01/15/2026
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Biomechanics of Excessive Femoral Retroversion
This image illustrates how excessive femoral retroversion alters hip–lower limb alignment and affects gait mechanics.
1️⃣ Structural alignment
Femoral retroversion means the femoral neck is oriented more posteriorly relative to the femoral condyles. When the foot is kept straight ahead, this orientation places the femoral head in a less congruent and less stable position within the acetabulum, increasing joint stress.
2️⃣ Compensatory external rotation
To improve femoral head coverage and joint congruency, individuals naturally adopt an externally rotated (out-toeing) foot posture. This external rotation aligns the femoral head more centrally in the acetabulum, improving stability and comfort during weight bearing.
3️⃣ Effect on gait mechanics
During stance phase, the externally rotated limb shifts the ground reaction force (GRF) laterally relative to the hip and knee.
This alters hip muscle demand, often increasing reliance on posterior hip muscles (gluteus maximus and deep external rotators).
At the knee, persistent out-toeing can change tibiofemoral loading patterns and may increase lateral compartment stress.
4️⃣ Impact on energy efficiency
Because the limb is not aligned with the line of progression, gait becomes less mechanically efficient, potentially increasing energy expenditure and fatigue during prolonged walking.
5️⃣ Clinical significance
Commonly associated with out-toeing gait, hip discomfort, anterior hip instability, or knee pain
Important consideration in gait analysis, orthotic prescription, pediatric assessment, and pre-surgical planning
Differentiation from tibial torsion or foot deformities is essential for correct management