Acute exertional compartment syndrome has been described as occurring after sustained maximal exertion. The case described is that of acute exertional compartment syndrome of the leg occurring in a soldier after he attempted to complete the Army physical fitness test. This condition was initially neglected; necrotic muscle and acute tubular necrosis were sequelae. Earlier intervention could have occurred if the signs and symptoms were considered by the treating health care professionals. All active duty troops are required to perform to maximum exertion. Their complaints should be considered with the same differential diagnosis as those of a highly trained athlete.