Femoral Anteversion

A femoral version is defined as the angular difference between the axis of femoral neck and the transcondylar axis of the knee.  Excessive femoral anteversion (medial femoral torsion) is most common cause of in-toeing (pigeon-toed) that first presents in early childhood.  It is twice as common in girls as in boys, it is nearly always symmetrical, and it is often familial.  Anteversion is usually associated with a genu valgum and overpronation of the foot.

On average, femoral anteversion ranges from 30-40 deg at birth and decreases progressively throughout growth to about 15 deg at skeletal maturation.  In adults, anteversion averages between 8 and 14 deg, with an average of 8 degrees in men and 14 degrees in women. full size view

If associated with internal tibial torsion, femoral anteversion may lead to patellofemoral syndrome due to an increase in the Q angle

Custom orthotics will help to prevent some of the femoral anteversion functionally by decreasing overpronation and allowing the leg as a whole rotate somewhat laterally.


Femoral retroversion is less common that anteversion.  It is a reduction in the normal angulation relationship of the axis of the femoral neck and the transcondylar axis of the knee.  Retroversion is usually associated with a tibial varum and supination at the foot.

Like anteversion, custom orthotics are indicated to prevent supination of the foot and to encourage medial rotation of the hip and knee in function.