Plantar vein thrombosis: a rare differential diagnosis in patients with plantar pain

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.

Ultrasound findings in subcutaneous plantar vein thrombosis: retrospective analysis of seven patients

BACKGROUND

Several disorders may result in forefoot pain. An uncommon cause of forefoot pain is subcutaneous plantar veins thrombosis (SCPVT) involving veins superficial to the plantar fascia.

PURPOSE

To describe the ultrasound (US) appearance of SCPVT, which has been described only once in the radiological literature.

MATERIAL AND METHODS

We performed a retrospective search of our PACS system from 2016 to 2020 to collect all cases of US-diagnosed SCPVT. We collected data on seven patients. Two radiologists analyzed the US images retrieved. All US examinations were performed with a multifrequency linear probe (frequencies in the range of 5-17 MHz).

RESULTS

A localized plantar nodule was palpable in 86% of patients. The subcutaneous thrombosed vein appeared in all patients as a round or ovoid nodule located in the subcutaneous tissues that corresponded in four patients (4/5, 80%) to the painful palpable nodule. The size was in the range of 4-7 mm (mean = 5.4 mm). The thrombosed vein presented a connection with adjacent patent veins, appeared enlarged, and almost filled with hypo-isoechoic material, and in two patients (2/7, 29%), a thin peripheral fluid component surrounding the thrombus was detectable. Continuous scanning demonstrated slow blood movements inside the peripheral component due to blood circulation. Failure to compress the lumen of the thrombosed vein during the real-time US was evident in all patients.

CONCLUSION

SCPVT is a rare or underreported condition. Sonologists must know the US appearance of SCPVT to exclude other conditions and avoid unnecessary invasive studies.

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.

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.