Plantar Vein Thrombosis: An Unusual Cause of Plantar Pain

Abstract

We present a case of an 80-year-old man with progressive pain for 5 days at the medial and plantar aspect of the left heel. Wearing shoes aggravated the pain. Ultrasound and magnetic resonance imaging (MRI) revealed thrombosis of the medial plantar veins. Plantar vein thrombosis is a rare condition. The clinical symptoms are non-specific and can be confused with plantar fasciitis. It has been associated with hypercoagulable conditions, foot trauma and recent surgery. The imaging modality of choice is ultrasound. MRI may add to the diagnosis in unclear cases.

Magnetic Resonance Imaging Features of Plantar Vein Thrombosis

“…PVT is a condition that has not been extensively explored in the literature, with a few studies published [ 2 , 3 , 6 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Legrand et al [ 24 ] was the first to describe it in a case report in 1997.…”

“…Clinical diagnosis is usually challenging due to the unfamiliarity of this entity with clinicians and surgeons, with many differential diagnoses for plantar foot pain, including plantar fasciitis, Morton’s neuroma, sesamoiditis, plantar fibromatosis, tendon pathologies, and stress fractures, among others [ 1 , 2 , 4 ]. PVT pathogenesis is uncertain and can be idiopathic in up to 50% of cases [ 5 ], or related to local or systemic factors [ 1 , 6 , 7 , 8 ]. The “Virchow triad” (venous ectasia, endothelial damage, and inflammation) is recognized as the traditional explanation for the pathophysiological mechanism behind the development of deep venous thrombosis (DVT) [ 8 , 9 ]; however, the possible predisposing factors include coagulation disorders, oral contraceptives, infection, malignancy, airplane travel, trauma, mechanical stress, athletic activity, recent surgery, pos-operative immobilization, and pressure from orthotics [ 1 , 2 , 6 , 7 ].…”

“…PVT pathogenesis is uncertain and can be idiopathic in up to 50% of cases [ 5 ], or related to local or systemic factors [ 1 , 6 , 7 , 8 ]. The “Virchow triad” (venous ectasia, endothelial damage, and inflammation) is recognized as the traditional explanation for the pathophysiological mechanism behind the development of deep venous thrombosis (DVT) [ 8 , 9 ]; however, the possible predisposing factors include coagulation disorders, oral contraceptives, infection, malignancy, airplane travel, trauma, mechanical stress, athletic activity, recent surgery, pos-operative immobilization, and pressure from orthotics [ 1 , 2 , 6 , 7 ]. The most common presentation is a non-specific plantar sensation, or moderate-to-severe localized foot pain and swelling [ 1 , 6 , 10 ].…”

Plantar Vein Thrombosis Mimicking Tendinopathy

“…The risk factors include vessel wall damage, intravenous stasis of the blood, inappropriate footwear and hypercoagulable states caused by medication, neoplasia, postoperative states, trauma, and genetic disorders [ 1 ].…”

“…The primary imaging modality to diagnose the deep plantar vein thrombosis is color Doppler ultrasonography, while MRI can be very useful in the obese patients and patient with a horny skin [ 1 ]. Due to the more frequent use of MRI nowadays, the disease is often detected first on MRI.…”