Adult leg & foot deformities: femoral anteversion, metatarsus adductus

[chrisjs]

Hello. My wife is 35 years old and has multiple issues with her legs and feet. She's had these problems since childhood but never received proper medical care for them. She still to this day has never sought professional help for her issues as she's severely doctor-avoidant (an unfortunate by-product of her childhood neglect).

From examining her myself and doing internet research, I believe she may suffer from significant femoral anteversion and metatarsus adductus with some mild internal tibial torsion. Basically, she's knock-kneed with very high-arched pigeon-toed feet with toes that curve inward and overlap one another. Her knees naturally point inward, as do her feet, causing her a great deal of hip pain when she walks. She also has foot pain because the way her feet are angled, all the pressure is on the outside of her feet (excessive supination). She's developed severe "tailor's bunions" on the outer edges of her feet because of this. Her overlapping toes are painful as well. She was an uncorrected "w-sitter" as a child and this likely aggravated her condition (http://medical-dictionary.thefreedictionary.com/W+sitting). She also had ill-fitting shoes and didn't receive proper nutrition as a child which probably also added further complications.

From all the reading I've done, it seems femoral anteversion and metatarsus adductus usually resolve themselves naturally as a child ages. This was obviously not the case with her and the older she gets, the more pain these problems are causing her. What are her options for dealing with these conditions? I've seen surgery suggested for older children but what about a 35-year-old adult? Her legs and feet are completely misaligned and lots of abnormal stresses are occurring whenever she walks to compensate for this. Her leg muscle development is likely an indication of this as well. Short of surgery, what else can be done? If her feet were balanced somehow with orthotic inserts, could that help everything else align more properly? As I mentioned, her arches are very high and when she walks with her knees pointed inward, the outside of her feet take all the stress. The misalignment greatly affects her hips as well. What about her inward curling toes? Because of their odd shape, it's very difficult to find shoes that fit her comfortably.

I just want to know if she'll be stuck suffering with this for the rest of her life or if there's something that can be done. I'll follow up with more info, if needed. Thanks!

[EulaliaBon]

I know this post is almost a year old but perhaps I can offer some help . . . I'm a grad student studying human physiology and I also have hip anteversion (internal femoral torsion) although not as severe as either your wife's or lesleyann59's. I also have internal rotation of my arms and shoulders and posterior tilt of my rib cage, and all of these issues are commonly seen together.  I have been working on correcting my postural misalignment for a few years with strength training and yoga and have had extemely good results increasing my shoulder mobility and my hips have been slowly coming along.  Before resulting to surgery, I would recommend trying a good personal trainer.  If you live in a relatively big city you could probably find one that specializes in body alignment or even hip alignment.  If you cannot afford a personal trainer it could be possible to figure out an exercise regimen (youtube has a ton of videos from trainers) on your own but I would be wary of injury if you don't have some knowledge of human kinematics. The first step would be strengthening the core, outer hip and posterior chain. And as for surgery, remember, even if your x rays/MRI's look bad I would still try a non surgical approach first, many people with horrible looking xrays can get their symptoms under control without surgery and many people with horrible looking xrays remain asymptomatic their entire life. Here's a link with some good information on hip anteversion http://www.ericcressey.com/hip-anteversion-assessment-strength-and-conditioning-programs
Hope this helps someone!

[lesleyann59]

I felt quite emotional when I read your posting as I share some of the problems that your wife has and have never met anyone with the same problem that I have with my legs and feet.

I was born with in-turning feet and knock-knees as was also a 'w' sitter. There was a half-hearted attempt to correct it when I was very young by a couple of trips to outpatients and some wedges put into one pair of my shoes which didn’t do any good. I was always nagged ‘turn your feet out’ which I have always tried to do in order to look more normal.

As a child I was teased about my legs and absolutely dreaded sports day or having to go swimming and as a teenager I tried to cover them up with long skirts and even cycled in them for fear of showing my legs! Now I just get comments and people asking me why I walk so strangely.

Like your wife, my feet overlap one another when I am lying down and I have terrible trouble walking and getting shoes to fit. I have a horible red lump on the top of my left foot where it meets my ankle which I know is caused by my pronation.

About 4 years ago I noticed that I had lost some movement in my right hip and my inturning was getting worse so went to my GP who just ‘fobbed me off’ and said there was nothing wrong with my hips so I thought it must be muscular. It is funny but I have never been to the GP specifically about the shape of my legs and the in-turning as I never thought that anything could be done about them and no doctor has ever mentioned it.

I turn my feet over very badly, my left more than my right and I believe this is why I had to have a bunion operation on my left foot about 10 years ago. Then about 3 years ago I started getting pains in my left toes when I walk, I pointed this out to my GP who sent me to have podiatry innersoles made which helped a lot. I had secretly hoped that the innersoles would straighten my legs and feet as well but they didn’t and I thought that maybe I should get some custom-made innersoles and that this would solve all my problems. I felt that I had to sort my problems out myself.

For about the past 6 months I have been investigating my problems on the internet and discovered that it actually has a name and that children have surgery for it now.
I found your posting a couple of months ago but I didn’t know what to say then but it must have struck a chord because I decided to go to a different GP and discuss my problems.

This was about 6 weeks ago and she sent me straight away for x-rays and to see an orthopedic surgeon which I was pleased but surprised about. My appointment was on 24th June and he said that I have ‘very strange’ hip joints and that the socket ‘grabs’ the ball part rather than just kind of laying over it as happens with most people and that I was born like it. He said that ‘wear & tear’ has made it worse and that I need to have both hips replaced.

I had a phone call 2 days later to say that he has booked me in for the first op. next week on the 19th July so it is all very quick. I think he felt sorry for me!

It may seem daft but I never realised that my problem was caused by my hips, I just thought that the ‘wear & tear’ in my hips had exacerbated my existing problems. I am so excited now at the thought that I may be able to walk normally for the first time in my life. The consultant said that with physio there is no reason why I shouldn’t be able to walk with my feet pointing straight.

Before I have the op I want to take some photos of my legs and feet so maybe I can send them to you so you can see if I do have the same problem as your wife.

My husband also has a very bad fear of all-things medical so I know what it is like. I think your wife is very lucky as you obviously really care about her and I’m sure together you will be able to sort it out. Two months ago I would not have believed that anything could change but I am now very optimistic.

I am pleased I found your posting, it has helped me and I hope that my posting may also be of some help to you or at least offer you some hope.

[chrisjs]

Hi. Thanks for the reply. Yes, I understand she'd need an evaluation to find out exactly what needs to be done. Just in general, though, is correcting femoral anteversion in adults difficult? I can't really find any info about it online. It seems it's usually resolved in childhood, either through surgery or the natural growing process. I just want to get an idea of what she'd be in for regarding surgery. I assume there are no real non-surgical ways of dealing with this?

[S. Kaul, MD]

Hi there!

Well, without a detailed clinical evaluation it would be difficult to comment specifically on the situation or suggest a management plan; though with the situation described surgical correction may be  a feasible option and there is the possibility of multiple surgeries being required. I would suggest considering a detailed evaluation by an orthopedian for suggestion of an appropriate management plan.
Hope this is helpful.

Take care!