Tibial Nerve Palsy Secondary to Spontaneous Isolated Popliteus Muscle Rupture and Localized Compartment Syndrome

We report the case of a 68-year-old man who developed sudden pain at the right calf, followed by progressive tibial nerve palsy. Magnetic resonance imaging (MRI) demonstrated localized signal abnormalities and swelling of the popliteus muscle compressing the tibial nerve. A medial surgical approach in supine position provided direct access to both the popliteus muscle and the tibial nerve while minimizing operative risk. Intraoperative findings confirmed necrosis of the popliteus muscle, which was subsequently supported by histopathology. Surgical decompression consisted of debridement of the necrotic tissue, associated with the release of the tibial nerve at the soleus arch. This case highlights a dual mechanism of tibial nerve compression: 1. swelling of the popliteus muscle following spontaneous rupture exerting a direct mass effect and 2. concomitant localized compartment syndrome. This dual mechanism led to significant transient tibial nerve palsy, which was successfully reversed following surgical decompression, with sustained recovery at ten months.