Discussions By Condition: Vasuclar conditions

Popliteal Artery Entrapment Syndrome

Posted In: Vasuclar conditions 160 Replies
  • Posted By: bknotwell
  • June 16, 2008
  • 11:36 AM

I have been diagnosed with popliteal artery entrapment syndrome in both legs and was wondering if anyone else out there has this condition.

My symptoms are when walking my feet would go numb and then I experience pain down the sides of my calves but the pain would go away upon rest (claudication). I found the more I walked the longer it would take to recouperate. The pain has esculated over the years and I can only walk about 50 meters before I experience pain. I have been going to doctors for the last 7 years trying to get a diagnosis. I was always told to stretch my calf muscles or that I had shin splints.

After many tests, I was finally diagnosed in March 2008 and have had my first surgery on my left leg (it was 100% occluded upon flexing my foot and pointing my toe) in April 2008.

I was wondering if anyone has had surgery so I know if my recovery is going normally. Not much information is out there for this condition since it is not all that common. I have found no information on recovery from surgery.

Anyone out there that could help, it would be much appreciated.

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  • I'm currently trying to work out if i have popiteal artery entrapment and/or compartment syndrome. I had compartment pressure tests done which came back positive, but as my pain comes quickly and deminishes rather quickly (as well as cold feet and absence of pulse) I was sent to get some vascular studies done too. These have also come back positive so my next step is to go and see a vascular surgeon. As there doesn't seem to be much info around on this condition i'm wondering how you were diagnosed, whether you also had elevated compartment pressures as well and what your surgery involved...Sorry i can't help with your recovery from surgery question as i haven't quite got there yet!
    Anonymous 42789 Replies Flag this Response
  • I am glad that I can help you in any way. I wish I had someone out there to ask questions when I was going through all of this. As far as tests, I never had any compartment pressure tests done. How are these tests done? The doctors first ran a series of blood tests to check if I had any vascular diseases since I do have a family history of vascular disease. All came out normal. Then I was sent to a vascular specialist. I had an Ankle-Brachial Index done and it was within normal limits. The doctor then checked the pulses in my feet. Pulse was normal in both feet when relaxed. But upon flexing my foot or pointing my toes, the pulse was lost. I was then sent for an ultrasound which confirmed that something was cutting off the blood flow from my knee down. Several weeks later, I was then sent for a CT scan which was normal. I then had a treadmill stress test which was normal. My doctor then sent me for a Artierogram with runoff. I was awake for this procedure and had to flex and point both feet. This test confirmed that I did in fact have PAES. My left leg was 100% occluded and my right leg is 80% occluded. They wanted to perform surgery the following week! But due to personal reasons, I had to wait until the following month. I also had an MRI done to make sure there was no arterial damage. MRI showed no damage to the arteries. There are different types of PAES. Some types are due to the position of the popliteal artery but another type is caused from the actual calf muscle being too large. My diagnosis is the latter. As for the surgery...they made a large "S" incision on the back of my leg. Starts at mid thigh, goes across the back of my knee, and then about 4 inches down the side of my calf. They removed quite a bit of my muscle to release the artery. I was in the hospital for two days and was up walking the day after my surgery (which was painful). It has now been 3 months since my surgery. I definitely can tell a difference! But I still have to undergo surgery on my right leg. Just ready to be better! If you are diagnosed with PAES and have any questions, please contact me again on this board. I will be more than happy to answer any questions you may have. I wish you the best and hope they figure out what is ailing you.
    bknotwell 53 Replies Flag this Response
  • Hi For a quick introduction I have been suffering from bilateral PAES for around 6 years now. I was dignosed after 3 months of intense testing (because I couldn't walk) and had surgery on my right leg in Sept 2002, I had further surgery in June 2003 (same leg) and 5 years on I'm doing all I can to avoid having surgery on my left leg. My second surgery was the same as you and as a result I have nerve damage and I appears the problem was never fixed. I am meant to wear pressure stockings on a daily basis and limit my level of exercise. I do not choose to have any further surgury and manage my situation on a day to day basis (I am writing this to you after sitting on the couch for the 3rd day now after going out in high heel shoes, bad move). Like you all was well after the surgery on both occassions and I noticed an increased improvement straight away.. but I'm not sure if the doctors advised you that the problem can become longterm and is only managed by a change of lifestyle (I have been told on many occassion that I this is something I will have to manage for the rest of my life). I am 36 now and have days where I can not walk or lay awake as my leg is so cold I can not feel it.. I really hope that your situation is not longterm and the surgery has fixed the problem.. my only suggestion to you think hard before having any further surgery where possible as the nerve damage can be worse then the original problem. PS I hope I have not upset you in anyway as all situations are different. Please let me know if you wish for me to calarify anything!!!
    postpaes 3 Replies Flag this Response
  • Hi all, Hoping for a little bit of advise? Three weeks ago I underwent surgery for release of the popliteal artery, S incsion etc with approx 25mm of muscle remove from the head of the gastroc. in my left leg. I currently have numbness down the middle of the calf (top to bottom), swelling around the incision area and more pain on walking, than before the operation. The scar is healing ok. What stage should i be at now, my surgeon said after 3 weeks i could restart excercise, but this is not posible as my conditions appear worse than before surgery. Can anybody provide me with a timeframe of your actual recovery and symptoms along the way and any complications after PAES surgery? :confused:
    michael mills 6 Replies Flag this Response
  • Michael The numbness in your calf is from the surgury (they cut a lot of nerve endings when they do the s incision). After my first lot of surgury I was back at work in 6 weeks and running again at around the 3 month mark after doing a lot of pool work first. The numbness in your leg may never go away, it has been over 5 years since my second surgery and my leg is still numb.
    postpaes 3 Replies Flag this Response
  • As far as numbness in my leg, it has now been over 3 months and I am still experiencing it. My doctor told me it could take up to a year for the nerves to heal and there is a possibility that some areas may never heal. For now, most of the numbness is down the side of the outside of my calf which really hasn't changed much. Half of my foot has some numbness but it comes and goes. So this maybe a good sign. The middle of my calf was completely numb for about 2 months after my surgery. Now, I sometimes experience the "pins and needles" feeling and then there are days that it feels like my leg is sunburnt. If anything touches it, it feels like someone is taking a brillo pad to it. This feeling is worse at night so I have a very hard time sleeping. For the past three months since my surgery, I have had good days and bad days. I was up walking the day after my surgery but it was a slow painful process. I still experience a little pain in my calf muscle upon first getting up from a sitting or laying position. But as long as I stretch the muscle before taking that first initial step, the pain tends to subside. As far as walking, I had to gradually increase my distance and tried to walk several times a day. I now can walk downhill for about 1/2 mile but have to stop several times because my other leg cramps up (but then I could only make it 1/2 way back uphill so had to have someone come get me). As far as walking up hill, in the beginning I could not even walk up my driveway without hurting. I do still have a little bit of trouble but it seems to be getting better every day. As far as any other exercise (besides riding a stationary bike), I still can't do anything strenuous. I cannot run or do anything that requires me to jump. I have also been told not to ever do any squats. Like I'm gonna miss those! For the first week and a half after surgery, I could walk but could not bend my leg since I still had the staples in. Once the staples were removed, I had some range of motion in my knee and there was still some pain with walking. At right at about a month, my leg was still numb but felt I was making progress. Then all of the sudden, I took a turn for the worse. Started having pinching pains right above my knee and could not walk. Come to find out I was having major incision pain. Michael, if you do not do incision massage, I highly suggest you get someone to show you how. Also, you may need to start some kind of physical therapy to get your strength back in you leg. After three days of massage around my incision, I was back up walking again without a cane! Another thing, you may want to do is ride a stationary bike to get all of the range of motion back into your leg if you are having trouble walking...just make sure you have no resistence. And also, for about 2 months after surgery, I found that sitting in a chair for long periods of time without elevating my leg caused it to hurt and sometimes swell. So Michael, try to elevate it as much as possible for now. Compression stockings may help this problem, too. I'm waiting on my new ones right now. They originally gave me knee highs which irritated the incision site on the back of my knee so I'm awaiting thigh highs. Thank goodness, I'm in the Pacific Northwest or I would burn up with thigh highs!!! I have a question for both postpaes and Michael, how long were you dealing with your symptoms before anyone would listen to you and perform testing on you to get a diagnosis? It took 7 years before anyone would listen to me. I was either told I had shin splits (which I knew I did not have) or just to stretch my muscles before walking (ridiculous since casual walking is something you should be able to do without ever stretching your muscles). By the way, postpaes, you are not upsetting me in the least. I want to be aware of what I'm up against. I do have a few questions for you. Why did you end up having to have the 2nd surgery? Was it because the muscle grew back? And are you out of your mind wearing high heels for 3 days??? heeheehee just kidding. I just can't imagine being able to ever wear them again. I am a 38 (almost 39, afraid to admit it) female. I'm doing good to wear a VERY small heel for now. Also, exactly what do you mean by a lifestyle change? What are you having to do differently and why? I hate that any of you have had to deal with this condition. But I am glad that I'm not all alone. I really wish I could avoid having to have my other leg operated on but the risks of not having surgery outweigh the risks of having surgery. Thanks to both of you for sharing your stories with me. If I can help you in any way, please let me know. It's scarey having to go through this alone and there needs to be more information out there on recovery.
    bknotwell 53 Replies Flag this Response
  • bknotwell ; in reply to your questions. I first had calf pain symptoms in 2003 which appeared after training for a half marathon initially in the left leg, pain then also appeared in my right leg in 2006. The pain in the left leg continued to worsen and limit my training and took days for the pain to subside after a run, but i was also left with a dull pain which never went away. I have had sports massage, seen 3 Physiotherapists (muscle stretching and strethening programes were followed), had 3 different sets of orthotics, seen a Sports Physician, seen 2 orthapedic surgeons - 1 diagnosed compartment sydrome and i had a gastroc. superficial fasiotomy, a sural nerve release and a gastroc. slide procedure to cure any muscle micro tears in both calf muscles in Dec 2006. This didn't cure the problem then on seeing a 2nd vascular surgeon (after the first one told me i was over the hill at 37 and to stop all physical excercise) he agreed to carry out testing - ultra sound scan and doppler testing initially, followed later by tread mill and further doppler and scans, then a angiogram and radiography scans - this showed oclusion of the popliteal in both legs on pointing the feet and applying a presure to the balls of the feet i.e. to replicate running or walking. All this was followed by my latest surgry in my left leg as explained in my earlier posting. I hope in my pursuit to have some physical activity in my life has not been a big mistake by me not being able to walk without pain currently??. Whats scaring me is the swelling at the back of my leg just above where the leg bends is much greater after i walk and much greater than it ever was before surgery after any physical activity.(it also puts pressure on my scar and causes pain) I'm able to cramp up my calf mucle much more easier than before by pointing my toes downwards) Is this swelling in this area a common condition both pre and post sugery and does anybody think this swelling is related to my worsened calf cramps? Any comments welcome as i also feel that there is not much help out there which was evidenced after 5 years trying to get to the root cause of my calf pain - l'm hoping my latest diagnosis and treatment is correct and i will be pain free !!!!!!!!!!!
    michael mills 6 Replies Flag this Response
  • Michael, I completely understand your frustration right now. It wasn't until the 2 month mark that I was walking really good with limited pain. It maybe much longer than you think before you will be able to exercise like you used to. It has now been 3 months for me and I still cannot run. As far as your swelling at the back of the knee, this is normal. It took 2 1/2 months for mine to stop swelling. A lot has to do with bending the knee which irritates the incision. I highly suggest that you wear compression stockings, if you aren't already. Sometimes incision massage helps, too. Since the incision is healing, the surrounding soft tissue draws up. Massage helps to losen it. But you need to know the proper way to do it. Also, until your calf muscles are strengthened you will experience some calf pain/cramps. I still have some cramping after 3 months but it is nothing like before surgery or right after my surgery. If you feel that this is not normal for you, consult with your doctor, he/she can make sure that you do not have a blood clot or another complication due to the surgery. Have you started any physical therapy yet? I hope that you do not think I'm making light of your situation. Because I'm certainly not. I've been exactly where you are and have gotten very frustrated. Try not to get discouraged, as much as you want to be well, it can take time for your body to heal. Continue to try to stay mobile, but do not overdo it! Remember, it has only been 3 weeks and they did remove muscle from your leg. If ever you feel that you are not getting better to your satisfaction, consult with your doctor. I hope that you are well on your way to complete recovery soon. Brenda
    bknotwell 53 Replies Flag this Response
  • Michael & Brenda First of all I have to agree that there should be more information out there in regards to recovery from this problem.. Six years on I must say it is nice to talk to someone who is going through the same situation rather then just listening to doctors. I have been an active person for the majority of my life and leg pain was just something I dealt with from an early age and never considered that I may have a medical problem. The first I knew that I had a problem was when I went to sprint after someone at work and both legs failed to work and I fell flat on my back side... with out going into to much detail I am a police officer and at the time I did not have the pleasure of wondering what was wrong with my legs (at first I thought I had been shot - that should explain how quickly I dropped and the level of pain) I had to get up and keep chasing until the offender was in custody. To this day I have no idea how I managed to do that adrenalin is an amazing thing. When I did get a chance to overview the situation I realised that both my calf muscles and ham stings were rock solid like concrete I could not walk propley and heaven forbid if anyone tried to touch my legs. I went and saw a physiotheripist the next day and while he was massaging my legs I said I couldn't feel my right foot he stopped straight away (lucky for me he had seen the problem before) and refered me to a sports doctor. In between the physiotheripist and the sports doctor things got worse and the swelling in my legs made its way up to my lower back and I just could not move. That was it for me I had to stay on the couch and was carried everwhere. I had blood tests on a daily basis to count my KPA levels and after seeing the sports doctor was sent to a neurologist. He sent me for a MRI straight away and while I was in hospital a vascular surgeon cam to see me as well. I was refered to a vascular lab for a heap of tests (2 more MRI's, angiogram, treadmill) Finally after sitting on the couch for 3 months I was advised that I had PAES and that I needed surgery as I could risk losing my leg, needless to say I agreed. My first surgery was not the s incesion rather a parallel cut down the side of my inner knee. My recovery from that surgeory sounds a lot like Michael's, good at first then a few setbacks along the way.. My second surgey came less then a year after my first as my condition did not improve, my leg continued to swell even when sitting down and the cramps would keep me up all night and I still had trouble walking. The final straw was when I presented to emergency with a 12 degree difference in the tempture in my legs. I had pulses but me leg was that cold that I was on morphine for 4 days while they worked out what to do. I had more tests and finally they did further surgery (the s incision) to decover that the vein and artery in my leg was being strangled by fibres bands from the first surgery behind my knee and that both artery and vein were completly oncluded for the lenght of my calf. Once again things did not improve and 6 months after the second surgery my doctor was prepaired to give me a medical discharge from the service. I was not happy and agreed to slow down become a desk jocky and lessen my level of physical activity. My life style change is that I'm a lot less active then I was, I can no longer play contact or high intencity sports. I must say at times I get stubborn and go what the ***l and pay the price later. I still have a lot of problems with my legs and walk with discomfort on a daily basis (the pins and needles feeling is 24/7). I suffer from cramps still which I manage with magnisum tablets, leg fatigue, calf swelling and the worst is when my leg goes cold. My situation is something that I take on a day to day basis About a year ago I got frustruted with the situation and went for some follow up test, much to my dismay I was advised to slow down again as I could end up in a wheelchair as any further surgery is not an obtion. I don't focus on this and lead a reletivly good life (but it is always in the back of my head), just a lot less active. My aim is not to have surgery on my other leg as one bad leg is quite enough to manage. Sorry this is so long windid but I hoped that helped with a few things. Donna
    postpaes 3 Replies Flag this Response
  • Donna, Thank you so much for sharing with me. I hope by some miracle that some doctor will find a cure for your ailments (at least figure out something so you can have somewhat of an active life!). It sucks not being able to be active. For the longest time, I was embarrassed about it. I'm still not fully recovered and my leg never feels the same. One day, it will not bother me and then the next, I'm back at square one. I have a while to wait to determine for sure if I will have my other leg operated on (waiting for my husband to return from Iraq). But my left leg needs to be a lot stronger before I will even consider it. Thanks again for sharing. I don't know if you are a praying woman but I'll be praying for you all the same (and for you, too, Michael). Bren
    bknotwell 53 Replies Flag this Response
  • Hi,I'm really sorry to hear these stories - I'm also (I must admit) a little bit relieved as although I hear through my doctors about people with PAES - I have never actually spoken to somebody else with it. I'm not sure where everybody is from - I would be interested to know to find out if you have surgeons who perhaps communicate with each other for ideas how to treat this.I first developed compartment syndrome while in the military approx 7 years ago. I had fasciotomies to release the compartment pressures but had interruped rehabilitation so I never really found relief from the surgery. I then developed cramping, pain, swelling, colour changes, coldness, no blood flow to feet etc which the doctors did not believe so exercise was not reduced (marches, 5km runs etc). It wasn't until over 12 months later I had very dramatic changes in the legs (no blood getting to the feet at all, no pulses, rest pain - I had to sleep with my legs hanging over the end of the bed and the inability to walk at all) and I was seen by 2 x vascular surgeons and a vascular physician. I had an exercise study, duplex study and angiogram which all showed an occluded right artery and a moderately occluded left artery.Surgery was performed on the right first with an incision above and below the knee on the side of the knee - the surgeon found the artery to be crushed and later told me I had been six months away from amputation. The medial head of the gastrocnemious (sp) was split and I had instant results! It was wonderful! I had surgery on the left where the results were not as dramatic but still wonderful due to being pain free and able to walk!During the course of the next year and a half I went through rehabiltation and slowly returned to the stage where I was at the gym twice a day and running 2.5km several times a week. Then the pain and symptoms started to return and I had terrible calf and anterior compartment swelling with sitting and standing. I was told to increase exercise as it was suspected my valves were damaged and I needed the muscle pump to return the flow of blood. I was also told that I was catastrophising and that the artery could not become entrapped again. However it got to a stage where my work was reduced to half days and I could no longer exercise due to the pain and the footdrop, cramps, colour changes etc. Eventually I went through another round of testing (duplex, exercise study, angiogram etc) which showed that the right was occluding again and the left was moderately compressing. I decided to stop exercising and tried to atrophy the legs to no avail. Surgery was performed on the "worst" leg (right) and this time I had the s incision. Part of the medial head was removed and a "tunnel" was created from the top of the knee to the bottom of the calf.I was told it was not possible for the artery to become entrapped again - by muscle. I decided against surgery on the left artery as it had not fully occluded and due to the severe nerve pain and equally severe swelling in the compartments, again from sitting and standing. I could no longer stand or walk at all due to muscle failure if the compartments became swollen so I ended up being retired, sent home and had to use a wheelchair for short periods of time (sitting for more than 30 minutes = swelling, pain and muscle function failure) if I wanted to go anywhere. I had to elevate the legs above waist height to reduce any swelling - OUCH! Swelling could take anywhere from 10 minutes to 3 days to alleviate.Two years later a scan showed that the compression (muscle) on the left artery had become less compressed but the right showed signs of mild compression. I decided to leave it alone as I was now showing obvious signs of reflex sympathetic dystrophy. Late last year my surgeon told me to try walking more (to try and stop the atrophy from RSD and to see if the muscle pump would work). So I did. In January pain increased and by March the pain was unbearable, my feet were turning white, I had severe cramping, tingling, stabbing etc and by May I also had rest pain. The swelling became worse - less than 10 minutes in a chair. I have since had duplex studies and an angiogram which show dramatic occlusion on the right any time the foot moves and dramatic occlusion on the left - again any time the foot moves. For the first time I was sent for a venogram which shows that the right popliteal vein is completely occluding when I sit, stand or move the feet. The left is still yet to be checked. I am waiting to find out what my options are surgically. One proposal was to remove parts of the fibula bone to release the high pressures in the compartments and bypass both arteries using a vein graft. A second opinion was sought and the option presented was to bypass the right artery (there is far too much scar tissue in there to go in again) and to wrap stents around (normally they go in) the artery on the left after removing part of the muscle and the scar tissue. This will be the 3rd surgery on the right and 2nd surgery on the left.I am currently on very heavy duty pain relief and am extremely limited due to swelling, pain, loss of pulses, blood flow constantly cutting off to the legs and feet, cramping, and loss of muscle function. One surgeon (second opinion) is calling me tomorrow to tell me what he thinks I should do and my regular surgeon is meeting with a 3 other surgeons on Wednesday. I'm not telling my story to scare anybody......there are quite a few people who my surgeons have told me about who have had PAES, had surgery once or twice and have never had a problem since. For some reason, maybe having to continue rigorous exercise on occluded limbs perhaps??, I've had a very poor outcome. I'm hoping that there is something to be found that the drs haven't tried, apart from bypass. One thing that I will suggest is - if you start swelling in the compartments make sure your doctor checks it out!! Compartment syndrome, artery entrapment and popliteal vein entrapment can be very, very nasty if left untreated. Also if you suspect that your symptoms are again displaying artery entrapment - get it checked out!! The potential outcome for untreated PAES can be blood clots, aneurism (sp) and limb loss.Wow! I just previewed what I wrote!! Sorry about the length!
    Anonymous 42789 Replies Flag this Response
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  • I forgot to add that I am female and in my early 30's. I am incredibly hopeful for successful treatment in the future for PAES as I know one of the surgeons looking into PAES is a biomedical engineer who created a blood pump for people with vascular disease - he is now looking to see what he can do for muscular compression. He is not the only vascular surgeon who is interested either.
    Anonymous 42789 Replies Flag this Response
  • Hi Grumpylegs, Sounds like you have plenty of reasons for being grumpy, too. Thank you so much for sharing with us. I don't have a clue if my surgeons talk to other surgeons. I have not heard of any other surgeries (like the one I had) that they have performed. I'm pretty sure that if they have, it has not been many. I had my surgery done at a military base (which is a learning hospital) and everyone wanted to be a part of my diagnosis and surgery. I felt bombarded by doctors once I finally got a referral to a vascular specialist. The doctors never discussed with me about any other surgeries and the recoveries from them. So I have been pretty much in the dark about my own recovery and have felt alone in all of this. I appreciate any information from anyone regardless if it's good or bad. I'd like to know what I'm up against. Please let us know what your doctors determine your next step is and what you decide to do. Bren
    bknotwell 53 Replies Flag this Response
  • Hi Bren,Hey! It's gumbylegs not grumpy legs! lol. Although they can be pretty grumpy and gumby when they feel like it. hehehe.Okay what my surgeon has told me in regards to PAES (and what other doctors etc have told me) is this; people present with occluding arteries with plantar flexion. They are usually young, physically active and fit and the gastrocnemius muscle is usually the hypertrophied muscle. They go in for surgery - either the inside knee or the s incision and usually split the medial head of the gastrocnemius or remove part of the muscle which is pressing on the artery. The patient then goes through recovery....slowly. Patient needs to recondition legs and rehabilitation can take 6 months to 1 year or so. Nerve pain and symptoms can last for a year (though normally it is about 6 months) and swelling can take the same amount of time to come down. There may be signs of shin and calf pain as legs start to recondition soft tissue. Usually though symptoms don't last this long. Patient has complete success and starts to go back to normal life and activity. Artery never traps again.This is the case for the majority of people with PAES. Okay - from a military and civilian point of view (again this is what I have been told so if I'm wrong then I apologise). Patients symptoms start to return from 6 months to 2 years later. Testing shows reocclusion of artery. Surgery is then conducted where it is found that muscle fibres have grown from the area in the muscle that was cut and have wrapped around the artery. Scar tissue has also replaced the muscle. If the surgeon hasn't removed part of the medial head in the first surgery then he/she will remove it in this surgery. In recovery patient may have worse nerve symptoms due to the nerve lying so close to the artery - the surgeon has to move it to release the artery. Again however symptoms disappear 6 to 12 months later and patient returns to normal life. Now at this stage that is usually the end of the problem for a lot of people. Speaking from experience it can sometimes go on further.Symptoms again start to present 6 months to 2 years later. Surgeon has a choice. He can either go in and try to remove the scar tissue - which is incredibly risky due to the thickness of the scar tissue and the fact that it wraps around everything - nerves and veins etc. However by this stage surgeon realises that if he/she removes the scar tissue it will just return again 6 months to 2 years later and there will be more of it. Surgeon and patient then have to decide whether or not to go in again or to completely bypass the muscle and the artery - tying off the artery and depending on the grafted vein. The surgeons that I know who are working on this and the military are starting to wonder if they have gone about the surgery the wrong way due to the muscle fibres that grow from the cut muscle and the scar tissue that occludes the artery, most times the second and third occlusion is worst than the original occlusion. The military are also looking at the training and rehabilitation schedule to see if there is something there that is triggering the muscle fibres and the muscle. It's strange as elite athletes have this very same surgery and have complete success even returning to competition. However - and I'll repeat - the majority of cases of PAES have complete success after the first surgery. Those who don't, have surgery the second time and then have complete success. With my first recovery I started in the pool and started cycling. I then moved to slow walking extending the distance by approximately 10 percent by week. Six months after the surgery I was running 2.5km three times a week. I had numbness, a "bar" feeling across the bottom of my foot, pins and needles and other nerve symptoms which completely disappeared by the time I started running. I hope that this helps. Basically from what I understand PAES is becoming diagnosed more and more within the military and with young, fit otherwise healthy people. I wondered about your surgeons as I know that there have been 6 vascular surgeons who have examined my case and 1 vascular physician amongst 2 sports physicians and physios. I know that my surgeon has looked to the US to find answers and I have been a case study three times that I know about. I really hope that your recovery goes well - as for lifestyle change...you can actually reduce your muscle size by reducing all activity. It's perhaps not a great option but I believe it is preferable than having to go through further surgery.
    Anonymous 42789 Replies Flag this Response
  • Hi vl1,All of the military members that I have heard about, myself included, were all diagnosed first with compartment syndrome by pressure testing. All received fasciotomies and the surgery was performed where the compartments were released. I hope this helps.
    Anonymous 42789 Replies Flag this Response
  • Hi postpaes,In your first post you mention that you had three months of intensive testing as you could not walk. I'm wondering why you could not walk????The reason why I cannot walk is due to a compartment syndrome which happens when I sit or stand. The compartments swell, the pressure goes up and I lose muscle function. Is this the same reason why you couldn't walk???
    Anonymous 42789 Replies Flag this Response
  • Dear all, Its been a great reading the threads in helping me to understand further PAES post surgery. Having just had surgery where part of my muscle was removed i was wondering if i should be carrying out masaging on the s incision scar and doing as much flexing of the leg and muscles as possible to breakdown any scar tissue and prevent fiberous bands from forming and speed up my recovery time? Gumbylegs sorry to here about your recovery post PAES surgery i hope you eventually find a solution to your problems!. I currently suffer with compartment syndrome post PAES surgery which is currently worse 4 weeks after surgery than it was before in the soleus muscle not the gastroc (basically it goes rock solid). I have also noticed that at the rear of the leg where i had the s inscison swells up with any activity - have any of you had this swelling in this area and could it be this that is ultimately creating the compartment pressure build up in the soleus muscle by not allowing the blood to escape - but is this the vein then and not the artery that should be release - does any body know? I recently found out that my orthopedic surgeon who carried out my fasciotomy 1.5 years ago has referred a young rugby player for PAES studies - maybe the confusion and link between Compartment syndrome and PAES is being bridged - i hope so, so that people do not have to go through surgery that is not needed. In my search for answers i have found a small number of case studies searching the net but none relate to any complications so hopefully its just a mtter of time before things settle down and return to normal? but also none relate to recovery time and the do's and don't's of rehabiltation. Once again thanks for you all in sharing your knowledge and experiences which helps people understand more.
    michael mills 6 Replies Flag this Response
  • Hi all,All your posts have made for some very interesting reading! I am now grappling with the decision of whether or not to go down the road of surgery for my PAES issues. In terms of my diagnosis, it seems I have been lucky with the doctors etc I have been to see. Initially it was thought I had compartment syndrome but during these tests the tester thought it worth investigating the possibility of PAES due to my symptoms (as my earlier post describes). After the initial tests for this (by someone who didn’tseem to know what he was doing), the results were negative but I was referred by my compartment syndrome surgeon to a vascular surgeon. After a brief test from him listening to my pulse in various positions he sent me to get ultrasounds from his sonographer (which the surgeon also was present for). From this you could see my artery being cut off by the soleous muscle, rather than the gastrocnemius (my understanding is that this is not so straight forward to fix?). This process has taken me about 6 week so from what I’ve read it seems I have been very lucky with this! A few years ago I did go down the road of getting my compartment pressures tested and it was recommended that I get the surgery however it was never the right time (until this year when I started the investigations again). I am thankful that I didn’t end up getting that done as it now seems that the compartment pressure is not my (only) issue. From the ultrasound it seems that my arteries are not damaged and there is no urgent need to get surgery. My long-term options however look like getting the surgery done and hope that it works, or make a ‘lifestyle’ change and stop doing the activities that cause pain. As I am only 24 and enjoy being fit and active (or don’t enjoy being unfit and unactive as I am at the moment!) I feel that it is worth a shot. What are other people’s thoughts – if you were in my position knowing what you now know would you do anything differently???
    Anonymous 42789 Replies Flag this Response
  • Hi All,Wow! i cant tell you the relief after hearing all your stories,i guess im lucky its only taken 4 years,8 consultants,2 physios,1 biomechanical specialist,and numerous tests,not to mention many many feelings of self doubt and confusion.I too after many tests finaly had a consultation with a private doctor(as appossed to NHS) to try and find out once and for all what was wrong with my legs,i experiance pain on walking short distances,numbness,extremly tight calf muscles,walking is so bad that i literaly have to stop after just ten minutes as i cannot go any further,im physically fit,i go to the gym 3 times a week,and cycle,just no impact or walking,i have now developed pain on just standing and occassionaly when im just laying in bed!After having been diagnosed with compartment syndrome i thought that finaly my leg problems could be resolved,(it took 3 years to diagnose) how wrong i was, the surgeon i was under sent me for a doppler scan ,i thought what a waste of time, i have my diagnosis CS! the doppler scan did indeed show bilateral popliteal artery entrapment whilst my legs were in the dorsiflexion and plantar position.I was then refered to a vascular surgeon
    Anonymous 42789 Replies Flag this Response
  • Hi All,Wow! i cant tell you the relief after hearing all your stories,i guess im lucky its only taken 4 years,8 consultants,2 physios,1 biomechanical specialist,and numerous tests,not to mention many many feelings of self doubt and confusion.I too after many tests finaly had a consultation with a private doctor to try and find out once and for all what was wrong with my legs and to undergo a compartment pressure test(not available on NHS),i experience pain on walking short distances,numbness,extremly tight calf muscles,walking is so bad that i literaly have to stop after just ten minutes as i cannot go any further,im physically fit,i go to the gym 3 times a week,and cycle,just no impact or walking,i have now developed pain on just standing and occassionaly when im just laying in bed!After having been diagnosed with compartment syndrome i thought that finaly my leg problems could be resolved,(it took 3 years to diagnose) how wrong i was, the surgeon i was under sent me for a doppler scan ,i thought what a waste of time, i have my diagnosis CS! the doppler scan did indeed show bilateral popliteal artery entrapment whilst my legs were in the dorsiflexion and plantar position.I was then refered to a vascular surgeon.The surgeon agreed that my symptoms and the scan did show PAES but he would need to do an MRI to confirm this,well to my shock and pure frustration the scan came back "normal! but some discrepancy around the popliteal muscle, the doctor advised me that the MRI scan should of been performed with my legs in the same positon as the doppler scan,and that the consultant had agreed a meeting with the radioligists to discuss this,and i would be seen 2 weeks later.1 week later i recieved an appointment for a vascular exercise test,i went along to that this monday 28th,i had my ankle pressures taken,then asked to do heel to toe for at least 5 mins,i managed 1 minute just! the pressure was taken again and was shown to be a significant drop,then i was asked to extend my legs whilst the pulses were measured and my popliteal fossa area was scaned,this showed without any doubt that the diagnosis was correct,my left leg was shown to be totaly occulded,the right leg occulded by 75%,during the examination i also got cramp in my right calf,the tech there also noticed that the coulor change was abnormaly slow in returning to my leg.Well now iam waiting to see the vascular surgeon again,he is away so my next visit is 26th August.im hoping,praying that this will be a straight forward consultation to discuss the procedure,im not by any means expecting this to be a bed of roses,and judging by all of your struggles ,its going to be far from that! but just to finaly know what is going on and to feel as though someone believes me and im not going crazy.there certainly needs to be a greater understanding about this condition,to save so much pain, heartache,frustration ,let alone wasted time and resorces on tests that are not nessaseryI Hope that you all continue to recover well and wish you all the best for the future.Thankyou so much for sharing you experiences on hereSusan
    Anonymous 42789 Replies Flag this Response
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