Please click to enlarge.
Note what signs you see.
I (W. Wertelecki, M.D.) see a dorsal position of the right second toe and on the right a deep gap between the hallux and the second toe.
PERSPECTIVE: Perhaps the signs mentioned above are trivial but in fact they are not. At least at this instance the signs are signals of a dysmorphic disorder. The developmental complexity of a foot reflecting the morphogenesis of multiple developmental centers can be disrupted by multiplicity of causes. Not only feet manifest dysmorphic signs but also allow for assessment of symmetry. Both are disrupted in this illustrated instance.
What is the proof? You can see the proof by viewing the face which is likewise dysmorphic and furthermore suggestive of a specific dysmorphic syndrome. The clinical rule is that the presence of one or two dysmorphic signs may be trivial but usually it is not. The greater the number of dysmorphic signs observed more likely the signal indicate serous alterations of embryonal development. IF YOU SEE ONE DYSMOPRHIC SIGN YOU MUST SEARCH FOR OTHERS. FURTHERMORE, IF THERE ARE MULTIPLE DYSMORPHIC SIGNS CYTOGENETIC ANALYSES ARE VIRTUALLY ALWAYS REQUIRED UNLESS THE ETIOLOGY IS FIRMLY ESTABLISHED.