Davis, Patrick T.

Abstract Background Plantar vein thrombosis is a rare vascular condition typically presenting with unilateral plantar foot pain and edema. Of interest to the musculoskeletal clinician, mechanical trauma to the plantar foot has been cited as a risk factor for development of these thrombi. Objective To assess the demographics, presenting history, risk factors, treatment protocols, and long‐term sequelae of patients with plantar vein thrombosis secondary to increased mechanical trauma. Design Retrospective chart review. Setting Tertiary care center. Participants Adult patients with mention of plantar vein thrombosis in imaging impressions. Main Outcome Measures Primary outcome measure was determination of the demographic and clinical characteristics of plantar vein thrombosis in patients with mechanical trauma as a preceding risk factor. Secondary outcome was evaluation of treatment options in this patient population. Results Between 2005 and 2023, nine patients at a single institution were diagnosed with plantar vein thrombosis through imaging and were determined to have developed the thrombus due at least in part to mechanical trauma. Patients typically presented with localized plantar foot pain and foot edema. Diagnosis was made via magnetic resonance imaging or ultrasound. The most frequent treatment was therapeutic anticoagulation but initial conservative treatment with serial ultrasound resulted in conversion to anticoagulation in only one patient. Among those patients with mechanical trauma as an inciting factor, the only noted complication was propagation of the thrombosis in one patient. Conclusions Although rare, plantar vein thrombosis should be considered by the musculoskeletal clinician in the differential diagnosis of unilateral plantar foot pain. Treatment of these thrombi is most commonly therapeutic anticoagulation, but in the absence of additional high‐risk factors serial ultrasound evaluations may be an adequate first line treatment due to the overall minimal risk of thrombosis propagation.

Background: Plantar vein thrombosis (PVT) is a rare cause of unilateral plantar foot pain not commonly assessed during sonographic scans for venous thromboembolic evaluation. The present study aims to increase awareness of PVT when evaluating musculoskeletal conditions and to discuss the utility and characteristic imaging findings of PVT on magnetic resonance imaging (MRI). Methods: This is a retrospective chart review identifying patients with suspected PVT via search of a single institution’s radiology reports. Twelve patients had an available lower extremity MRI. These 12 MRIs were independently reviewed by 2 fellowship-trained musculoskeletal radiologists for common imaging characteristics. Of note, only 7 of the 12 available imaging studies contained MRI findings consistent with PVT as determined by the radiology reviewers. For these 7 patients, clinical characteristics were also recorded. Results: Between both radiology reviewers, there was 100% agreement confirming, localizing, and describing the findings of PVT. Of the 7 cases of MRI-confirmed PVT, 6 of 7 studies were performed without contrast and 1 of 7 was performed with and without contrast. The lateral plantar vein was the predominant vein involved in 85.7% (6/7). All 7 cases showed signs of intraluminal signal change, venous enlargement, and muscle edema. Two cases (28.6%, 2/7) displayed collateralization and/or enlargement of surrounding veins. In the only MRI performed with contrast, perivascular enhancement and a filling defect were noted. Conclusion: In the evaluation of a painful foot, an MRI can be used to diagnose PVT reliably and may have several advantages over compression ultrasonography (US) because of its ability to identify other unsuspected etiologies of a painful foot and elimination of technical limitations of compression US in the plantar foot region.