Foot Pain In Triathlete

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Foot Pain In Triathlete - Page #4

Working Diagnosis: Right lateral plantar vein thrombosis Treatment: Anticoagulation x3 months; held off on any further anticoagulation given risks of bleeding likely outweighs benefits. Outcome: Patient was able to do activity as tolerated, slowly increasing to high impact exercises. He was able to finish his next Ironman triathlon pain-free. Repeat ultrasound a few months later showed resolution. He also established with thrombophilia clinic Author's Comments: This was an interesting case, as the presentation of atraumatic foot pain and swelling after increased mileage suggests metatarsal stress fracture. However, it was discovered the cause of the pain was due to thrombosis, likely due to repetitive microtrauma from running with altered biomechanics (given history of right subtalar fusion), as well as his prothrombin G20210A mutation. A few quick tidbits on plantar vein thrombosis: A rare cause of plantar pain, more common in middle-aged women.1 The lateral plantar vein is more commonly involved than the medial.1 Symptoms: vague; include foot pain, swelling, pain with walking.2 Diagnosis: usually with sonography3 and MRI as confirmation.4 Risk factors: trauma, postoperative, paraneoplastic (patient is up to date on cancer screening), contraception, immobilization, HIV, or thrombophilia as in this case.5 In one study, 1/3 of cases occurred after physical strain to the foot.1 Treatment: anticoagulation x3 months.6 Complications: extension into deep calf veins, or recurrence.1 Return To The Case Studies List.		Back
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