Sandal gap in toes: How it links to down syndrome and why doctors take it seriously

That small gap between the big toe and second toe may be harmless for some, but doctors say it can also be an important clue to certain genetic or orthopaedic conditions. (Image: Canva)

Sandal gap is that extra space between the big toe and second toe. In some cases, it is a clue to congenital or acquired health conditions. Whether it appears in infants or adults, getting it checked can help guide treatment and improve comfort.

While some people naturally have this trait without ever seeing a doctor for it, paediatricians and geneticists sometimes see it as a subtle flag in the diagnosis of certain conditions.

One of the more well-known reasons doctors pay attention to a sandal gap — that space between the big toe and the one next to it — is because it can be a visible marker for Down syndrome, often picked up during prenatal scans. But it doesn’t stop there. That small gap has also been spotted in other, much rarer conditions like Wolf-Hirschhorn syndrome, CLOVES syndrome, and 8q22.1 microdeletion syndrome.

Also Read: From XXXL to Medium: How a 43-year-old fought postnatal depression with fitness and determination

Medical studies over the years — like one from Korea in 2003 and a global review in 2017 — have shown that the sandal gap pops up in several genetic conditions. It’s not something doctors use to diagnose on its own, but rather as part of a larger picture that includes things like facial features, growth patterns, or heart health. In short, it’s a clue — not a conclusion.

Orthopaedic surgeon Dr Shubham Katti, Apollo Spectra Hospital, Pune, informs that there’s a key difference between children who are born with a sandal gap and those who develop it later in life.

“In infants, a sandal gap can sometimes be due to a tight band of muscle that tugs at the toe,” says Katti. "It often comes along with other toe deformities, and if it’s picked up early, there are treatments that can help prevent it from getting worse or even correct it altogether", he explains. "Early detection and orthopaedic treatment in infancy can prevent progression and even correct it," adds Dr Katti.

However, in adults, sandal gap deformities are usually acquired — often due to previous injuries, surgeries, or underlying nerve or inflammatory conditions. “In such cases, it’s more than a cosmetic concern. People often experience pain, difficulty wearing shoes, or walking properly. But with proper footwear modification, splints, or even surgery, quality of life can be significantly improved,” he adds.

While most sandal gaps are harmless, if the spacing is noticeable and paired with other unusual features, it is vital to consult a doctor. "Watch out for features such as facial differences, developmental delays, or foot pain. Orthopaedic assessments, genetic testing, or imaging may be suggested, depending on age and associated symptoms", says Dr Katti.

Also Read: Harvard-trained AIIMS gastroenterologist recommends 5 gut-friendly breakfast foods for better digestion

FAQs on Sandal Gap Toe:

1. What is a sandal gap toe?
A sandal gap toe refers to the extra space between the big toe and the second toe.

2. Can a sandal gap toe indicate a health condition?
Yes, in some cases, a sandal gap toe can be a clue to congenital or acquired health conditions.

3. Is sandal gap toe common in Down syndrome?
Yes, a sandal gap toe is often a visible marker for Down syndrome, detected during prenatal scans.

4. Are there other conditions associated with sandal gap toe?
Yes, sandal gap toe has also been observed in conditions like Wolf-Hirschhorn syndrome, CLOVES syndrome, and 8q22.1 microdeletion syndrome.

5. Should infants with a sandal gap toe be medically evaluated?
Yes, early detection and orthopaedic treatment can prevent progression and even correct the condition.

6. Can adults develop sandal gap toe?
Yes, adults can develop sandal gap toe due to previous injuries, surgeries, or underlying nerve or inflammatory conditions.

Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for a specific health diagnosis.