Chronic exertional compartment syndrome (CECS) of the leg is an activity-related increase in intra-compartmental pressure that leads to transient ischemia, pain, and occasionally neurologic symptoms during activity. It predominantly affects young physically active individuals, especially runners and military recruits, and most commonly involves the anterior and lateral compartments. The diagnosis relies on a characteristic clinical pattern—pain and tightness appearing after a certain amount of time, distance, or intensity of exercise and resolving rapidly with rest. The diagnosis is supported by post-exercise intra-compartmental pressure measurement. Non-surgical management emphasizing training load modification, footwear correction, and gait retraining should always precede surgery. When non-surgical management fails, fasciotomy remains the gold-standard treatment, enabling more than 80% of patients to return to sport.