This rarely diagnosed condition involves a blood clot in one of the veins running through the sole of your foot. It may be misdiagnosed at times as plantar fasciitis.
Plantar vein thrombosis (PVT) is an uncommon but potentially very painful condition affecting the bottom of the foot. It means that you have a blood clot in one of the veins that carry blood from the sole of the foot back toward the heart.
The condition may be treated with medications to help dissolve the clot and compression stockings to help keep blood moving from the legs up to the heart.
Learn more about thrombosis.
Plantar vein thrombosis is a rare circulatory disorder, with fewer than 50 cases reported in international medical literature, according to a 2021 report.
However, that report and other research suggest that the number of cases of plantar vein thrombosis (PVT) may be much higher because the condition could be misdiagnosed as the much more common heel pain problem known as plantar fasciitis.
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PVT means that a blood clot has formed in one of the deep veins (deep vein thrombosis, or DVT) at the bottom of the foot, interfering with healthy blood flow back to the heart and causing pain and discomfort in the affected foot.
The two main symptoms of PVT are heel pain and pain along the medial arch — the inside part of your foot’s arch. The pain may be so severe that affects your ability to walk or stand for long periods.
You may notice foot swelling if PVT is present. The affected foot is sometimes described as feeling “heavy.”
Like other DVTs, plantar vein thrombosis may be caused by several factors, including:
- cancer
- infection
- injury to the foot or leg
- surgery that affects the veins or arteries of the foot or lower leg
Inheriting any of several genetic blood clotting abnormalities can raise your risk of developing plantar vein thrombosis. Among inherited clotting disorders that may raise PVT risk are:
- Factor V Leiden thrombophilia
- hyperhomocysteinemia
- prothrombin 20210 mutation
- sticky platelet syndrome
Other inherited risk factors include deficiencies in certain blood clotting proteins known as protein C, protein S, and antithrombin.
Other risk factors include a sedentary lifestyle and obesity, as well as being seated for long periods of time, such as taking long plane rides. Hormone replacement therapy may also raise the risk for PVT and DVT.
When a blood clot is suspected in a lower limb, the plantar veins are seldom screened, as most DVTs are located in the calves or thighs.
A 2024 report suggests that while ultrasound is often used to screen for DVT, magnetic resonance imaging (MRI) has become a reliable option for identifying PVT.
The main initial treatment for PVT is anticoagulation. Anticoagulants, known commonly as blood thinners, may be administered orally or through IV drips.
Commonly prescribed anticoagulants include heparin and warfarin. You also may be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) to help bring down swelling and inflammation in the foot.
You also may be advised to wear compression stockings, which apply mild pressure to the legs to help support improved blood flow back to the heart.
If the clot is large enough to pose a threat of pulmonary embolism — a deep vein blood clot that travels to the lungs and poses a potential life threatening condition — the use of thrombolytics, or “clot-busting” drugs, may be appropriate.
Because PVT is rarely diagnosed, there’s little research to suggest what the long-term outlook is for most people who develop the condition. However, if treated promptly and effectively, a PVT should not cause any long-term complications.
If PVT is diagnosed but there’s no obvious cause or diagnosis of a coagulation disorder, you may need to be screened for thrombophilia. This is a condition, usually inherited, in which there’s an imbalance of clotting factors or clotting proteins. Thrombophilic disorders are usually treated with anticoagulation.
How do you treat a thrombosis in the foot?
Treating a blood clot in your foot or legs may require only a regimen of anticoagulant therapy, which helps reduce the size of an existing blood clot and prevent the formation of a new thrombosis.
Other necessary treatments may include thrombolytic medications and compression stockings to help restore healthy blood flow back to the heart.
Can a blood clot be mistaken for plantar fasciitis?
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PVT may also be incorrectly diagnosed as other conditions that cause similar symptoms, such as tendon inflammation or abnormalities and bone fractures.
Plantar vein thrombosis is rarely diagnosed, but it may be a more common cause of heel and arch pain than research suggests.
For that reason, and because a blood clot anywhere in the body can be potentially quite dangerous, you should talk with your doctor about imaging and other screenings that might be helpful in getting an accurate diagnosis of your symptoms.