Plantar vein thrombosis secondary to mechanical trauma: A rare cause of plantar foot pain.

Abstract

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. 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. Retrospective chart review. Tertiary care center. Adult patients with mention of plantar vein thrombosis in imaging impressions. 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. 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. 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.