Other Studies:
Imaging, pre-diagnosis:

April 2023:
B/L Tibia/Fibula MRI WO Contrast
Bilateral Anterior Tibia: Bilateral grade 2 stress injuries, right greater than left.
December 2024:
Left Tibia/Fibula MRI WO Contrast
Postsurgical status after compartment fasciotomy. No evidence of stress fracture.
Gastrocnemius muscles: Mild edema and volume loss.
Peroneus muscle: Mild edema of unknown clinical significance, possibly due to disuse or strain.
ABI With Exercise
Popliteal Entrapment Maneuver Pressures: Ratios >1.0 consistent with a normal study.
Right and Left Ankle Brachial Index (ABI): Within normal limits, no hemodynamically significant stenosis or occlusion from heart to ankle.
Right and Left toe brachial index: Within normal limits, no hemodynamically significant stenosis or occlusion at or proximal to digits.
Pulse Volume Recording Grade: Right and left ankle and transmetatarsal pulse volume recording waveforms within normal limits.
Left Lower Extremity Arterial Duplex
Left Lower Arterial: Spectral waveforms suggest no stenosis. Popliteal entrapment maneuvers displayed no significant change in waveform morphology and velocities, suggestive of negative results for popliteal entrapment syndrome.
August 2025:
ABI with Exercise
Popliteal Artery Entrapment Maneuvers: Performed after exercise (50 toe raises, which provoked patient symptoms). Ratios >1.0consistent with a normal study.
Right and Left ABI: Within normal limits.
Right and Left Toe Brachial Index: Within normal limits.
PVR Grade: Right and left ankle and transmetatarsal pulse volume recording waveforms within normal limits.

Imaging; Diagnosis, Post-Diagnosis, and Recovery:
September 2025:
B/L Lower Extremity diagnostic angiogram with provocative maneuvers; left popliteal intravascular ultrasound
Left Leg: Normal vasculature at rest of left distal superficial femoral artery, popliteal artery, and tibial trifurcation. With active plantarflexion, significant (>90%) diameter reduction of P2 popliteal artery. Case Photo #1 , Case Photo #2 Intravascular Ultrasound captured high-grade narrowing of P2 segment with near vessel occlusion. Case Photo #3 , Case Photo #4
Right leg: At rest, vessels are normal. P2 segment popliteal artery occludes with strong plantarflexion. Case Photo #5 , Case Photo #6 No reconstitution of P3 segment or tibials while in active plantarflexion, but flow immediately restored in neutral position.
Bilateral: Three-vessel runoff initially at the below-knee trifurcation to the mid shin bilaterally.

February 2026 (After Left Popliteal Entrapment Release):
ABI'S with Exercise
Right and Left ABI: Within normal limits, no hemodynamically significant stenosis or occlusion from heart to ankle.
Right toe brachial index: Abnormal, suggesting hemodynamically significant stenosis or occlusion at or proximal to digits.
Left toe brachial index: Abnormal, suggesting hemodynamically significant stenosis or occlusion at or proximal to digits.
ABI Exercise: Right and left lower extremity ankle/brachial indices within normal limits post treadmill exercise.
PVR Grade: Right and left ankle and transmetatarsal pulse volume recording waveforms within normal limits.

Consultations:
Physical Therapy
Musculoskeletal Ultrasound
Vascular Surgery

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