This case report concerns an unusual complication of neurovascular compression following an isolated popliteus muscle rupture. A 59-year-old man, after a fall from a horse, gradually developed symptoms of a swollen leg, dysesthesias in the sole of his foot, and muscle weakness of his toe flexors. At presentation, he was found to have a complete tibial nerve injury at the level of the popliteal fossa and significant neuropathic pain. MRI demonstrated a rupture in the muscular portion of the popliteus muscle with extensive edema and hemorrhage compressing the tibial nerve in the popliteal fossa. The edema extended up to the distal part of sciatic nerve where there was evidence of intraneural hemorrhage. In the course of recovery, the patient additionally developed deep venous thrombosis in the ipsilateral popliteal vein. Spontaneous recovery was documented on serial clinical and electrodiagnostic examinations. The patient's neuropathic pain improved significantly within 6 months and his neurologic function recovered nearly fully by 2 years.