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Plantar vein thrombosis is a rare condition, with only a handful of cases reported in the literature. The cause is unknown; however, the disease has been attributed to prior surgery, trauma, and paraneoplastic conditions. We present a case of a 32-year-old female runner with plantar vein thrombosis diagnosed on contrast-enhanced MRI and confirmed on ultrasound. The symptoms resolved with conservative treatment and evaluation revealed the presence of a prothrombin gene mutation and use of oral contraceptive pills. To our knowledge, this is the first case of plantar vein thrombosis diagnosed initially by MRI. Moreover, this case suggests that plantar vein thrombosis should be considered in patients with hypercoagulable states and plantar foot pain.
Objective: This study was designed to describe the characteristics and clinical outcome of patients diagnosed with plantar vein thrombosis.
Methods: Patients presenting with sudden pain and/or swelling of the foot were evaluated by duplex scanning of the affected leg. All the main foot veins were imaged with high resolution multi-linear array transducers. The location and extent of thrombosis was recorded in detail. All patients were scheduled for clinical and ultrasound follow-up within a week from the diagnosis and at various intervals thereafter.
Results: Acute thrombosis was found in the plantar veins in 11 patients of whom 7 were females. Pain was presented in all patients, swelling in 8 and the left foot was involved in 7. From the risk factors evaluated, the most common were recent surgery 4, use of contraceptive pills 3, followed by malignancy, airplane travel, HIV-AIDS infection, and past history of DVT in one each. Plantar veins were exclusively affected in 8, with lower segment of the posterior tibial veins in 2 and the great saphenous vein in 1. In the follow up, there was evidence of thrombosis extension in 3 patients. At six months partial recanalization was found in 9 and complete in 2.
Conclusions: Pain and swelling of the foot can be caused by plantar vein thrombosis. Complete or partial recanalization occurs in these patients by 6 months. Thrombi in the plantar veins can progress more proximally with the possibility of postthrombotic events
A 32-year-old woman with severe foot pain came to our emergency department after a busy night duty in hospital followed by an extended sleep period. Physical examination revealed a discrete swelling of the medial aspect of the right foot and a painful plantar arch during digital examination. Magnetic resonance imaging (MRI) with intravenous gadolinium showed filling defects in the lateral plantar vein. Doppler sonography displayed noncompressible structures in the plantar veins without flow signals, suggesting a plantar vein thrombosis. Therapy was initiated with low-molecular-weight heparin in combination with customized elastic bandages for the lower leg. Follow-up sonography 6 weeks later showed complete patency of the plantar veins. To our knowledge, we present the first case of isolated plantar vein thrombosis independent of trauma, surgery, or malignant disease, most probably caused by a busy night duty on the intensive care unit (ICU) followed by a prolonged sleeping period.
We aim here to highlight the importance of diagnosing and treating promptly the rarely thought of diagnosis of plantar vein thrombosis. We hereby report two cases with no known thrombotic risk factors. Less than 20 cases are reported in the literature. Detection of this unusual site of involvement of the deep venous system can be easily made by ultrasound examination if searched for. Plantar vein thrombosis is a rarely evoked pathology. Knowledge of its occurrence could further improve its diagnosis especially that it could reveal an unknown neoplasia or coagulation abnormality.