Plantar vein thrombosis is a remarkably rare and underdiagnosed vascular condition that affects the venous system of the foot, particularly the medial and lateral plantar veins. While deep vein thrombosis (DVT) in the lower limbs is relatively common, isolated involvement of the plantar veins has been documented in only a few dozen cases globally. The rarity of this entity, combined with its nonspecific clinical presentation—typically characterized by unexplained plantar foot pain, worsened by walking, and associated with localized swelling—makes diagnosis particularly challenging. Traditional risk factors for DVT, such as prolonged immobilization, recent surgical procedures, and underlying malignancy, are often present, but in plantar thrombosis, mechanical factors such as repetitive microtrauma from tight footwear, high-impact physical activity, or use of orthotics may play a more central etiological role by damaging vascular endothelium and triggering local thrombogenesis.

Given the subtle clinical signs, imaging is crucial for accurate diagnosis. Doppler ultrasound often demonstrates non-compressible plantar veins with absent flow signals, while magnetic resonance imaging (MRI) provides more comprehensive anatomical and functional assessment. Key MRI findings include a lack of contrast enhancement within the thrombosed veins, loss of the normal T2 hyperintense signal, and evidence of surrounding soft tissue edema, which further supports inflammatory changes. In our reported case, a 62-year-old obese woman presented with sudden-onset plantar pain, with MRI revealing thrombosis of the medial plantar veins extending into the posterior tibial veins. Timely diagnosis allowed for the initiation of anticoagulant therapy, which remains the cornerstone of treatment and is essential to prevent further thrombotic complications.

Although rare, plantar vein thrombosis should be considered in the differential diagnosis of persistent or unexplained plantar foot pain, especially in patients with underlying risk factors. Increased awareness among clinicians and radiologists, along with prompt imaging evaluation, can improve recognition and outcomes for this often-overlooked condition.