Excessive femoral anteversion and in-toeing

In normal gait, the greater trochanter is positioned to allow the hip abductor muscles (the gluteus medius and minimus) to function most efficiently. In a child with normal femoral anteversion, where the greater trochanter is relatively laterally placed, this results in a normal, straight-ahead foot progression angle. In a child with increased femoral anteversion (left panel), the greater trochanter has to rotate to the more lateral position, resulting in an in-toed gait. When reminded by parents, a child with excessive femoral anteversion can walk with their feet straight ahead, but less efficiently because of the posterior position of the greater trochanter (right panel). As the child tires, they will tend to select a more efficient gait and rotate the greater trochanter more laterally, resulting in an increasingly in-toed gait.