Insidious symptomatology and misleading physical findings in popliteal artery entrapment syndrome. A case report.

A patient presented with an ischemic right forefoot. She suffered rest pain but had relief on walking and on flexing her leg. Popliteal and pedal pulses were palpable. The underlying condition was popliteal artery entrapment. Compression of the popliteal artery occurred with extension of the knee and additional contraction of the gastrocnemius muscles only and was released with flexion. Distal embolizations into all three lower leg arteries had caused acute ischemia. As the emboli had travelled through both tibial vessels very distally pedal pulses were found to be normal. Treatment was operatively by resection of a tiny lateral portion of the medial gastrocnemic tendon which crossed the artery dorsally as the vessel pierced the tendon.