Tropical Doctor > Volume 37, Number 4 > Pp. 238-241

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Short Reports

Swan-neck sign of the big toe - association with hypocalcaemia

Kishore S Agarwal MBBS DBN     Noopur Baijal MBBS     Lokesh Tiwari DNB     Neeraj Verma MBBS     Mohit Sahni MBBS     Jacob M Puliyel MBBS  

Department of Pediatrics, St Stephens Hospital, Tis Hazari, Delhi 110054, India

Correspondence to: Dr Jacob M Puliyel puliyel{at}vsnl.com

The sensitivity and specificity of a new clinical sign of hypocalcaemia were evaluated. The Swan-neck sign, wherein infants with symptomatic hypocalcaemia keep their big toe hyperextended at the metatarsophalangeal joint and flexed at the interphalangeal joint, was looked for in 25 infants presenting with non-febrile seizures, alongside their serum calcium levels. The study showed that the sign had a sensitivity of 63.6% and specificity of 66.6%. (Predictive values of positive and negative tests were 93.3% and 20%, respectively.) This is compared with the standard Trousseau and Chvostek signs.

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