This review focuses on the clinical history, diagnosis, and treatment of chronic exertional compartment syndrome (CECS) of the lower leg. Measurement of muscle compartment pressures, the most conclusive way to confirm the diagnosis, may yield significantly elevated values in CECS patients compared to normal controls. It is important to recognize that medial tibial syndrome is a distinct clinical entity from deep posterior CECS. Once a diagnosis of CECS is established, surgical decompression of the involved compartment is recommended. For as yet unknown reasons, the results of fasciotomy are almost always satisfactory in the anterior compartment and significantly less so in the posterior compartment.