Chronic exertional compartment syndrome (CECS) is a condition characterized by increased pressure within muscle compartments, often observed in athletes engaging in repetitive impact activities. This condition compromises microcirculation, leading to tissue ischemia and nerve dysfunction. The condition is most common in individuals aged 20–30, affecting the anterior leg compartment in 48% of cases and the deep posterior compartment in 40%. Diagnosis is primarily clinical, with compartment pressure testing being the gold standard. Symptoms include cramping, bulging, muscle hernias, and progressive pain during exercise. Advanced imaging techniques, like ultrasound, can help rule out other pathologies. Conservative management includes gait retraining and cessation of provoking activities. Surgical techniques, such as arthroscopic assisted mini-incisional fasciotomy, have been developed to reduce recovery time and improve functional outcomes. Ultrasound-guided fasciotomy offers a targeted approach that maximizes therapeutic efficacy while minimizing procedural invasiveness and recovery time.