepted clinical guideline]. The process of spontaneous correction is influenced by normal bone remodeling, muscle development, and weight-bearing activities during childhood.
Key Considerations
- Femoral anteversion is a common finding in young children, with most infants born with approximately 40 degrees of anteversion.
- The angle of anteversion naturally decreases as children grow, reaching the adult norm of approximately 15 degrees by around age 8.
- Persistent significant femoral anteversion beyond age 8 may warrant clinical evaluation, especially if associated with functional issues such as in-toeing gait, tripping, or pain [1 provides guidance on the evaluation and management of hip instability in infants, which indirectly supports the importance of monitoring developmental abnormalities like femoral anteversion].
Clinical Implications
- Mild persistent anteversion can remain asymptomatic and may not require intervention.
- The natural history of femoral anteversion demonstrates the remarkable ability of the growing skeletal system to adapt and remodel in response to developmental and mechanical forces.
- Clinical decisions regarding the management of femoral anteversion should prioritize the prevention of long-term morbidity and the optimization of quality of life, considering the potential impact of persistent anteversion on gait and lower limb function.
From the Research
Femoral Anteversion in Children
- Femoral anteversion is a common condition in children, where the femur is angled more than usual 2, 3.
- Studies have shown that femoral anteversion is normal in children up to a certain age, but the exact age is not specified in the provided studies.
- However, it is known that femoral anteversion and tibial torsion are common rotational abnormalities in children, and their courses are most often benign and self-resolving 3.
Age-Related Femoral Anteversion
- A study of 1,140 children between 8 and 9 years of age found that the mean anteversion angles were 24 degrees, 36 degrees, and 14 degrees in different groups 2.
- Another study of 30 adolescents with patellofemoral instability, aged 12 to 18 years, found that the mean femoral anteversion was 26.5° ± 9° 4.
- These studies suggest that femoral anteversion may be present in children up to adolescence, but the normal range of anteversion angles is not clearly defined.
Relationship Between Femoral Anteversion and Other Conditions
- Femoral anteversion has been linked to other conditions, such as flat foot and intoeing 5.
- However, studies have found that femoral anteversion is not a significant predictor of hip or knee arthritis 3.
- The relationship between femoral anteversion and dynamic hip rotation is also unclear, with one study finding a weak correlation 4.