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Dear Doctor

July 2019


My son’s legs are turned outward at the hips and we we were recently told there is nothing that can be done about it. He walks and runs with his legs and feet in “second” position. He is 8 years old and autistic which means he already has problems doing everyday things. This is another hurdle in our everyday world. Can any type of physical or aqua therapy help at all?

- Maryellen - Florida (Parent)


Thank you for your question. Orthopedic conditions in children with autism can be challenging and depends largely on how affected a child is. It sounds from your description that your son has femoral retroversion. Usually our femurs (thigh bones) are naturally rotated inward, or “anteverted”, about 15 to 20 degrees. A common cause of in-toeing in children is excessive femoral anteversion, where a child is able to sit like a “W”. This is a harmless condition that has until the age of 8 to 10 years to naturally de-rotate with growth and muscle strength. The more rare rotational condition, or “retroversion” is similar but not as well studied as anteversion. We generally feel that all rotational conditions have until 8 to 10 years of age to derotate, but I would probably follow your son with time. As surgeons, we can always “do something” but we want to make sure that we are doing the right thing for a patient and their family. Physical therapy is a great idea to try and help strengthen up the hip girdle muscles to help your son compensate for the retroversion, but that is where the challenge in autistic children comes in, especially following explicit instructions required in therapy. Depending on where you live, you may want to ask your school therapist if they have a physical therapist trained to work with autistic children or if there is one nearby in the community. This way, someone will be able to connect with your child and be able to instruct him in exercises to get him better! I hope this helps.

- Maryellen - Florida (Parent)