Abnormal fingertip morphology Transverse distal phalangeal crease A horizontal transverse crease over the distal phalanx or fingertip pulp. This feature may be associated with prominent fingertip pads (which are also known as persistent fetal finger pads), and if so, the crease is located distal to the fingertip pad. Transverse distal phalangeal creases may be a feature of Costello, CFC and Noonan syndromes.