THE ROBERT WILLIAMS III LEG PROBLEM

CLEVELAND CLINIC

What is popliteal artery entrapment syndrome?

Popliteal artery entrapment syndrome (PAES) is a rare vascular disease that affects the legs of some young athletes. The muscle and tendons near the knee are positioned so that they compress the popliteal artery – the main artery that runs through and behind the knee. Compression of the artery restricts blood flow to the lower leg and can damage the artery.

Patients with PAES may be born with the condition due to a developmental defect in the calf muscle on the back of the lower leg (gastrocnemius or popliteus muscle) and the popliteal artery. The condition can also develop over time, as exercise and training lead to an enlarged calf muscle that compresses the popliteal artery.

Who is at risk for PAES?

PAES occurs most often in male athletes under age 30, particularly those who are runners or play soccer, football or rugby. However, the condition can also affect young female athletes.. As the muscles next to the popliteal artery get larger, there is a greater chance of compression. This may be referred to an "over-use" injury.

Less than 3% of people are born with the defect that can lead to PAES, and most people with the condition never develop symptoms.

What can I expect after PAES surgery?

Hospital stay is typically one to two days. Physical therapy may be done as an outpatient to help facilitate recovery by using stretching and flexibility exercises. Once you fully recover, you can expect to go back to training and your normal routine.

What type of follow-up care will I need?

Follow up ultrasound of the repaired artery and blood pressure checks in the feet will be done in the office at one to two months in the office and at one year. If the artery has returned to normal you won’t need any further follow-up visits unless your symptoms return or a bypass of the artery was required.

SYMPTOMS AND CAUSES
What are the symptoms of PAES?

Patients with PAES have history of aching pain, numbness, and tiredness or cramping in the calf when they exercise. The symptoms typically go away in three to five minutes of resting. In many cases, the pain always occurs at the same point during exercise and affects the same leg. In some cases they may note leg swelling. The leg pain is known as intermittent claudication (walking pain).

The symptoms of popliteal artery entrapment (PAES) are similar to adventitial cystic disease. If young patient has pain when walking, the doctor will check for both of these conditions.

DIAGNOSIS AND TESTS
How is PAES diagnosed?

A vascular specialist is the type of doctor who can best diagnose PAES. You will have a physical exam that includes checking the pulse in your foot and popliteal artery. If you have the condition, the doctor may be able to feel the pulses while you’re resting, but they may be harder to detect when you exercise or flex or extend your foot. Diagnostic tests are done to measure blood flow through the knee, leg and foot.

These can include:

Ankle brachial pressures with exercise – Measures the blood pressures in the arms and legs before and after exercise
Duplex Ultrasound – Uses sound waves to image the artery and measure blood flow

Computed tomographic angiography (CTA) – Type of CT scan that uses dye to look for areas around the knee with poor blood flow or narrowed arteries

Magnetic Resonance Angiography (MRA) – Test using magnetic field and pulses of radio wave energy to provide pictures of muscles tendons and blood vessels inside the body

MANAGEMENT AND TREATMENT
What treatments are available for patients with PAES?

Surgery can be done to correct the problem with the muscle or tendons and release the popliteal artery. This eliminates the compression of the artery and allows normal blood flow to the leg.

In more advanced cases when the popliteal artery is blocked, rather than pinched, the surgeon will correct the problem with the muscles or tendons and also perform a bypass around the blocked section of the artery to restore blood flow.

Celtics rookie Robert Williams acknowledges leg condition

Boston Globe By Adam Himmelsbach Globe Staff,Updated July 11, 2018, 1:48 a.m.

Robert Williams said that NBA teams were aware of his leg issue and that it came up frequently during the pre-draft process.

Robert Williams said that NBA teams were aware of his leg issue and that it came up frequently during the pre-draft process.
CHARLES KRUPA/ASSOCIATED PRESS

LAS VEGAS — Celtics rookie Robert Williams on Tuesday confirmed that he has played through an artery condition in his legs that can cause cramping and calf pain, but he said the issue has dissipated recently and is not a major concern moving forward.

“Yeah, it was just a time-to-time thing,” Williams told the Globe. “I haven’t been dealing with it for a while really. The last time was in the middle of my college season last year.”

MassLive.com, citing an anonymous source, on Monday first reported Williams’s condition, which is known as popliteal artery entrapment syndrome, or PAES. Williams, who was drafted 27th overall by the Celtics last month, said that NBA teams were aware of his issue and that it came up frequently during the pre-draft process.


“Definitely, they asked me about it,” he said. “Every team is supposed to have concerns about what they’re investing money in, and I tell them it’s under control. I’ve been playing with it for two years in college and playing pretty well. It starts like a little burning sensation and then it’ll just cramp up. It goes away though. I play through it.”

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Williams said that when pain sprouted while he was at Texas A&M, it was treated with acupuncture, massage, and rest. He said acupuncture was a particularly effective course of action.

“It’s something that can affect me over time, but doctors said I’m clear now,” Williams said. “Obviously when I’m done playing basketball I might look into a surgery and make sure everything is good, but for right now I’m good.”

PAES is most common in athletes and it is caused by tendons and muscles around the knee entrapping the primary artery behind the knee, slowing blood flow to the lower leg.

Williams, who has missed the Celtics’ last two summer league games with a knee contusion, was expected to take part in portions of Tuesday’s practice. His status for the team’s upcoming opening-round summer league playoff game is unclear.

“Anyone would want to be out there playing right now,” Williams said. “It’s tough as hell to just watch my team play and not be able to play. But you’ve got to support them in any way possible.”

Williams said he is aware of the buzz that surrounded his arrival with the Celtics, and the high-flying, shot-blocking big man hopes he is able to finally put his talents on display soon.

“Boston is a crazy place, especially the fan base,” Williams said. “I’m definitely ready to give them what they’ve been waiting for.”

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Celtics rookie Robert Williams acknowledges leg condition

Boston Globe By Adam Himmelsbach Globe Staff,Updated July 11, 2018, 1:48 a.m.

Robert Williams said that NBA teams were aware of his leg issue and that it came up frequently during the pre-draft process.

Robert Williams said that NBA teams were aware of his leg issue and that it came up frequently during the pre-draft process.
CHARLES KRUPA/ASSOCIATED PRESS

LAS VEGAS — Celtics rookie Robert Williams on Tuesday confirmed that he has played through an artery condition in his legs that can cause cramping and calf pain, but he said the issue has dissipated recently and is not a major concern moving forward.

“Yeah, it was just a time-to-time thing,” Williams told the Globe. “I haven’t been dealing with it for a while really. The last time was in the middle of my college season last year.”

MassLive.com, citing an anonymous source, on Monday first reported Williams’s condition, which is known as popliteal artery entrapment syndrome, or PAES. Williams, who was drafted 27th overall by the Celtics last month, said that NBA teams were aware of his issue and that it came up frequently during the pre-draft process.


“Definitely, they asked me about it,” he said. “Every team is supposed to have concerns about what they’re investing money in, and I tell them it’s under control. I’ve been playing with it for two years in college and playing pretty well. It starts like a little burning sensation and then it’ll just cramp up. It goes away though. I play through it.”

Get Sports Headlines in your inbox
The Globe's most recent sports headlines delivered to your inbox every morning.

Williams said that when pain sprouted while he was at Texas A&M, it was treated with acupuncture, massage, and rest. He said acupuncture was a particularly effective course of action.

“It’s something that can affect me over time, but doctors said I’m clear now,” Williams said. “Obviously when I’m done playing basketball I might look into a surgery and make sure everything is good, but for right now I’m good.”

PAES is most common in athletes and it is caused by tendons and muscles around the knee entrapping the primary artery behind the knee, slowing blood flow to the lower leg.

Williams, who has missed the Celtics’ last two summer league games with a knee contusion, was expected to take part in portions of Tuesday’s practice. His status for the team’s upcoming opening-round summer league playoff game is unclear.

“Anyone would want to be out there playing right now,” Williams said. “It’s tough as hell to just watch my team play and not be able to play. But you’ve got to support them in any way possible.”

Williams said he is aware of the buzz that surrounded his arrival with the Celtics, and the high-flying, shot-blocking big man hopes he is able to finally put his talents on display soon.

“Boston is a crazy place, especially the fan base,” Williams said. “I’m definitely ready to give them what they’ve been waiting for.”

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