title: Botulinum toxin as a treatment for functional popliteal artery entrapment syndrome.
abstract: OBJECTIVE
  Functional popliteal artery entrapment syndrome is responsible for exercise-induced muscle leg pain. This syndrome is caused, in most of the cases, by the excessive size of the gastrocnemius muscles. Currently, its treatment is based only on surgery with variable results.
  
  
  METHODS
  We report the case of a young professional soldier in a combat unit with bilateral functional popliteal artery entrapment syndrome that was confirmed by dynamic arteriography, magnetic resonance angiography, and ultrasonography and did not improve after bilateral popliteal arteriolysis without resection of the gastrocnemius medial head. Treatment by injecting botulinum toxin in the proximal part of the gastrocnemius muscles was proposed and carried out.
  
  
  RESULTS
  Regular follow-up (from 1 month to 3 yr after botulinum toxin treatment) showed the disappearance of exercise-induced pain and the improvement of the patient's physical and sports performance. Results of follow-up ultrasonography during dynamic maneuvers at 2.5 months and 2 yr after botulinum toxin injection were normal. Neither adverse effects nor motor deficit of the gastrocnemius muscles was reported.
  
  
  CONCLUSIONS
  This case report suggests that botulinum toxin treatment could be an alternative to surgery for patients with functional popliteal artery entrapment syndrome. Botulinum toxin could reduce functional compression and, consequently, exercise-induced pain by decreasing the volume of the gastrocnemius muscle.
authors.affiliation: 1University Institute of Rehabilitation Clémenceau, Department of Physical and Rehabilitation Medicine, Strasbourg University, Strasbourg, FRANCE; 2Fédération de Médecine Translationnelle de Strasbourg (FMTS), EA 3072 "Mitochondrie, stress oxydant et protection musculaire," Strasbourg, FRANCE; 3Faculty of Sports Sciences, Strasbourg University, Strasbourg, FRANCE; 4Faculty of Medicine, Department of Radiology, Strasbourg University and University Hospital, Strasbourg, FRANCE; and 5Faculty of Medicine, Institute of Physiology, Strasbourg University and Strasbourg University Hospital, Strasbourg, FRANCE.
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Isner-Horobeti
authors.forename: Guillaume
authors.initials: G
authors.lastname: Muff
authors.forename: Julien
authors.initials: J
authors.lastname: Masat
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Daussin
authors.forename: Stephane P
authors.initials: SP
authors.lastname: Dufour
authors.forename: Jehan
authors.initials: J
authors.lastname: Lecocq
mesh_terms: D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003251:Constriction, Pathologic; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008889:Military Personnel; D010147:Pain Measurement; D011150:Popliteal Artery; D013577:Syndrome; D055815:Young Adult
chemical_list: D019274:Botulinum Toxins, Type A