Background: Idiopathic persistent femoral anteversion is a common cause of intoeing causing walking difficulties with painful hip and knee joints. This study presents if the proximal femoral derotational osteotomy using a simplified Ilizarov external fixator effective in idiopathic intoeing Patients and methods: Thirty-seven limbs in 21 children underwent proximal femoral derotational osteotomy in the period between January 2014 and June 2017. The deformity was bilateral in 16 children while one side was affected in five cases. There were nine boys and twelve girls with a mean age of 9.3years. Both limbs were operated at the same time in all bilateral cases. The technique in the present study was done using two Ilizarov arches fixed to the proximal part of the femur with the osteotomy performed percutaneously using multiple drills an osteotome technique. Children were nursed in a wheelchair for the first two weeks postoperative after which partial weight-bearing was allowed using two crutches. During follow up, children were evaluated according to the Staheli rotational profile and the improvement of their preoperative symptoms. Results: All cases were followed for at least two years. Complete consolidation of the osteotomy site was obtained within an average of 8.8 weeks. The internal rotation degree was decreased significantly from an average of 82.4 to 45.4 postoperatively. The main complication was superficial pin tract infection in ten limbs (23.8%) Conclusion: The less invasive derotation proximal femoral osteotomy technique, fixed by the two arches system is applicable in the management of idiopathic femoral ante-version.