Abstract

Rotational problems of the lower extremities affect a vast number of infants and children, whereas increased femoral anteversion (inward rotation) is the most frequent cause of intoeing in school-aged children. Femoral anteversion is defined by the angle of the femoral neck in relation to the femoral shaft in the coronal plane, whereas the degree of anteversion is greatest in infancy and gradually decreases towards skeletal maturity in most children. In about 15 % of all children increased femoral anteversion persists into adulthood. In cases of excessive anteversion gait problems, hip and/or knee pain are common. Derotational osteotomy of the femur is an established treatment for the condition. However, there is a lack of knowledge and clear evidence when to perform surgery and how this affects function and pain in these patients. The current paper is not based on a complete literature review and, therefore, does not fulfill the criteria of a review article. However, the article is based on the authors’ in-depth knowledge and a rapid review of the literature, and it can be defined as a scholarly article providing a perspective on the condition.

Highlights

  • Gait problems with hip and knee pain due to increased femoral anteversion are frequent problems in children and adolescents

  • Femoral anteversion is defined by the angle of the femoral neck in relation to the femoral shaft in the coronal plane, whereas the degree of anteversion is greatest in infancy and gradually decreases towards skeletal maturity

  • Persistent increased femoral anteversion after the age of 8 years has shown gait disturbances and a variety of clinical symptoms such as hip and knee pain during running and sport activities, including anterior knee pain, patellofemoral instability and a life-long burden for these patients [6]. These children are mainly referred to a pediatric orthopedic surgeon because of intoeing gait, and treatment has so far been limited to surgical correction for symptomatic cases of excessive anteversion [1], depending on the severity of symptoms [7]

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Summary

Horn1,2

Rotational problems of the lower extremities affect a vast number of infants and children, whereas increased femoral anteversion (inward rotation) is the most frequent cause of intoeing in school-aged children. In about 15 % of all children increased femoral anteversion persists into adulthood. In cases of excessive anteversion gait problems, hip and/or knee pain are common. Derotational osteotomy of the femur is an established treatment for the condition. There is a lack of knowledge and clear evidence when to perform surgery and how this affects function and pain in these patients. The article is based on the authors’ in-depth knowledge and a rapid review of the literature, and it can be defined as a scholarly article providing a perspective on the condition.

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