Normal Variant or Something to Worry About?
Case Summary
- Gestational age: 22 weeks 3 days
- Examination: Detailed second-trimester ultrasound
- Finding: Flexed appearance of the right 4th toe
Ultrasound Findings
- Flexion of the right 4th toe
- Other toes aligned normally
- Normal foot length and shape
- No rocker-bottom configuration
- No syndactyly
- Long bones within normal range
- No additional structural abnormalities
๐ Isolated finding
What Is a Curly Toe?
A curly toe refers to a flexed or slightly underlapping toe appearance.
In fetal ultrasound, this can be seen due to:
- Intrauterine positioning
- Transient muscular tone
- Normal anatomical variation
The 4th toe, in particular, may appear flexed because of its anatomical alignment and scanning angle.
Is It a Soft Marker?
Isolated curly toe is not considered a strong soft marker for chromosomal abnormalities.
However, further evaluation is important when:
- Multiple anomalies are present
- Persistent overlapping toes are observed
- Fixed deformity is suspected
- Associated skeletal abnormalities exist
In this case, no additional abnormalities were identified.
What Should Be Checked?
When a curved toe is seen, the examiner should assess:
โ Overall toe alignment
โ Foot contour
โ Long bone measurements
โ Presence of other structural anomalies
โ Fetal growth pattern
Context is everything.
Counseling Perspective
When isolated and not associated with other findings, a curly toe is most often:
- Positional
- Benign
- Likely to resolve or remain clinically insignificant
Follow-up imaging can help confirm stability.
๐ Clinical Takeaway
Not every unusual image represents pathology.
Ultrasound interpretation requires pattern recognition and context.
An isolated 4th curly toe at mid-gestation is usually a normal variant.
