Plantar vein thrombosis: Clinical presentation, diagnosis, treatment

Plantar vein thrombosis is an underdiagnosed and, therefore, underestimated pathology with subsequent complications of various degrees of severity. However, the close anatomical relationship between the plantar veins and the superficial and deep leg veins can lead to proximal thrombus propagation with all the consequences that come with it, including fatal pulmonary embolism. The main manifestation of plantar vein thrombosis is pain that worsens with walking, which is an obvious reason to see a surgeon or orthopedic traumatologist. As a significant number of such patients have anatomical foot deformities of varying severity, the mostlikely diagnoses are platypodia, plantar fasciitis, osteoarthritis, etc., followed by orthopedic correction and prescription of nonsteroidal anti-inflammatory drugs. It is apparent that in some cases the treatment is partially successful, which confirms the “correctness” of the diagnosis. At the same time, missed plantar vein thrombosis can reappear, and its consequences can negatively impact the calf musculovenous pump function which is the primary mechanism of centripetal blood flow from the lower extremities. This article presents a case report of a 73-old-patient D. with moderate plantar pain in his left foot in the region closer to the calcaneal tuberosity, which increases with walking. An ultrasound examination demonstrated an occlusive thrombosis of theleft foot medial andlateral plantar veins. The prescribed therapy included rivaroxaban, 15 mg twice daily with food for 3 weeks, followed by switching to a single daily dose of 20 mg for 3 months, wearing of Bauerfeind VenoTrain micro compression stockings, knee high, class 2 (Germany), and foot correction with orthopaedic appliances. After 3-month therapy, the ultrasound examination showed signs of successful recanalization of thrombotic masses in the medial andlateral plantar veins of theleft lower extremity. It should be highlighted that routine ultrasound is the best method used to diagnose plantar vein thrombosis.

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