A 61-year-old mountain hiker presented with acute pain of the medial-plantar aspect of the right foot. As the location, intensity and acute onset of the pain were atypical for fasciitis plantaris, an ultrasound was performed. This demonstrated a segmental plantar vein thrombosis (PVT), which was confirmed on consequent MRI. Patient was a non-smoker, without a medical or family history of coagulopathies. Four months previously, he suffered from metatarsalgia of the left, thus contralateral, foot, which prompted treatment with bilateral orthoses. In addition to metatarsal padding, medial-arch support was prescribed due to the presence of flexible flatfeet. Following internal medicine consultation, treatment consisted of discontinuing the use of orthoses, rest and non-steroidal anti-inflammatory drugs (NSAIDs). At 2-week follow-up, the patient was pain-free. In this case report, PVT, a rare cause for plantar heel pain, is discussed. In addition, a summary of the diagnosis and treatment of PVT is outlined.