Compartment syndromes of the leg, and to a lesser extent the forearm and other areas, occur in both acute and chronic exertional forms. Similar inciting events may precipitate either form, with different presentations, prognoses and implications for treatment. A complete knowledge of the anatomy and pathophysiology of these syndromes is essential for diagnosis. Measurement of compartment pressures is a valuable tool in the diagnosis of chronic exertional compartment syndrome. In our experience, athletes who desire to return to the same level of exercise will require fascial release, although symptoms may improve if the intensity or duration of the activity is decreased. Fascial release is the treatment of choice in acute compartment syndrome and in chronic exertional compartment syndrome unresponsive to nonoperative treatment.