Popliteal Artery Entrapment Syndrome (PAES)

What is Popliteal Artery Entrapment Syndrome (PAES)?


PAES is a rare vascular condition that typically effects the younger athletic population when exercising or playing sport (under the age of 30).

PAES is where the main artery behind the knee called the “Popliteal Artery” is compressed mainly by the calf muscle/other soft tissue structures which restricts blood flow to the lower leg/foot when exercising.

Signs and Symptoms:

  • Pain in one or both legs in the back on the calf extending down in the centre portion of the calf
  • Pins and needles with or without numbness of lower legs and feet
  • Muscle weakness and cramping
  • Discolouration of lower leg and feet if severe
  • Symptoms aggravated by running or walking up inclines for approx. 3-5 minutes
  • Symptoms typically stop after 3-5 minutes of relative rest

Note: can also have a similar presentation to compartment syndrome or lower limb exertional syndrome (AKA shin splints)

How to diagnose PAES?

PAES is rare but can be clinically diagnosed by a physiotherapist, sports physician or vascular surgeon by taking a thorough subjective history and clinical objective testing.

Clinical testing should include a series of calf raising, hopping/jumping, running on a treadmill and walking up on a high incline for a period until symptoms are reproduced (as an example).  When symptoms have occurred, the treating health professional will stop the test and palpate/feel your foot pulses to see whether it has decreased or not.  If the pulses in the feet have decreased, then a series of tests will be performed to confirm the diagnosis.

1- Ankle Brachial pressures with exercise

2- Doppler Ultrasound (measures blood flow through the popliteal artery)

3- Computed tomographic angiography (uses dye to pick areas of poor blood flow)

4- Functional MRI scan (uses magnetic field to provide pictures of muscles/tendons and blood vessels in the body while the person pumps ankles up and down)

If there is positive findings of PAES, you will be referred to a vascular consultant for a clinical opinion on what treatment methods would suit.

PAES Treatment options:

If PAES has been diagnosed, physiotherapy can help by improving strength and flexibility of the lower limbs (calf muscles) to reduce the onset of symptoms and improved exercise tolerance under the guidance of the sports physician or vascular consultant.

If you are experiencing any of the above symptoms and would like it assessed by our experienced physiotherapists, please call 4728 2116 or visit www.physioonross.com.au for an appointment.

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