Hip & Thigh

What It Is

Femoral anteversion is a condition where the thighbone (femur) is twisted inwards. It causes a child's knees and feet to turn inward, which creates what is often called a "pigeon-toed" appearance, or in-toeing (Boston Children's Hospital, n.d.). It occurs in up to 10 percent of children and is somewhat more common in girls than boys (Boston Children's Hospital, n.d.). Signs usually first become noticeable when a child is between 2 and 4 years old, and the condition is most obvious at 5 to 6 years of age (Boston Children's Hospital, n.d.; American Academy of Orthopaedic Surgeons, n.d.).

Femoral Anteversion Anatomy

The hip is a ball-and-socket joint: the ball at the top of the thighbone sits in a socket in the pelvis. In toddlers and young children, walking with pigeon-toes is a normal part of the development of the hips, even when it is caused by femoral anteversion, and the toes usually straighten out on their own as children learn to walk (Boston Children's Hospital, n.d.).

Femoral anteversion is usually considered to be a variation of normal development. Doctors do not know what causes it, or why some children develop a severe form (Boston Children's Hospital, n.d.).

When to Talk to Your Child's Doctor

It is a good idea to talk to your child's doctor if your child has (Boston Children's Hospital, n.d.):

Pigeon-toed walking
Difficulty walking with their feet close together and legs straight
Legs that swing out when they run
Frequent tripping and falling

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Femoral Anteversion

1. Observation

Most children are monitored over several years, because the twist in the thighbone usually corrects itself with time. Most children achieve normal or near-normal walking patterns by the time they are 8 to 10 years old, and others by the time they reach their teenage years (Boston Children's Hospital, n.d.).

2. Braces or Special Shoes

Braces, special shoes and exercises do not usually speed up or help the body's natural process of correcting the anteversion (Boston Children's Hospital, n.d.; American Academy of Orthopaedic Surgeons, n.d.).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Surgery: in a very few cases, the twist is severe and has not corrected itself by around 8 or 9 years of age. For these children, surgeons may perform an operation (a femoral derotation osteotomy) in which the thighbone is cut, turned to a more normal position and reattached (Boston Children's Hospital, n.d.). Your child's surgical team will explain the recovery, which includes physical therapy to restore muscle strength (Boston Children's Hospital, n.d.).

How I can help (see the My Approach tab)

Easing tired or achy leg and foot muscles
Play-based balance and strength activities
Supporting recovery after surgery, once the surgeon has cleared it

Tips

Most cases of femoral anteversion happen without any clear reason (Boston Children's Hospital, n.d.).
It often, but not always, affects both legs (Boston Children's Hospital, n.d.).
It is somewhat more common in girls than in boys (Boston Children's Hospital, n.d.).
It occurs in up to 10 percent of children (Boston Children's Hospital, n.d.).
If you are worried about your child being in pain, very few cases are painful (Boston Children's Hospital, n.d.).
Femoral anteversion corrects itself in up to 99 percent of cases, the long-term outlook is very positive, and it does not usually lead to arthritis or other future health problems (Boston Children's Hospital, n.d.).

Treatment

My Approach

Femoral anteversion is a twist in the thighbone that usually straightens out on its own as a child grows. Massage and exercise don't change the twist itself, so I help with what can come with it: tired or achy legs, tight muscles, and recovery if your child needs surgery. Your child's doctor and surgical team lead the care, and I work within their plan.

I assess how your child stands, walks and runs, and the strength and flexibility of their hips, legs and feet. Parents can sit in, with your child's agreement, and decide for a child who is too young to agree to treatment.

Without Surgery

Gentle massage for tired or achy leg and foot muscles
Short, play-based balance and strength activities to help with confidence when running and playing

After Surgery

Hands-on treatment only once the surgeon has cleared it, so please bring any notes from the surgical team
Gentle lymphatic drainage for swelling, and work on the back, other leg and arms, which work harder while your child is less mobile
Scar work once the wound has healed, and easing hip and knee stiffness within the team's limits
Supporting the physical therapy plan to rebuild strength, with a home programme parents learn too

Work near the hip or buttock is only done with consent, a signed consent form and your child's agreement. I can also help parents with neck, shoulder or back strain from carrying and caring for a child after surgery.

If your child has pain, a limp or tripping that is getting worse, see your child's doctor.

What to Expect

Typical Course

Typical course: Without surgery, most children need only a few visits, weekly at first and then spaced out, while the twist itself usually corrects with time, with most children walking normally or near-normally by 8 to 10 years old. After surgery, visits usually start once or twice a week once the surgeon gives the okay, then become weekly and space out, following the surgical team's recovery plan.

What I Focus On

Assessment

Easing Achy Muscles

Play-Based Strength

Recovery After Surgery

Working Within the Team's Plan

Sources

References

Boston Children's Hospital (n.d.) Femoral anteversion. Available at: https://www.childrenshospital.org/conditions-treatments/femoral-anteversion (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.) Intoeing. OrthoInfo. Available at: https://www.orthoinfo.org/diseases--conditions/intoeing/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooFemoral Anteversion

What It Is

Femoral Anteversion Anatomy

When to Talk to Your Child's Doctor

Self-Care & Treatment

How to Treat Femoral Anteversion

1. Observation

2. Braces or Special Shoes

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Without Surgery

After Surgery

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooFemoral Anteversion

What It Is

Femoral Anteversion Anatomy

When to Talk to Your Child's Doctor

Self-Care & Treatment

How to Treat Femoral Anteversion

1. Observation

2. Braces or Special Shoes

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Without Surgery

After Surgery

Typical Course

References

Related Conditions

Compartment Syndrome – Thigh/Buttocks

Developmental Dislocation (Dysplasia) of the Hip (DDH)

Femoral Fracture

Fracture After Total Hip Replacement

Book a session