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VOLUME 37 | NUMBER 7 | JULY 2007 JULY 2007
Volume 37, No. 7


Research Report

Sex Differences in Clinical Measures of Lower Extremity Alignment

Anh-Dung Nguyen, Sandra J. Shultz

DOI: 10.2519/jospt.2007.2487



STUDY DESIGN: Descriptive, cohort design. OBJECTIVES: To comprehensively examine sex differences in clinical measures of static lower extremity alignment (LEA). BACKGROUND: Sex differences in LEA have been included among a myriad of risk factors as a potential cause for the increased prevalence of knee injury in females.  While clinical observations suggest sex differences in LEA exist, little empirical data are available to support these sex differences or the normal values that should be expected in a healthy population. METHODS AND MEASURES: The right and left static LEA of 100 healthy college-age participants (50 males [mean ± SD age, 23.3 ± 3.6 years; height, 177.8 ± 8.0 cm; body mass, 80.4 ± 11.6 kg] and 50 females [mean ± SD age, 21.8 ± 2.5 years; height, 164.3 ± 6.9 cm body mass, 67.4 ± 15.2 kg]) were measured. Each alignment characteristic was analyzed via separate repeated-measures analyses of variance, with 1 between-subject factor (sex) and 1 within-subject factor (side). RESULTS: There were no significant sex-by-side interactions and no differences by side. Females had greater mean anterior pelvic tilt, hip anteversion, quadriceps angles, tibiofemoral angles, and genu recurvatum than males (P<.0001). No sex differences were observed in tibial torsion (P = .131), navicular drop (P = .130), or rearfoot angle (P = .590). CONCLUSION: Sex differences in LEA indicate that females, on average, have greater anterior pelvic tilt, thigh internal rotation, knee valgus, and genu recurvatum. These sex differences were not accompanied by differences in the lower leg, ankle, and foot. Understanding these collective sex differences in LEA may help us to better examine the influence of LEA on dynamic knee function and clarify their role as a potential injury risk factor.

J Orthop Sports Phys Ther. 2007;37(7):389-398, published online 16 April 2007. doi:10.2519/jospt.2007.2487

KEY WORDS: malalignment, posture, risk factor assessment


Sex differences in lower extremity alignment (LEA) indicate that females, on average, have greater anterior pelvic tilt, thigh internal rotation, knee valgus, and genu recurvatum. Understanding these collective differences may help us to better examine the influence of LEA on dynamic knee function and clarify their role as a potential injury risk factor.