Sandal gap deformity
Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Campos A, Jones J, et al. Sandal gap deformity. Reference article, Radiopaedia.org (Accessed on 28 Mar 2025) https://doi.org/10.53347/rID-13184
Permalink:
rID:
13184
Article created:
Disclosures:
At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Arlene Campos had no financial relationships to ineligible companies to disclose.
View Arlene Campos's current disclosures
Revisions:
7 times, by
7 contributors -
see full revision history and disclosures
Systems:
Tags:
Synonyms:
- Sandal gap foot
- Sandal gap toe
- Sandal gap toes
- Hallux varus
A sandal gap deformity, also known as hallux varus, is an imaging observation in antenatal ultrasound (typically second trimester) where there is an expanded first interspace, i.e. the gap between the great toe of the foot from the rest of the toes (likened to the gap caused by a sandal).
While it can be a normal variant (especially when it is the only finding) it is also sometimes considered a soft marker for other fetal anomalies.
Pathology
Associations
Recognized associations include
- Down syndrome 1-3,4
- CLOVES syndrome 5
At least 40 other rare conditions have also been associated with this anomaly 6.
Differential diagnosis
For an unusually wide gap between the 1st and 2nd toe on antenatal ultrasound consider
- a deformity due to an amniotic band
- spectrum of ectrodactyly
References
- 1. Ryu JK, Cho JY, Choi JS. Prenatal sonographic diagnosis of focal musculoskeletal anomalies. Korean J Radiol. 4 (4): 243-51. Korean J Radiol (link) - Free text at pubmed - Pubmed citation
- 2. Smith-bindman R, Hosmer W, Feldstein VA et-al. Second-trimester ultrasound to detect fetuses with Down syndrome: a meta-analysis. JAMA. 2001;285 (8): 1044-55. doi:10.1001/jama.285.8.1044 - Pubmed citation
- 3. Devlin L, Morrison PJ. Accuracy of the clinical diagnosis of Down syndrome. Ulster Med J. 2004;73 (1): 4-12. - Free text at pubmed - Pubmed citation
- 4. Guidelines on soft markers from the RCOG : www.rcogcourses.org.uk/topics/soft%20ultrasound%20markers.pdf
- 5. Alomari AI. Characterization of a distinct syndrome that associates complex truncal overgrowth, vascular, and acral anomalies: a descriptive study of 18 cases of CLOVES syndrome. (2009) Clinical dysmorphology. 18 (1): 1-7. doi:10.1097/MCD.0b013e328317a716 - Pubmed
- 6. NCBI MedGen Library. Sandal Gap. MedGen UID: 374376. Concept ID: C1840069. Accessed on 03/02/2020 on https://www.ncbi.nlm.nih.gov/medgen/374376.
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