Calf pain in runners may be caused by venous insufficiency

NewsBot · Aug 7, 2008

Members do not see these Ads. Sign Up.
Calf pain in runners may be caused by venous insufficiency.
Holzheimer RG, Stautner-Brückmann C.
Eur J Med Res. 2008 May 26;13(5):218-20.

Sportsman complaints in the legs are most often associated with diseases and/or trauma of the musculoskeletal system. More rarely disturbances of the vascular system, e.g., popliteal artery entrapment have been reported in sportsman. Venous entrapment or venous claudication is mainly observed in cases of deep venous thrombosis. We report a case of venous claudication in the right leg of a sportsman (long distance runner) without any history of venous thrombosis who presented himself to the Praxisklinik Sauerlach. After running one to two km the man had to stop running due to increasing numbness in the lower leg, aching muscles in the calf and finally pain. An orthopaedic evaluation including magnetic resonance imaging of the leg by two orthopaedic specialists did not reveal any disturbance in the musculoskeletal system being responsible for the pain. - At the first clinical evaluation in ambulatory surgery clinic in Sauerlach there were no visible signs of varicose veins in the legs. B-mode and duplex-sonographic investigation of the right leg revealed an enlarged (0.63 cm) insufficient sapheno-popliteal junction with reflux in the right leg, the investigation of the venous system in the left leg was normal. A popliteal artery entrapment was excluded by colour duplex sonography. The operative procedure, ligation of the sapheno-popliteal junction with segemental saphenous vein stripping, has been well tolerated. 2-3 weeks after ligation of the sapheno-popliteal junction and segmental saphenous vein stripping the patient resumed his running program and could run without any painful disturbances.

Conclusion: Athletes, e.g., runners with complaints in the leg should be investigated for musculoskeletal defect but also for vascular disease,e.g., small saphenous vein insufficiency. The choice of treatment is ligation of the sapheno-popliteal junction with segmental saphenous vein resection which gives the patient optimal results and allows practicing long-distance running shortly after the operation.
Click to expand...

Admin2 · Aug 11, 2008

Related:
Subclinical nerve entrapements in runners
Other threads on venous disorders

NewsBot · Aug 11, 2008

The prevalence of occult peripheral arterial disease among patients referred for orthopedic evaluation of leg pain.
Bernstein J, Esterhai JL, Staska M, Reinhardt S, Mitchell ME.
Vasc Med. 2008 Aug;13(3):235-8.

Lower extremity peripheral arterial disease (PAD) and musculoskeletal conditions both produce symptoms of leg pain, and may coexist. This study assesses the prevalence of PAD among patients referred to orthopedic surgery for evaluation of lower extremity pain. Fifty consecutive patients aged 50 years or more who had a chief complaint of leg pain, no history of trauma, and no previous history of PAD were studied prospectively. The presence of known risk factors for PAD and classic claudication symptoms was assessed by telephone interview and medical record review. Individuals were then evaluated by measurement of the ankle-brachial index (ABI) using Doppler and pulse volume recordings (PVR). A patient was deemed to have PAD if the ABI was below 0.9 or if the PVR demonstrated significant abnormalities. Occult PAD was detected in 10 of the 50 patients (20%) on the basis of the non-invasive vascular studies. There were no differences between patients with PAD and those without PAD regarding the presence of risk factors for PAD. None of the patients without PAD had claudication, while only one of the 10 patients with PAD had symptoms of classic claudication. In conclusion, 20% of patients referred by primary care providers to the orthopedic surgery clinic for lower extremity pain were discovered to have occult PAD. The majority of these patients did not have claudication. Orthopedic surgeons and primary care providers must maintain an appropriately high index of suspicion for PAD when evaluating patients with non-traumatic lower extremity pain.
Click to expand...

NewsBot · Nov 13, 2012

Case Report: Lower Extremity Deep Vein Thrombosis Following an Intense Calf Workout
Yim, Eugene S.; Friedberg, Ryan P.
Current Sports Medicine Reports: November/December 2012 - Volume 11 - Issue 6 - p 282–286

We report a case of a high-performance athlete with hemoglobin SC who presented with asymmetric calf soreness after an intense calf workout. By ultrasonography, he was diagnosed with a deep vein thrombosis (DVT) of his right calf. Subsequently he presented with a number of sequelae of sickle cell disease: acute chest syndrome, avascular necrosis of the hips, and chronic kidney disease. The case is instructive as an example of DVT after exercise of the lower extremities, which has not been documented well. The case also illustrates a number of health sequelae of sickle cell disease that mimic more common musculoskeletal complaints. Sports medicine providers will have to consider these uncommon but profound diagnostic entities when caring for athletes with sickle cell disease. The case further highlights how research can inform the clinical decisions and policies aimed at reducing the risk of life-threatening and lifelong sequelae of sickle cell disease in athletes.
Click to expand...

NewsBot · Sep 23, 2017

Popliteal Artery Entrapment Syndrome: Bilateral Lower Extremity Involvement
Havalee T. Henry, MD, MS; Lauren K. Szolomayer, MD; Bauer E. Sumpio, MD, PhD, FACS; Karen M. Sutton, MD
Orthopedics; September 22, 2017

Popliteal artery entrapment syndrome is a condition in which compression of the popliteal neurovascular structures results in symptoms of lower extremity claudication by way of a constricting anatomic structure or a hypertrophied surrounding musculature. This diagnosis is often missed or misdiagnosed because popliteal artery entrapment syndrome has a presentation similar to that of exertional compartment syndrome. Popliteal artery entrapment syndrome may result in persistent disability or unnecessary morbidity or prevent athletes' return to sport. A female collegiate athlete presented with bilateral popliteal artery entrapment syndrome. She had successful surgical treatment and returned to a high level of sport. This article describes popliteal artery entrapment syndrome, emphasizes the importance of a thorough history and physical examination to elucidate the diagnosis, and provides information that may lead to the identification of individuals who will benefit from surgical intervention
Click to expand...

NewsBot · Apr 28, 2018

Functional Popliteal Artery Entrapment Syndrome.
Gamas L et al
Rev Port Cir Cardiotorac Vasc. 2017 Jul-Dec;24(3-4):183.

INTRODUCTION:
Popliteal artery entrapment is an uncommon syndrome, caused by extrinsic compression of the popliteal artery by muscular or tendinous structures. It occurs mainly in young individuals, with no atherosclerostic risk factors, and a mean age of presentation of 20 to 40 years, and has higher prevalence in males (83% of patients). Clinical presentation depends on the degree of arterial lesion, the most common being intermittent claudication, with critical ischemia being frequent. Occasionally, it may present as acute ischaemia.

METHODS:
A 40-year-old female patient, physical education teacher, presented with a history of left foot paresthesia and left calf muscle pain during jogging for one year. The patient used to previously run 10 kilometers, currently mentioning claudication at 500 meters. No other medical conditions were mentioned. Lower extremity arterial duplex ultrasound revealed left popliteal artery compression and occlusion during active plantar flexion and passive dorsal flexion. The patient was referred to a vascular surgery center. Physical examination revealed palpable bilateral lower extremity pulses, with left asymmetry. Lower limb angiography and magnetic resonance imaging (MRI) were performed which demonstrated left popliteal artery compression and occlusion during a resisted plantar flexion. MRI revealed no anatomic anomalies, pointing to a probable functional entrapment caused by calf muscle hypertrophy (typo VI).

RESULTS:
Entrapment correction surgery was performed through a posterior approach and exposure. During the procedure, the artery showed no signs of significant fibrosis. Since compression by the medial head of the gastrocnemius muscle was observed, myotomy of its lateral fibers was performed. The patient was discharged on the second day post-surgery. After three months, the patient remained free of symptoms, having taken up sports practice with no limitations.

CONCLUSION:
Continuous popliteal artery compression leads to its progressive fibrosis, which may cause thrombosis or post-stenotic aneurysmal dilation. Treatment should be performed as soon as possible as to avoid this course and the eventual necessity of interposition or bypass grafting. Futhermore, late intervention worsens the interposition/ bypass grafting prognosis5. In this sense, the possibility of this diagnosis should be considered in a young patient presenting with intermittent claudication. Diagnostic tests are often decisive for differential diagnosis and to establish the disease subtype and intervention strategy. In most patients, a culprit muscular or tendinous anomaly is detected before surgery, however, in some individuals, especially physically active ones, compression results from muscular hypertrophy.
Click to expand...

NewsBot · Dec 22, 2018

Deep vein thrombosis in a well-trained masters cyclist, is popliteal vein entrapment syndrome to blame?
Kean J et al
J Thromb Thrombolysis. 2018 Dec 19.

Whilst athletes are the epitome of health, venous thromboembolisms (VTE) including deep vein thrombosis and pulmonary embolism have been demonstrated to occur in well-trained athletes. VTE is frequently misdiagnosed and poorly treated within this population, often resulting in career or life-threatening ramifications. Furthermore, VTE risk rises with increasing age (> 40 years), potentially affecting masters athletes. A 44-year-old well-trained male cyclist volunteered to participate in a research project investigating the influence of exercise on haemostasis in well-trained athletes. The cyclist presented with elevated D-Dimer levels both pre- (2251 ng/mL) and post-exercise (2653 ng/mL). The cyclist reported constant mild-pain in the left mid-calf region, with a cold tingling sensation in their left foot. Diagnosis of DVT was confirmed via a DVT squeeze test and Doppler ultrasound, with the clot located in the left popliteal vein. During the research project, the cyclist was exposed to numerous thrombogenic risk factors including travel, dehydration, prolonged sitting and exercise. The DVT in the popliteal vein may have resulted from repetitive movements associated with cycling. Additionally, hypertrophy of the gastrocnemius muscle may have impinged the vein. When diagnosing DVT within a cycling population, PVES should not be overlooked as a contributing factor.
Click to expand...

NewsBot · Oct 23, 2019

Popliteal Artery Entrapment Syndrome: Three Unusual Cases with Different Courses to Diagnosis
Siegl G et al
ZentralblChir. 2019 Oct;144

INTRODUCTION:
Popliteal artery entrapment syndrome (PAES) is a pathology characterised by anatomical anomalies of the relative position of the popliteal artery (PA) to the medial head of the gastrocnemius muscle (MHGM), resulting in mechanical compression causing damage to and occlusion of the artery.

PATIENTS:
From 2012 to 2018, we operated on 3 male patients aged 17 to 48 years, who presented with PAES in our department. The first and oldest patient had previously undergone femoro-popliteal bypass surgery in 2003 when aged 23, with the underlying diagnosis of "posttraumatic PAOD II b" followed by several reoperations. In 2012, during the preparation of the popliteal fossa for the interposition of the aneurysmatic bypass vein a strong tendinous strand of the MHGM was found intraoperatively to be constricting the vessels. This aberrant part of the MHGM was resected and the vein replaced. The second patient was referred to us in 2014 with the diagnosis "PAOD II b with thrombosed popliteal aneurysm" after having undergone intra-arterial lysis at age 33. Due to the remaining wall adherent thrombi and position of the aneurysm, interposition of the PA with a venous graft was planned. Intraoperatively a tendon was found proximal to the aneurysm, causing significant stenosis of the PA. This structure was resected and the interposition performed as planned. The third patient was a 17 year old adolescent, who presented with plantar and calf claudication in his right leg with paleness and pulselessness. Imaging showed occlusion of the popliteal artery in both legs. After initial intra-arterial lysis, HRMRI of the knee showed the atypical course of the PA undercrossing the MHGM from the medial side. Open surgical treatment was performed by myotomy, leading to refixation of the tendon of the MHGM in its physiological position. All patients received individual medical treatment for prophylaxis of rethrombosis. All three patients declined surgical treatment of the asymptomatic contralaterally diagnosed PAES.

CONCLUSION:
Popliteal artery entrapment syndrome is rare and usually associated with athletic, largely young male patients with pronounced calf muscles. Delayed diagnosis of PAES leads to severe vascular defects, unnecessary reintervention and prolonged illness as is shown in our first case. Therefore, calf and foot claudication in young patients should always bring to mind the differential diagnosis of popliteal entrapment syndrome.
Click to expand...

NewsBot · Jan 10, 2020

Popliteal Artery Entrapment Syndrome
N.L. Grimm;R. Danilkowicz;C. Shortell;A.P. Toth;
JBJS Reviews. 8(1):e0035, JANUARY 2020

Popliteal artery entrapment syndrome is a commonly misdiagnosed condition that should be considered in patients presenting with exertional lower-extremity pain.
In addition to a focused physical examination, the ankle-brachial index and advanced imaging consisting of computed tomography and computed tomographic angiography or magnetic resonance imaging and magnetic resonance angiography are crucial in evaluating the underlying cause of entrapment.
Consultation with a vascular surgeon or team is necessary when planning surgical treatment of popliteal artery entrapment syndrome.
Click to expand...

NewsBot · May 9, 2020

Popliteal Artery Entrapment Syndrome in a Young Baseball Pitcher: A Case Report.
Huang WC et al
J Pain Res. 2020 Apr 21;13:777-781

BACKGROUND:
Popliteal artery entrapment syndrome (PAES) is a rare disease in young adults and is thought to be under-diagnosed, and its main cause is the abnormal structure between the popliteal artery and gastrocnemius muscle. The patients experience symptoms after the blood vessels are compressed. Failure to diagnose and treat PAES can cause serious sequelae.

CASE:
A 19-year-old male baseball pitcher with PAES type 2 suffered from left calf muscle tension and foot numbness and was mis-diagnosed for nearly a year. Finally, the lesion was detected by ultrasonography and confirmed by magnetic resonance imaging. After surgical intervention, he quickly returned to sport.

DISCUSSION/CONCLUSION:
PAES has 6 types. Type 2 (25%) and type 3 (30%) are the most common. Patients with this syndrome suffer from aching pain, numbness, and cramping in the calf area when they exercise. It is necessary to include this disease in differential diagnosis to implement early diagnosis, and ultrasonography is a more cheap and simple method for early detection
Click to expand...

NewsBot · Jun 10, 2021

Popliteal Artery Entrapment Syndrome: A Diagnostic and Treatment Enigma for Orthopaedic Surgeons
Timothy L Miller, Rose Backs, Patrick S Vaccaro
J Am Acad Orthop Surg. 2021 Jun 9

Popliteal artery entrapment syndrome (PAES) is an uncommon condition that causes recurrent posterior leg pain and foot paresthesia in running athletes. This condition occurs most commonly due to an accessory or abnormal implant of the medial head of the gastrocnemius muscle. It may mimic or coincide with other chronic conditions of the lower extremity including chronic exertional compartment syndrome but is most consistent with vascular claudication. Clinical features that distinguish PAES from other causes of leg pain include a sensation of coolness of the posterior leg during exercise and associated paresthesia of the plantar aspect of the foot. Physical examination often reveals decreased intensity of the posterior tibial or dorsalis pedis pulses with passive dorsiflexion or active plantarflexion of the ankle. Diagnostic tests that confirm the presence of PAES include lower extremity angiography during active resisted plantarflexion or maximal passive dorsiflexion, and magnetic resonance angiography done after exercise provocation. Nonsurgical treatment with physical therapy and stretching of the gastrocnemius complex should be done as the first line of treatment. When conservative treatments are ineffective, referral to a vascular specialist for surgical intervention with a muscular band excision or transection, vascular bypass, or arterial reconstruction is necessary.
Click to expand...

NewsBot · Jul 23, 2021

Popliteal Artery Entrapment Syndrome: A Diagnostic Enigma. Case Report and Current Concepts Review
in International Journal of Athletic Therapy and Training
Timothy L. Miller MD and Rose Backs PA-C
International Journal of Athletic Therapy and Training

Presented here is the case of a 16-year-old male cross-country runner with chronic leg pain who was diagnosed with popliteal artery entrapment syndrome. An extensive workup was performed on the athlete that eventually included a postexercise arteriogram to reach the diagnosis. Ultimately the athlete’s symptoms required him to undergo bilateral leg surgeries to decompress the popliteal arteries. Extensive collaboration between athletic trainers, physical therapists, orthopedic surgery, sports medicine, and vascular surgery was required to treat the athlete’s condition and return him to distance running.
Click to expand...

NewsBot · Aug 5, 2021

Functional Popliteal Artery Entrapment Syndrome: An Approach to Diagnosis and Management
Thomas Lovelock, Matthew Claydon, Anastasia Dean
Int J Sports Med

Popliteal Artery Entrapment Syndrome (PAES) is an uncommon syndrome that predominantly affects young athletes. Functional PAES is a subtype of PAES without anatomic entrapment of the popliteal artery. Patients with functional PAES tend to be younger and more active than typical PAES patients. A number of differential diagnoses exist, the most common of which is chronic exertional compartment syndrome. There is no consensus regarding choice of investigation for these patients. However, exercise ankle-brachial indices and magnetic resonance imaging are less invasive alternatives to digital subtraction angiography. Patients with typical symptoms that are severe and repetitive should be considered for intervention. Surgical intervention consists of release of the popliteal artery, either via a posterior or medial approach. The Turnipseed procedure involves a medial approach with a concomitant release of the medial gastrocnemius and soleal fascia, the medial tibial attachments of the soleus and excision of the proximal third of the plantaris muscle. Injection of botulinum A toxin under electromyographic guidance has recently shown promise as a diagnostic and/or therapeutic intervention in small case series. This review provides relevant information for the clinician investigating and managing patients with functional PAES.
Click to expand...

NewsBot · May 8, 2022

Popliteal artery entrapment syndrome treated by a posterior approach in a 15-year-old athlete
Lili Sadri et al
J Vasc Surg Cases Innov Tech. 2022 Mar 30

Popliteal artery entrapment syndrome is a rare source of claudication in young people. We present the case of a 15-year-old male athlete who presented with intermittent numbness of his right foot with exertion. Imaging revealed classic compression from a right type III popliteal artery entrapment. The left popliteal artery was chronically occluded with a large collateral vessel. He underwent release of the accessory bands of the gastrocnemius muscle with significant arteriolysis on the right side via a posterior approach. Chronic popliteal artery entrapment can be treated from a posterior approach, resulting in arterial occlusion and will be asymptomatic if well collateralized.
Click to expand...

NewsBot · Nov 19, 2023

Exertional calf pain at kilometer five – Finding the cause
Samuel A. Renier et al
Sports Medicine and Health Science; 11 November 2023

A 23-year-old professional distance runner with several years of exertional calf pain was diagnosed with a unique mixed type III and functional popliteal artery entrapment syndrome (PAES). Surgical reduction of the obstructing tissue allowed her to return to professional running. This case highlights the importance of including PAES in the differential for chronic intermittent lower extremity claudication and outlines the work-up required to diagnose this vascular obstruction in younger athletes.
Click to expand...

NewsBot · Mar 4, 2024

Exertional calf pain at kilometer five – Finding the cause
Samuel A. Renier et al
Sports Medicine and Health Science; Volume 6, Issue 1, March 2024, Pages 89-93

A 23-year-old professional distance runner with several years of exertional calf pain was diagnosed with a unique mixed type III and functional popliteal artery entrapment syndrome (PAES). Surgical reduction of the obstructing tissue allowed her to return to professional running. This case highlights the importance of including PAES in the differential for chronic intermittent lower extremity claudication and outlines the work-up required to diagnose this vascular obstruction in younger athletes.
Click to expand...

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Egyptian shaped foot and calf pain in runners

severe foot ankle calf knee pain

Experiencing shooting pains in foot/toe/calf sudden and acute..

Avulsion Fracture - 5th Metatarsal Calf pain

Experiencing shooting pains in foot/toe/calf sudden and acute..

Ball of foot pain after calf injury

Ankle sprain with calf bruising and pain

Share This Page