Femoral Anteversion, Craig's test and Poor Advice

The intent of this article is to shed some light on lower extremity joint coupling from femoral versions. I hope that it is easy enough for non-healthcare folks to understand, yet detailed enough for healthcare providers to reference.

I am getting frustrated with patients coming into the clinic and telling me they received a gait analysis, or a bike fitting from someone with zero anatomy education but a self-perceived wealth of healthcare advice.

The impetus and motivation to write this article stems from a patient encounter a couple weeks ago. She is a triathlete with pain when she runs and bikes. Recently, she had a bike fitting and the bike fitter told her that her knee was tracking inward (toward the top tube) when she biked and she should make a conscious effort to force her knee outward at the top of the pedal stroke. There was also talk about putting a varus wedge between the cleat and the shoe to help force the knee straighten out. (Not only did he say that, but also that the knee was going inward because the ITB was too tight and she needed to stretch it…?)

Sorry if I’m stepping on toes here, but my opinion is that in a situation like that, the bike fitter should be sticking to properly fitting the bike to the person rather than dispensing treatment advice and modalities.  I’m all for bike fitters helping performance, but if someone has pain, I think there may be some boundaries that are crossed if they are prescribing stretches or installing orthotic wedges.  The same goes for coaches helping runners.

During my office examination, I did a standard procedure that I do on many patients: Craig’s test to check for femoral versions. This patient did have significant femoral anteversion (explained below in the video). This femoral anteversion explains some of the knee tracking inward and it reminded me of why people without any anatomical or biomechanical education should be cautious about dispensing therapeutic advice.

What is Craig’s test and femoral anteversion? Below, I have made a video explaining femoral versions/torsions and Craig’s test (how to easily screen for them). I have to used this video occasionally for clients of Running Reform. When clients submit their video to me and there are significant rotational distortions in their lower extremity, I ask them to perform this test at home and report back. Ruwe et al., (1992) proved this test to be more reliable than CT scan and I think it’s pretty easy to perform.

Please watch the 3 minute video here which explains a lot more than just Craig’s test:

[vimeo]https://vimeo.com/63363312[/vimeo]

Since femoral anteversion causes internal rotation of the femur and internal rotation of the femur is associated with greater knee valgus, one could assume that femoral anteversion is associated with knee valgus.

Figure 1: Running form with knee valgus

This idea makes sense and has been proposed by Hvid et al., (1982) and by Nguyen et al., (2007). However, Nguyen et al., (2009) used Craig’s test to evaluate femoral version and found no relationship to knee valgus which contradicts the previously listed studies. However, they tested knee valgus in a static double leg stance and this doesn’t mean that there would not be any dynamic valgus. In other words, standing still may not have increased knee valgus, but when running, jumping biking etc., there may be increased knee valgus in those with femoral anteversion. This is due to a couple reasons:

  1.  Merchant (1965) that the gluteus medius is at a mechanical disadvantage in those with femoral anteversion. Basically, the lever arm is reduced. Since the gluteus medius is important for maintaining frontal plane stability of the hip and knee (not allowing the hip to adduct or the knee to collapse inward).
  2.  Nyland et al. (2004), showed there is decreased activation of the gluteus medius, as measured by surface electromyography amplitude, in people with increased relative femoral anteversion.

When you put these together (reduced mechanical leverage plus reduced activation) it suggests that those with femoral anteversion would have a tendency to have increased dynamic valgus at the knee.

There are suggestions that femoral anteversion increases anterior knee pain most likely due to patellofemoral pain – Eckhoff et al., (1994) and Eckhoff et al., (1997). In addition, Takai et al., (1985) and Eckhoff et al., (1994) found increased arthritis in the patellofemoral joint was associated with femoral anteversion.

Moving on from femoral anteversion to femoral retroversion…When patients talk about getting a “knee replacement”, they are usually talking about arthritis in the tibiofemoral joint. This type of arthritis is generally on the medial (inside) compartment as it is usually prone to develop arthritis. Therefore, a patient at risk of this (family history, cartilage degeneration etc.) should be wary of anything that places extra pressure on the medial compartment. There are studies that show femoral retroversion increases the pressure on the medial compartment of the tibiofemoral joint. Bretin et al., (2011) not only showed that femoral anteversion predisposes the knee to a valgus deformity but also that femoral retroversion predisposes the knee to a varus deformity and also increases the pressure in the medial tibiofemoral joint. Kenawey et al., (2011) confirmed this notion by reporting that the medial tibiofemoral joint increased it’s pressure by nearly 30% when there was 20 degrees of femoral retroversion compared to anteversion. Again, Papaioannou et al., (2013) confirmed the increased compression medial compartment of the knee joint due to femoral retroversion.

So, if femoral retroversion is susceptible to knee joint pain and arthritis, and femoral anteversion is susceptible to patellofemoral pain and arthritis, everyone should be trying to force the knee straight, right? Not so fast. If a person with either retro or anteversion tries to rotate the leg so that the toes are pointing straight, the result may not be what you want. Essentially, the person is being asked to force the hip into a position where the head of the femur is no longer seated properly in the acetabulum which could lead to hip joint pathology. There are no studies that have evaluated this, but logic has to take over at some point. In his book Human Locomotion, Michaud states, “Unfortunately, once the femoral anteversion has been formed, attempts to modify an individual’s gait by having him/her walk with a straight gait pattern decreases the mechanical efficiency of the gluteus medius musculature and increases femoroacetabular contact pressures.”

Unfortunately, in many cases a person with femoral anteversion or retroversion will wrongly be instructed to keep their knee straight, or point their toes forward. They may be given a varus or valgus post in their running shoes or bike cleats to try and “straighten things out.” This can potentially be detrimental, since they essentially are being instructed to lose congruency in the hip socket which would increase contact pressures and risk potential injury.

So, as usual, the answer to this and many other conditions of the body is “it depends.” You can’t absolutely state with 100% confidence that a person with their knee going in toward the top tube should be forcing it to go straight via conscious efforts or with a cleat wedge. Then again, you can’t absolutely state with 100% that they shouldn’t either! Femoral versions need to be considered, tibial torsions need to be considered (perhaps in another blog post), patient genetic susceptibilities need to be considered, movement patterns need to be evaluated, patient symptoms need to be considered and the list goes on. Despite this, there will still be people with zero knowledge of biomechanics or anatomy dispensing advice with way more confidence than I have, even after I have considered the information above.

Will they guess correctly? Roll the dice and find out!

 

41 Comments so far:

  1. Monique says:

    This is an incredible article. I have only just noticed my femoral anteversion in my mid to late 20s, since I am not an overly active person. No one else has ever commented but I still think the angle is quite significant. Does femoral anteversion get worse as you grow older?? And does it affect your ability to run, as in, is it best to stay away from running due to complications with joints, arthritis etc?
    Thanks so much for this informative article and video

    • admin says:

      Hi Monique,
      Thanks for the kind words about the article…
      Femoral anteversion should remain constant after you have hit skeletal maturity, so if you’re in your mid to late 20’s, it should not be changing.
      With respect to your question on whether or not it would prohibit you from running, I am tempted to say ‘no’, but without actually having a doctor/patient relationship and doing a physical exam on you, I cannot say. I would suggest that you find someone knowledgeable about this in your area and get their opinion.
      Let me know if you have any further questions, and thanks again for the nice comment
      Kevin

  2. Katie says:

    Interesting article. I had an expensive gait analysis and the results were the need to strengthen my glute medius. 4 months and thousands of clam shells later, there has been no change in my symptoms. I have significant femoral anteversion and believe that is the problem. Your article seems to suggest the same, that the glute med is at a disadvantage because of the anteversion. So, it seems like I would need to address that. I have seem many, many professionals at this point and still don’t know who is supposed to know how to treat it. The PTs I have seen don’t seem to know what to do. What do you know about what it takes to correct the anteversion?

    • Brad says:

      It’s hopeless. Give up. I’ve been at this for 10 years and am WAY worse off now than when I started, and doc’s and PT’s don’t seem to care.

      • I am sorry to read you have not gotten better. If you are still having problems I highly recommend you locating a PT clinic that has clinicians trained in Postural Restoration techniques. This is a holistic approach that should help seat your femur better in the socket and balance your asymmetries. Check out : Postural Restoration Institute’s web site.

  3. Scott Harres says:

    Your video is so awesome. The view of how the bone sits in the hip socket was like a lightbulb going on for me! Thanks!

  4. Rebecca says:

    I have a problem where only my left leg turns in. To me it only seems from the knee to toe that it is noticeable. As a result I do sometimes still trip over my own feet, and my right knee aches if I walk more than average or have to do more stairs. Is there anything I can do about fixing it? My doctor referred me to a physiotherapist… But it didn’t really understand him very well… Nor did the exercises he gave me help. It’s only recently that I’ve started full time work that it’s become an issue. And up until before it, in college and school I thought I was just clumsy. Now I don’t like it of people walk behind me, because I know they can see and make comment. Is this something that can be fixed with a knee brace? And if so which knee should I wear it on to refuce the pain?

    • Kevin Maggs says:

      Rebecca,
      If it is just from the knee down, that would be called tibial internal torsion. However, you need to be evaluated. I am not diagnosing you with internal tibial torsion. See someone in your local area who is competent. Your right knee ache may be due to a million other things other than femoral version or tibial torsion. In either bone deformity situation, a knee brace is unlikely to help. I will reiterate again though…I am not telling you what to do, and you need to see someone local for a physical examination.
      Good luck,
      Kevin

  5. Maurizio says:

    Hello,

    Excellent video and information, thank you.

    I am an active and athletic man in my late 30s. I have pretty extreme femoral retroversion, more on the right than the left. The external rotation in my hip joints is quite extreme and conversely I have virtually zero internal rotation. It should be noted that in the case of femoral version there is usually excessive rotational range of motion in one direction, and a reciprocal lack of range of motion in the opposite direction. This has been problematic for me in sports and yoga.

    I am seeing more and more information online about the significance of femoral version and unfortunately the prognosis is not positive as the wear and tear in the hip and knee joints is greater than in “normal” hips. However, I have yet to encounter some substantial advice and tips on what individual with these conditions can do to optimize their body mechanics and prevent having pain and a need for hip and knee replacements in the future. I would like some advice and tips on what I can do to preserve my hip joints into older age considering that I have femoral retroversion.

    Thank you very much.

    • Kevin Maggs says:

      Hi Maurizio,
      I tend to agree that there may be some sparce evidence that femoral versions can contribute to knee problems, however, I haven’t seen any convincing evidence that it can contribute to significant amounts hip pathology. I would recommend that you consult with your local orthopedist/physio/chiropractor, and be sure they understand femoral versions prior to making an appointment with them.
      Good luck,
      Dr. Maggs

    • Kelli says:

      I am in the same position – anteversion + tibial torsion = problems with yoga. I was also “diagnosed” by my yoga instructor with lack of mid glute recruitment as well as lack of pelvic floor engagement. Got same (official!) diagnosis from my physical therapist. For now I am working to strengthen those, and i suspect core/pelvic floor will be more important for yoga. It’s all very frustrating – i am in my late 40s and am just now experiencing symptoms in my hip (labral tear = pain and limping). Doctors either want to do arthoscopic surgery or give me a cortisone shot – neither of which tells me WHY it happened and how I can still be active and ensure it doesn’t happen again. I still don’t know if i will ever be able to do external hip rotation in my practice 🙁 I have an appointment in 5 weeks to see “the hip guy” in my area – hoping for some answers.
      And this is a GREAT article – thank you!

  6. Greg says:

    Hello,
    I have been diagnosed with femoral anteversion in both hips, with my right being much worse. My activity level has been significantly reduced, and I have constant knee pain. I consulted a surgeon about a femoral derotation operation, and I was informed that it was a bad idea because it is a major procedure and most people have severe problems with foot alignment after the procedure. I have been going to PT for almost five years with no improvement. Should I risk the surgery anyway?

    • Kevin Maggs says:

      Greg,
      As you would probably guess, I don’t like to give out specific advice to specific people, since you are not my patient. So, I will not advise you if you should/should not get the surgery. I would suggest that if you don’t think you are getting the results you should be, you consult with a couple other PT’s in your area and see if they have a different approach than the one you’ve been getting for the past 5 years.
      Kevin

    • Andrea says:

      Hi Greg my name is Andrea. And I have exactly the same symptoms as yours.
      If you find a solution, tips or if you want to share your experience after the sugery I would love to listen to you. I am 28years old. Thank you.

  7. Jim Hansen says:

    I just saw this page and video for the first time. I have femoral anteversion on my left side (as well as tibial torsion on that side) so my knee turns in and my foot turns out. I was able to run through hs and college somewhat successfully, but when I turned to triathlons in the 1980s, the biking hurt my back. I was messed up (although still running marathons) up until I found out I had a labral tear in that left hip. I had surgery in 2011, but if I run now I will feel it for the next few days. I don’t know if it is the hip or all the compensations my body did through the years. I am learning not to be a runner anymore, unless I can figure out how to get things working. I have found the ElliptiGO and I would recommend this to an athlete who likes to move and can’t run or bike like they would like to. I get no pains using this and have done almost 6000 miles this year alone. Doing 100 mile centuries are my new marathons! I think it works with my abnormal structure because I can rock it back and forth a little to adjust my stride as I go and because there is no joint pounding. Here is an blog post I made post surgery in 2011 and after seeing Dr. Michaud, which didn’t help in any way, who you referenced here: http://recoveryourstride.blogspot.com/2011/12/so-not-born-to-run.html Do you find that people with a femoral anteversion tend to also point there feet out to the side? Strangely after 50 marathons and 5 Ironman triathlons, and almost 40 years of competitive running, that left knee with all the twisting going on never seemed to bother me.

  8. Sarah says:

    Great article! However, I was sad to see so many disappointing experiences with physical therapy in the comments section. As a physical therapist and marathon runner with very anteverted hips, I love treating the hip – bony alignment issues and all! It often takes a little more patience (from the patient AND PT) and a knowledgeable physical therapist to make improvements. My advice to anyone that is frustrated – keep looking for a good PT! Unfortunately you have to keep searching to find a qualified clinician. If you happen to be near Colorado Springs, come visit me at Rocky Mountain Rehabilitation, otherwise I may be able to help you find someone in your area. Email me at sarahroederdpt@gmail.com

  9. […] idea of femoral anterversion isn’t easy without some vsuals.  This video accompanies this blog post. 5)  Hamstring Tension During Running:  This is a video explaining various factors of sagittal […]

  10. John says:

    I think I may have this issue as well, been a bad year and a half for me and sure it won’t get better..I’ve been to PT but after going to two different places just realize they are clueless and treat everyone the same.

  11. Gabrielle Coleman says:

    Hello, thanks for writing such an insightful article that is easy to understand. My daughter is 9 years old and has femural anteversion in both legs, but stronger in her right. Her foot turns significantly inwards, rather noticeably. I first noticed a problem when she was three but our family doctor just kept saying she would “grow out of it”. So I waited a couple of years and went back when she clearly wasn’t growing out of it. After hearing the same thing again, I requested to see a specialist and they sent me to Levien Children’s Specialist. They had her move, walk and jump in specific ways and then told me she had femural anteversion and that it wouldn’t get worse and that as she got older, around 8-9, she would begin to correct on her own. They erasures me not to be worried, unless she began having pain. So, time goes by and it never gets better, in fact it seemed more pronounced than ever. When she was 8 1/2 she began complaining of leg pain specifically in the right femur area and when I would ask her to walk with her legs pointing forward instead of inward, she would have to completely change her hip posture to do so and wouldn’t stay that way for longer than a couple of minutes. So, demanded an X-ray from out family doc and they sent us somewhere to get one. When I got there the doctor looked at her for one minute and said she had hip something or another and they don’t do X-rays there. She also informed me that I was torturing my child for nothing and that the only thing that could be done about femoral anteversion was surgery to physically disconnect and then move the femur bone back a normal position and that it would be too traumatizing for her. I obviously don’t want that so I asked about braces and she basically said braces were old school and it has been found they don’t even work. She seemed crazy so left and went to an orthopedic doctor who finally took an xray of her legs, hips and back which showed she has femoral anteversion and a slight imbalance in her hip, with the right side being lower where her femur is more inwardly pronounced. The doc said she would never grow out of it, the pain was most likely growing pains(and that it’s hard to tell at this age whether it’s from the leg or growing pains), not to let her sit in a W position and that overall she would be fine. He didn’t seem to be worried that she could get arthritis or hip problems later on in life or that she would be hindered from sports. However, she is almost ten now and I swear her gait is worse than a year ago. Sometime, not often, she complains of pain. ESP after playing softball or swimming. She is always the slowest girl on the team or in the gym and can barely run around the perimeter of the gym without stopping and coming of pain in her femur. After reading the previous comments I am worried that if left untreated her leg may get worse and she may have to deal with serous pain as an adult. BUT, do I put her through more doc visits?? Esp if it’s not going to get worse? I won’t put her through surgery but I’m lost as to what to do without looking like a crazy mom…

    • Kevin Maggs says:

      Hi Gabrielle,
      Sorry to hear of your daughter’s troubles. As always, I try and refrain from giving specific advice to anyone without a Dr/patient relationship. I’m exposing myself to many legal issues.
      So I think I’m safe to say the following:
      – How are you positive that her intermittent pain is directly a result of the femoral anteversion? (there are many people with femoral anteversion who are not in pain and there are many people in pain without femoral anteversion)
      – Is it definitely femoral anteversion (it could also be acetabular anteversion or femoral torsion, the only way to know is with CT or MRI, not necessarily x-ray)?
      I hope those 2 questions aren’t provocative, I didn’t mean them to be that way.
      – Have you tried conservative treatments like rehabilitation with physical therapy or a chiropractor? (preferrably not a chiropractor who just cracks backs and not a physical therapist who just gives a generic sheet of exercises and puts hot packs on people)
      BTW, I don’t think you’re a crazy mom…just a concerned mom
      Hope that helps,
      Kevin

  12. Greer Logue says:

    Gabrielle, Your story is like reading my own…almost exactly… Except my daughter in 6, she has been waking at night with horrible pain in the back of one knee, My next step is to take her to my much trusted chiropractor.

  13. Natalie says:

    As an orthopaedic surgeon I find this article well written and important for patients and health professions. Thank for combining knowledge with logic.

  14. miguel says:

    Hi I have a question, what kind of exam should I take to determine if I have anteversion of the hip, rtg or ct

  15. melih says:

    I have unilateral femoral anteversion on my left leg but my both knees are facing forward symmetrically. Instead of knee facing inward, my femoral head turns externally and as a result of that, I can’t squeeze my left glute properly. Because the femoral head is stucking at the posterior side of the socket. Apologize for poor English. I hope I explained myself well.

  16. Katie says:

    I’m sixteen and I’ve been diagnosed with femoral anteversion and tibial torsion. This article makes me feel so much better because now I know that my tripping and knee pain is not just me being clumsy. I was told my hips are rotated 90 degrees inward. When I put weight on one hip it tends to pop in a weird way that’s sort of outwards. It doesn’t really hurt but it is pretty surprising. Should I be concerned about this?

    • Kevin Maggs says:

      Hi Katie,
      The popping could be a number of different things. It would be irresponsible of me to tell you whether or not you should be concerned about it. I would suggest that you consult with your personal physician.
      Kevin

  17. Sydney Walker says:

    If I’m not mistaken, femoral anteversion causes (or often causes) the colloquially dubbed “pigeon-toed” stance, correct? Whilst I’ve never been clinically tested, I’ve performed the Craig’s test too many times to count and read scores of academic literature on the subject. So basically, I’m all but medically positive I have quite a severe case of femoral anteversion as my father does as well. However, is it common, in regards to the resulting effect of “pigeon-toes”, to have one leg significantly more rotated? My left leg is quite noticeably more inwardly turned than my right (though both are atrociously “pigeon-y”) and it has progressively gotten worse over my adolescent lifetime (or the right leg has gotten “better”…the point being they used to be much more comparably rotated). Also, I’m finding I have hip pain following extended periods of walking/running/jogging…is this common as well for patients with anteversion? I apologize for my excess of questions but there is a disappointing lack of medical research and reports regarding femoral versions, at least available on the internet for public eyes. But I do have one further question…I’ve recently been having a plethora of foot problems that I previously only associated with old-age. I have bunions on both feet (though markedly worse on my left foot which again is the more rotated of my legs) as well as terrible heel pain and pain below and around my big toe (bunions are sure to account for that). I continuously form bulging callouses on my heels and the side of my foot on the bunions (someone REALLY needs to come up with a better, less repugnant-sounding term than “bunion”…) Would all of this be something potentially connected to my anteversion and the resultant position of my feet when walking? Or could this be totally unrelated (based on your personal experiences with anteversion of course, I by no means presume an online diagnosis to be the last word)? Thank you for this article and any light you could shed on my various ailments! 🙂

  18. Elvin says:

    Are you still able to reply to questions raised?

  19. Annie says:

    Hi, fabulous article.

    I am 19 years old and I have been quite active all my childhood (activities about 3 times a week, ranging from all school sports, swimming, spinning and modern dancing). However, at the age of 16, after a night wearing heels, I woke up with both my knees swollen and painful. I was told that I had internal femoral torsion, causing the patellar to not fit in well with the bottom of the femur which puts pressure on the cartilage. I stopped doing sports and started physiotherapy to strengthen my quadriceps. I stopped all sports. After 2 months I started swimming twice a week and then around 2 months later my hips started paining terribly during swimming. I got diagnosed with bilateral trochanteric bursitis. And, my hips were snapping. I was told that due to the femoral anteversion, my illotibial band is tense causing both knee and hip pain and this band rubbed over the bursas during swimming, causing the inflammation. From then on, walking without pain was difficult. I started physiotherapy to stretch my illotibial band and continue strengthening quadriceps, this time strengthening my gluteus muscles and hip flexors as well. I was also training my leg muscles so that I walk and run with my knee straight (rather than falling inwards due to the valgus). I also had several sessions of Intratissue Percutaneous Electrolysis EPI on both hips- which was painful! However, the pain persisted. I’ve had three corticosteroid injections and it still didn’t help my hips. It was only once I was given insoles with an arc (to minimise the knee valgus), and a whole summer of morning and evening sessions of physiotherapy, did I manage to start walking about 40 mins without pain. This was only 9 months ago. However, about 7 months ago, I started university and after two weeks of sitting in cinema like chairs in lectures, I noticed my hips worsening- which was odd, considering that for the previous 2 years, having a sedentary lifestyle was suiting me and walking was giving me pain. I stopped sitting down and I was the pain was easing. But that meant that I had to bunk lectures and I have now taken the year out. I have done several X-rays and MRIs (normal and with contrast) and I have been diagnosed now with- torn labrum (3mm one hip, 5mm other hip), femoracetabular impingement and a mild hip dysplasia. I still have a trochanters bursitis and a snapping hip syndrome. I have been advised by a surgeon to have a PAO surgery, labrum repair and illotibial band extended through arthroscopy on both hips. However, my pain in the last 3 months has minimised so much ever since I’ve started training in the gym. I can squat below 90 degrees with around 30kg without pain at all, and mobilising the hip join every day helps a lot. Of course, I have been avoiding sitting down on low chairs. However, I am not sure whether the PAO surgery is right for me. I have never had groin pain- only lateral hip pain (on the trochanter) and I still have pain there if I press or lie down on the side in bed. I have knee pain on high impact exercises at times. My hips keep snapping (on the side). I still depend on insoles, if not I get hip pain. I just feel my symptoms are more of an ongoing illotibial band problem due to the femoral torsion but I know this should be unjustified because all this time PT did not work. I am just worried because PAO is an aggressive surgery and I need to be sure this is my way out.

  20. Linda says:

    I have one leg that is longer than the other, or at least one side of the pelvis is higher than the other. Could femoral anteversion or retroversion contribute to a leg length discrepancy Thanks.

  21. FORM Insole says:

    Thanks for sharing this experience because there are several lessons we can learn from this encounter, one is to not listen to advice from someone who is not a trained specialist in that particular area.

  22. Sandra says:

    Hi. I’m 20 and I have been suffering from knee and trochanter pain since the last 3 years. Corticosteroid injections and other conservative treatment did not help my trochanteric bursitis. I have low back pain and I’m fussy about footwear. I have pops and clicks on my trochanter. I have been diagnosed with slight femoral anteversian and a bilateral mild hip dysplasia, 22 and 23 degrees. I also have a 3mm and 5mm labral tear. I have been recommended to undergo periacetabular osteotamy to correct the mild dysplasia, and correct the labral tears with arthroscopy. However I am not sure whether this will solve trochanter and knee pain. Any suggestions?

  23. Andrea says:

    Hi. I had femoral anteversion since I was a kid. My knees never hurt before until I had an injury 1 year ago on my knee doing acrobatics. Bad rotation fall. I did acupunture, IMS, felt really good for 1 month but I injured again overstretching I guess.
    I feel like my knees are every time more week and they keep rotating inside, specially the right one, the injured one.

    My question is, what kind of exercices should I do? Stop stretching I guess would be smart. And the most important thing, if you have femoral anteversion, what kind of shoes should I use for walking? I walk a lot. Is there something to do with pronators? Thank you.

  24. Elissa says:

    Hello.
    Fabulous article. I have found my way here just doing regular research for my condition. Which I believe is medial femoral anteversion combined with lateral tibial torsion. At least, I think so. My toes don’t point inward when I walk. When standing still if I have my feet parallel it feels as though I am standing with my feet turned in…so I normally stand with them slightly angled outward. The patellas point at each other when standing with my feet together.
    I have been doing private pilates classes for the past year and find your article interesting because my instructor does try to have me do things in the “proper” position with feet facing forward and hips turned however they should be, and usually I find it difficult to execute it properly or experience mild pulling, and nerve type pain. The reason for her attempt in correcting the malalignment is because of my complaint of having one glute (the right side) that is significantly larger and asymmetrical than the other. I find this problem not only distressing as it is evident in clothing that I wear as the folds of jeans for example don’t match up since the gluteal folds don’t, but worry if it will cause me problems in the long run…and of course the biggest, is it even related to the anteversion…if so perhaps the rotation is greater on the right side. I really wish there was something I could do about it. I assume that no amount of physical therapy or exercise can promote better alignment? I see a lot of websites that have exercises that claim to help by strengthening/stretching certain muscles.

    I have also recently (old as I am…39) been wanting to take up ballet as an adult beginner and train to do the splits. I realize you can’t give any advice specifically to people who are not patients, but I was wondering if having femoral anteversion can prevent you from such activities or if they should be avoided? My husband is actually an orthopedic surgeon, however he specializes in the hand and wrist, so he helps a lot but doesn’t specialize. We do have many doctor friends that I can consult with and plan to, but I thought I would just bend your ear to see what you think about these issues, given the added problem of the tibial torsion.

    Thank you so much!

  25. michael says:

    Very informative readying this forum.

    I am a 47 year old male who has been prescribed a femal derotation osteotomy for my L hip by Dr. Buly at HSS in NYC.

    I would like to get a second option and would like to know what other doctors in the country are renowned for femal derotation osteotomy.

    Dr. John Clohisy at Washington Univ and Dr. ira Zaltz in Detroit has been mentioned.

    Any help with recommendations would be greatly appreciated.

    • Kevin Maggs says:

      Sorry Michael, I don’t have any recommendations for you. You aren’t my patient, so I can’t comment, but I wonder why at 47 y.o., anyone would need this surgery. A 47 y.o. body has become adapted to the shape of it’s skeleton. Hypothetically, a person who is 47 should have cartilage, ligament and tendon adaptation, and changing that could put that body at risk of a different pain/injury. I would think that pain or injury in a 47 y.o. may not be stemming from some bony alignment that that 47 y.o. body has had for decades. Why would pain manifest now? Just a thought. Certainly not advising YOU! I don’t know your history, nor have I done any clinical exam on you. Litigation the way it is these days, I am steering clear of that.

  26. Carolyn says:

    This is the best video explanation of Femoral Aniversion I have ever seen.
    Is Femoral antiversion tied to lordosis as well? If so, is the lordosis correctable with exercise – tightening and stretching the correct muscles?

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