Magnetic Resonance Imaging Features of Plantar Vein Thrombosis

Plantar vein thrombosis (PVT) is an underdiagnosed condition affecting the deep plantar veins, with challenging clinical diagnosis, often presenting with non-specific symptoms that mimic other foot pathologies. This study assessed the magnetic resonance imaging (MRI) features of patients diagnosed with PVT to contribute to the understanding of this condition. We performed the comprehensive analysis of a substantial dataset, including 112 patients, with a total of 130 positive MRI scans (86 of the forefoot and 44 of the ankle) presenting with PVT. Upon evaluating all the veins of the feet, we observed a higher frequency of involvement of the lateral plantar veins (53.1%) when compared to the medial veins (3.8%). The most affected vascular segments in the forefeet were the plantar metatarsal veins (45.4%), the plantar venous arch (38.5%), and the plantar communicating veins (25.4%). The characteristic findings on MRI were perivascular edema (100%), muscular edema (86.2%), venous ectasia (100%), perivascular enhancement (100%), and intravenous filling defects (97.7%). Our study provides valuable insights into the imaging evaluation of PVT and shows that MRI is a reliable resource for such diagnosis.

Plantar vein thrombosis: 17-year longitudinal study of consecutive patients from a Swiss academic center

Background

Plantar vein thrombosis (PVT) is a rare condition. Less than 50 cases have been described in the literature. Evidence from interventional and observational studies is sparse or lacking.

Objectives

To describe a consecutive cohort of patients diagnosed with PVT at a single academic institution over the past 17 years.

Methods

We searched medical charts from patients managed at the University Hospital Zurich between 2005 and 2022. PVT was detected through sonography (eg, in the presence of a noncompressible deep vein) and/or magnetic resonance (eg, a vein with a filling defect on non-contrast-enhanced or contrast-enhanced imaging). The study was approved by the local ethics commission.

Results

We identified 45 patients who had been assessed for PVT. After manual check of these cases, we selected 16 patients with a confirmed, objective diagnosis. Median age was 62 (25th-75th percentiles, 46-73) years, and 9 (56%) patients were women. All patients were symptomatic, usually reporting local pain in the foot (100%) and swelling (67%). The most frequent risk factors were cancer (n = 6; 38%) and prior deep vein thrombosis (n = 4; 25%). Overall, 80% of patients received oral anticoagulation and 20% received parenteral anticoagulation for a median of 90 days. Over a median follow-up of 17 months, 2 (12.5%) recurrent venous thromboembolism events were recorded following the discontinuation of anticoagulation. Index vein recanalization occurred in all 15 survivors. One patient died from cancer 2 years after PVT diagnosis.

Conclusion

We provided initial information on the clinical characteristics, treatment, and course of PVT, which partly resembles that of distal deep vein thrombosis.

Imaging Features of Plantar Vein Thrombosis: An Easily Overlooked Condition in the Differential Diagnosis of Foot Pain

Plantar vein thrombosis is a venous disorder affecting deep plantar veins that can manifest with non-specific localized pain, plantar foot pain, swelling, and sensation of fullness. Plantar veins are not routinely assessed during sonographic scans for deep venous thrombosis, which makes plantar venous thrombosis a commonly missed diagnosis. This paper provides a comprehensive review of the venous anatomy of the foot and imaging findings of plantar venous thrombosis as well as discusses the current literature on the topic and its differential diagnoses.

Venous thrombosis: a mimic of musculoskeletal injury on MR imaging

Clinical signs and symptoms of venous thrombosis and musculoskeletal pathologies frequently overlap. Sometimes, patients with venous thrombosis undergo MR examinations under an equivocal suspicion of muscle, tendon or articular injury. A low pretest clinical suspicion and lack of familiarity with the conventional MR imaging signs of venous thrombosis may result in failure to diagnose venous thrombosis, delaying treatment and raising morbimortality. In MR imaging, thrombosis presents as venous ectasia with intraluminal heterogeneous content. Small vein thrombosis is often identified as having a branching aspect. Perivenous edema and inflammatory soft tissue changes may be the most prominent findings. The purpose of this paper is to illustrate MR findings of venous thrombosis in patients who underwent MR examinations due to suspected musculoskeletal pathologies. Cases of venous thrombosis in different sites of the body diagnosed through MR are presented.

Plantar Vein Thrombosis in the Medial Branch of the Posterior Tibial Vein: A Case Report

Plantar vein thrombosis (PVT) is an atypical cause of plantar heel pain and is seldom reported in the literature. We present a unique, rare case report of a patient exhibiting plantar heel and medial arch pain caused by thrombosis in the plantar medial branch of the posterior tibial vein. The diagnosis was made by means of magnetic resonance imaging, showing lobulated hypointensity in the medial plantar vein, consistent with a PVT. In this article, we provide an overview of the clinical signs of PVT, which is most commonly plantar heel pain. Furthermore, we discuss ultrasound and magnetic resonance imaging as diagnostic modalities, and conservative treatment options, including anti-inflammatory medications, anticoagulation therapy, and compression therapy. As with other types of venous thromboembolism, this condition must also be diagnosed without delay to avoid potential complications.

Four new cases of isolated foot vein thrombosis: Is the first metatarsal interspace perforator responsible?

Isolated foot vein thrombosis is an infrequently reported condition, the cause of which is still questioned. Four new cases are detailed, covering different physio-pathological situations ranging from plantar vein to Lejars' sole thrombosis. They are compared to the literature. The common vein altered in most of the cases is the first metatarsal interspace perforator, which is hypothesized as the area of the onset of many cases of foot vein thrombosis. Diagnostic workup could reveal neoplasia, inflammatory diseases, or coagulation abnormality. There is no consensus regarding plantar vein thrombosis treatment, and conservative therapy, non-steroidal anti-inflammatory drugs and anticoagulant therapy have been reported.

Plantar vein thrombosis masquerading as plantar fasciitis: A case report

Plantar vein thrombosis is an uncommon and under-diagnosed cause of plantar foot pain characterised by the formation of a blood clot (thrombus) within one of the plantar veins. There is no current diagnostic guideline for this condition however compression ultrasound and magnetic resonance imaging appear suitable. Treatments range from rest and non-steroidal anti-inflammatory drugs to six months of anticoagulant therapy. A 51-year old female was referred reporting a two-week history of left heel pain suspicious of plantar fasciitis. Ultrasonography and Magnetic Resonance Imaging showed thickening and expansion of the lateral plantar vein. The patient's symptoms disappeared following two weeks of non-steroidal anti-inflammatory medication and compression therapy, and follow-up ultrasound six weeks later showed recanalisation of the lateral plantar vein.

Plantar vein thrombosis

Plantar vein thrombosis is an uncommon and under-diagnosed cause of plantar foot pain. It is characterized by the formation of a blood clot (thrombus) within one of the plantar veins. Factors leading to this condition are unclear and multiple potential causes have been proposed. Plantar vein thrombosis presents as non-specific unilateral plantar foot pain, swelling, and a heavy feeling in the affected foot. There is no current diagnostic guideline for this condition however compression ultrasound and magnetic resonance imaging appear suitable. Treatments range from rest and non-steroidal anti-inflammatory drugs to six months of anticoagulant therapy. Herein, we aim to consolidate the current literature on plantar vein thrombosis to guide clinicians and future researchers.

Plantar vein thrombosis provoked by mechanical strain to the foot: a rare cause of plantar heel pain

A 61-year-old mountain hiker presented with acute pain of the medial-plantar aspect of the right foot. As the location, intensity and acute onset of the pain were atypical for fasciitis plantaris, an ultrasound was performed. This demonstrated a segmental plantar vein thrombosis (PVT), which was confirmed on consequent MRI. Patient was a non-smoker, without a medical or family history of coagulopathies. Four months previously, he suffered from metatarsalgia of the left, thus contralateral, foot, which prompted treatment with bilateral orthoses. In addition to metatarsal padding, medial-arch support was prescribed due to the presence of flexible flatfeet. Following internal medicine consultation, treatment consisted of discontinuing the use of orthoses, rest and non-steroidal anti-inflammatory drugs (NSAIDs). At 2-week follow-up, the patient was pain-free. In this case report, PVT, a rare cause for plantar heel pain, is discussed. In addition, a summary of the diagnosis and treatment of PVT is outlined.

Plantarvenenthrombose bei postoperativer Immobilisierung und Infektion des Fußes

Die Diagnostik und Therapie eines 72-jährigen Patienten mit zunehmenden Fußschmerzen, Rötung und Schwellung eine Woche nach der Osteosynthese des trimalleolären Sprunggelenkfraktur und Immobilisierung wird vorgestellt. Zuerst erfolgte eine röntgenologische Diagnostik nach der, bei unauffälligem Befund, eine Abklärung in der angiologischen Praxis erfolgte. Nach einer klinischen und duplexsonographischen Untersuchung sind eine Fußphlegmone und eine isolierte Plantarvenenthrombose diagnostiziert worden, die mit Antikoagulation, Kompressionstherapie und Antibiose erfolgreich behandelt wurden.

Clinical characteristics and course of plantar vein thrombosis: a series of 22 cases

Objectives

To evaluate the clinical presentation and disease course of symptomatic plantar vein thrombosis.

Patients and methods

Patients with a first diagnosis of symptomatic plantar vein thrombosis at our institution were retrospectively identified from a prospectively maintained database. All patients underwent complete venous compression sonography extended to the plantar veins because of local symptoms at the sole of the foot. Clinical characteristics were obtained from the medical records.

Results

Between 2005 and 2013, 22 patients were diagnosed with a first episode of plantar vein thrombosis (64% women, mean age at diagnosis 58.2 years, range 32–79 years). All patients reported moderate to heavy pain of the sole of the foot. The lateral plantar veins (96%) were more frequently affected than the medial plantar veins (41%) and extension into the deep calf veins was common (27%). Half of the episodes were idiopathic, with subsequent diagnosis of occult malignancy in two of these patients. In seven patients (32%), plantar vein thrombosis occurred in association to physical strain to the foot. All patients were treated with anticoagulation. Symptomatic pulmonary embolism was not observed and during a mean follow up of 21 months, the post-thrombotic syndrome did not occur. However, recurrences were common (27%) and frequently again affected the plantar veins.

Conclusion

Plantar vein thrombosis should be considered as an important differential diagnosis of acute foot pain.

Plantar vein thrombosis and pulmonary embolism

Plantar vein thrombosis is an unusual and under-diagnosed condition that affects the plantar deep venous system. Current ultrasound investigation protocols for deep venous thrombosis neglect this entity. To our knowledge, there are only seven reports in the literature of 20 patients with plantar vein thrombosis detected with sonography without an associated pulmonary embolism. We present a case report of a patient with a plantar vein thrombosis associated with pulmonary embolism. Patients who present with pain and/or swelling of the foot should undergo ultrasound examination and careful evaluation for respiratory symptoms.