Femoral torsion is a twist in the position of the femur, causing the kneecaps to turn toward each other and leading to an in-toed gait instead of a neutral position for the feet and lower legs. This condition is usually apparent by around age three and can resolve on its own by age 10. In some cases, patients need treatment to straighten the femur and address the problem. An orthopedic doctor can review a child's case to determine what, if any, treatments may be beneficial.
When people are born, the femur is naturally turned inward, a position known as femoral anteversion. As children grow and engage in physical activities, the femur begins to turn outward and the angle where the femur meets the hip bone becomes more natural. In some people, this fails to occur, and the patient can develop femoral torsion. Another issue can be weakness in the quadriceps muscles of the upper leg, where weaker muscles fail to support the leg and it slides out of position.
Sitting in stress positions can exacerbate femoral torsion or make it more difficult for a patient to recover. Children who sit with their legs in a W shape, for example, are putting stress on the femurs and forcing them to turn inward. Sitting more naturally will allow the femur to straighten out over time. Physical therapy and gait training can sometimes help manage femoral torsion effectively, to strengthen the muscles and teach children to sit and walk comfortably.
Braces and other orthopedic devices are available to manage femoral torsion, but their efficacy is a topic of debate. Studies seem to suggest comparable outcomes between patients who use braces and those who do not. Braces can also be uncomfortable and may attract negative attention from peers, an important consideration when they do not appear to provide benefits. If femoral torsion does not seem to be resolving on its own, a doctor can evaluate the patient to discuss more invasive treatment options.
Inturned gaits can cause problems for people in the long term. Wear on shoes will be unequal, and the patient's body can develop muscle pain and stress as a result of being under constant stress. This may eventually lead to problems like back pain and poor posture. It is important for people with gait abnormalities to receive a thorough evaluation to determine the cause, as treatments vary, depending on why a patient has an unusual gait. While femoral torsion may resolve itself, other disorders require intervention.