Sandal gap is a common symptom of which of the following conditions?

BTSC Staff Nurse 31 July-2025

Child Health Nursing (Pediatrics)

Easy

Appeared in: BTSC Staff Nurse 31 July-2025

Explanation

The term 'sandal gap' refers to an increased space between the first (great) and second toes, a finding clearly visible in the provided image.
This physical trait is a classic and common dysmorphic feature associated with Down's syndrome, also known as Trisomy 21.
It is often observed along with other characteristic signs such as a single transverse palmar crease (simian crease), epicanthal folds, and a flattened facial profile.
Its presence in a newborn should prompt a thorough physical examination and consideration for genetic testing.

Option A: Ehlers-Danlos syndrome is a disorder of connective tissue. Its primary manifestations are related to skin hyperextensibility and joint hypermobility, not specific toe spacing.
Option B: Wolff-Parkinson-White (WPW) syndrome is a cardiac condition involving an abnormal electrical pathway in the heart. It is diagnosed via ECG and presents with palpitations or tachycardia, not with physical dysmorphic features.
Option C: Sheehan's syndrome is an endocrine disorder (hypopituitarism) that occurs as a rare complication of severe postpartum hemorrhage. It is an acquired condition and not a congenital syndrome with physical markers like a sandal gap.

Clinical Relevance

Nursing practice connection: Knowing Physical assessment findings in congenital syndromes helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses performing newborn assessments must be skilled in identifying minor and major dysmorphic features, as these can be the first clues to an underlying genetic condition.
Early detection of signs like the sandal gap facilitates prompt referral for genetic counseling and diagnostic testing, which is essential for planning care and providing family support.
What if? If an infant with a sandal gap also presents with a heart murmur on auscultation, the nurse's suspicion for Down's syndrome should be significantly heightened. This is because congenital heart defects (e.g., atrioventricular septal defect) are present in nearly 50% of infants with Down's syndrome, and this finding would warrant an urgent echocardiogram.

How to Approach the Question

First, analyze the image provided. Identify the key visual feature, which is a prominent gap between the big toe and the second toe.
Recall the clinical term for this sign, which is a 'sandal gap' or 'sandal toe'.
Review the options provided and consider the pathophysiology of each condition.
Systematically eliminate the options that are unrelated to congenital physical features. WPW syndrome is cardiac, and Sheehan's syndrome is an acquired endocrine disorder.
Differentiate between the remaining genetic syndromes. Ehlers-Danlos syndrome affects connective tissue (joints/skin), while Down's syndrome is known for a specific set of physical markers, including the sandal gap.
Select Down's syndrome as the condition most strongly associated with the visual evidence and the term 'sandal gap'.

Concept Tested & Keywords

Concept Tested: Physical assessment findings in congenital syndromes
Stem keywords: Sandal gap, common symptom
Lead-in keywords: which of the following
Clinical cues: The visual presence of a sandal gap in the image is the primary clinical cue.

Q8OY9xVD7U7_XpD74HFIZ5