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Coxa valga is a deformity of the proximal femur characterized by an increased femoral neck–shaft angle, typically >135° (normal: ~125–135°).

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It leads to mechanical inefficiency of the hip joint, altered gait, and may predispose to subluxation or dislocation, especially in neuromuscular conditions.

Comparison: Coxa Valga vs Coxa Vara

Feature	Coxa valga	Coxa vara
Neck–shaft angle	>135°	<120°
Leg length	Apparent lengthening	Apparent shortening
Common causes	Neuromuscular disorders, DDH	Rickets, trauma, fibrous dysplasia
Clinical gait	Waddling gait, Trendelenburg	Antalgic or Trendelenburg gait
Surgical correction	Varus osteotomy	Valgus osteotomy

Etiology

A. Congenital/Developmental

Condition	Notes
Cerebral palsy	Muscle imbalance causes hip abduction forces
Spina bifida	Weak gluteals and abductors
Developmental dysplasia of the hip (DDH)	Acetabular hypoplasia leads to femoral malalignment
‣	Contractures and abnormal muscle forces

B. Acquired

Condition	Mechanism
Skeletal dysplasias (e.g., spondyloepiphyseal dysplasia)	Disturbed endochondral ossification
Trauma	Malunion of proximal femoral fractures
Overgrowth syndromes	Disproportionate growth of the femoral neck
Growth plate disturbances	Due to infection, radiation, or previous surgery

Clinical Features

Feature	Description
Waddling gait	Due to altered hip biomechanics
Trendelenburg sign	Weak hip abductors
Hip instability	Especially in neuromuscular disorders
Leg length discrepancy	Apparent increase due to vertical femoral neck
Limited abduction or rotation	May be present depending on etiology

Complications

Complication	Description
‣	Due to altered alignment and shallow socket
Secondary osteoarthritis	Malalignment leads to abnormal joint loading
Gait dysfunction	Due to inefficiency of hip abductor muscles
Pelvic obliquity/scoliosis	From compensatory posture due to limb alignment

Radiology

A. Plain X-ray (AP Pelvis)

Feature	Description
Neck–shaft angle >135°	Diagnostic threshold for coxa valga
Vertical femoral neck	More upright orientation of the femoral head
Shallow acetabulum (if present)	May indicate underlying DDH or neuromuscular etiology
Symmetry	Important to determine if unilateral or bilateral

B. Additional Imaging