OBJECTIVE: To determine whether ultrasound-guided injection of botulinum toxin type A (BTX-A) is a viable alternative to surgical intervention for the treatment of functional popliteal artery entrapment syndrome (PAES). MATERIALS AND METHODS: Twenty-seven patients met diagnostic criteria confirming the presence of functional PAES and agreed to go ahead with ultrasound-guided BTX-A injection at the level of artery occlusion. Patients were assessed and treated at baseline and given the option for 'top-up' injections at 6 and 12 months. Patients provided subjective symptom reports at 6 and 12 months post intervention. RESULTS: No patients reported being worse off after the intervention; 59% of patients were categorized as having a good response (i.e., initial improvement that was maintained at 12 months), 22% a mixed response (i.e., an initial improvement that subsequently reduced over 12 months) and 19% a poor response (i.e., no difference) to treatment. CONCLUSIONS: Ultrasound-guided BTX-A injection represents a viable alternative to surgery in the treatment of functional PAES. Further study will help determine the optimum dose and frequency of injection to prevent recurrence of symptoms.