Case Report of a Professional Cyclist with Functional Popliteal Artery Entrapment: the Importance of Dynamic Diagnosis

Abstract

Introduction: Functional popliteal artery entrapment syndrome is a rare cause of exercise-induced calf pain in active young people, caused by transient dynamic occlusion of the artery, usually due to medial gastrocnemius hypertrophy. Its diagnosis requires dynamic studies, as examinations at rest are usually normal. Although surgery has been the traditional treatment, less invasive alternatives such as botulinum toxin type A infiltration have been proposed.

Objective: To present a clinical case of functional popliteal artery entrapment syndrome, confirmed by dynamic studies and managed with a conservative therapeutic approach.

Clinical case: We present the case of a 25-year-old male professional cyclist with pain in his left calf and sole of his foot triggered by intense exercise and absent at rest. Initial studies were normal. Subsequently, a dynamic Doppler and magnetic resonance angiography with maneuvers revealed findings consistent with functional popliteal artery entrapment syndrome associated with medial gastrocnemius hypertrophy. Botulinum toxin type A was administered, resulting in significant clinical improvement and recovery of athletic performance.

Conclusions: This case highlights the importance of timely diagnosis through functional studies and shows that botulinum toxin treatment is an effective and minimally invasive alternative, capable of preserving functionality and avoiding more aggressive surgical procedures in young athletes.