Final answer:
Femoral anteversion is a condition often seen in children that can cause intoeing and may require treatment if it persists. Treatment can include physical therapy and orthoses, with surgical options available for severe cases. Referral to a specialist is recommended when there is significant disability, pain, no improvement with non-surgical treatment, or concerns about the underlying cause.
Step-by-step explanation:
Femoral anteversion refers to the condition where the femoral neck is twisted forward relative to the rest of the femur, leading to an inward turning of the thigh or knee. Common in children, it can cause intoeing or 'pigeon toes.' Most cases resolve naturally as the child grows, but some persist and require treatment. The decision on when to refer to a specialist depends on various factors.
Non-surgical treatment options may include observation, physical therapy, and orthoses. Orthopaedic referral is indicated if the patient experiences significant functional disability, pain, or if the condition is worsening. If non-surgical measures fail, surgical treatment such as derotational osteotomy might be considered.
Generally, children are referred to a specialist if they are older than eight years of age with persistent symptoms, as spontaneous correction is less likely after this age. Additionally, referral is appropriate if there are concerns about the underlying cause, such as neuromuscular disorders, or if there's a bilateral asymmetry that affects walking. Referral should be made to a pediatric orthopedic surgeon for an expert evaluation and personalized management plan. It is essential to address severe cases to prevent complications such as osteoarthritis and chronic pain.