Functional Popliteal Artery Entrapment Syndrome in Athletes: Insights from the Patient Perspective

Functional popliteal artery entrapment syndrome (fPAES) is a rare cause of exertional leg pain in athletes that is frequently underdiagnosed. This study aimed to characterize the patient perspective, including symptom presentation, recovery, and return to sport following surgical treatment. A mixed-methods study was conducted in patients undergoing surgery for fPAES. Functional outcomes were assessed using the Tegner Activity Scale (0 = no activity, 10 = full activity), and structured interviews were analyzed to evaluate symptom burden, diagnostic delay, and psychosocial impact. Thirty-six patients (64 limbs) were included with a mean follow-up of 8.3 years. The average time from symptom onset to diagnosis was 57.5 months. The most commonly reported symptoms were calf pain (89%), neurologic symptoms (42%), rest pain (33%), cold sensation (31%), and swelling (19%). Neurologic symptoms were associated with a higher likelihood of full recovery, whereas pain at rest was associated with incomplete improvement in most cases. Functional improvement at 1 year was 80%. Higher preoperative activity levels were associated with lower odds of improvement (p = 0.0017). Younger patients (<20 years) more frequently reported incomplete recovery compared with older groups; however, all returned to sport, and adjunctive botulinum toxin therapy appeared beneficial. Surgical treatment provides durable symptom relief and high rates of return to sport, although delayed diagnosis remains common and younger athletes may be at increased risk of incomplete recovery.