931 - Treatment of Popliteal Artery Entrapment Syndrome with Botulinum Toxin Chemodenervation: A Case Report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

TE

Tyler M. Emery, DO

PM&R Resident
University of Kentucky PM&R
Lexington, Kentucky, United States

Co-Author(s)

DD

Derek Dixon, DO

PM&R Assistant Professor
UK PM&R
Lexington, Kentucky, United States

Submitter(s)

TE

Tyler M. Emery, DO

University of Kentucky PM&R
Lexington, Kentucky, United States

Case Diagnosis: Treatment of Popliteal Artery Entrapment Syndrome with Botulinum Toxin Chemodenervation: A Case Report

Case Description: Popliteal artery entrapment syndrome (PAES) is a dynamic condition in which aberrant muscular contraction compresses the popliteal artery during physical activity, leading to reduced arterial flow resulting in claudication. Here we present an active duty military male in his late 30’s, with PAES, which persisted after bilateral myotomies years earlier. This case study explores the use of botulinum toxin (Botox) injections as a novel, minimally invasive therapeutic approach for patients with PAES and persistent symptoms after myotomy.

Discussions:

This patient was treated with electromyography and ultrasound-guided Botox injections. We performed 25 units of botulinum toxin into his bilateral medial and lateral gastrocnemius muscles based on dynamic compression seen on ultrasound. Initial follow up at 6 weeks produced excellent results, but continued to have symptoms into the anterior calf. At 3-month follow up, repeat ultrasound-guided injections to the bilateral medial and lateral head of the gastrocnemius with addition of plantaris and tibialis anterior were trialed. The same level of relief was not achieved with these injections. In collaboration with the patient, decision was made to repeat original recipe of Botox injections with increase of 30 units into bilateral medial and lateral head of gastrocnemius for a total of 120 units. These results gave significant relief of claudication symptoms with running.

Conclusions: This case demonstrates the symptom relief and improvement in quality of life possible with chemodenervation in PAES that is persistent even after myotomy, which is the current standard treatment. Although the initial outcomes are encouraging, further studies with larger sample sizes and long-term follow-up are required to establish optimal dosing protocols, injection guidelines, and evaluate sustained efficacy.