Leg pain is a common indication to refer patients for vascular sonography. Before the introduction of duplex and, subsequently, color Doppler imaging, the diagnosis and assessment of lower extremity peripheral vascular pathology fell into the scope of practice of the noninvasive vascular technologist. During the past decade, however, with the blurring of some of the practice boundaries between sonographers and vascular technologists, the onus for recognizing, diagnosing, and assessing lower extremity vascular pathology has fallen on the shoulders of many a competent sonographer who has had little clinical training in this area. Noninvasive vascular diagnosis relies strongly on the clinical assessment of the patient in addition to the duplex or color Doppler examination. Indeed, basic competence in the performance of noninvasive vascular studies, as outlined by the American Registry of Diagnostic Medical Sonographers, includes a strong clinical component. In this article, the author describes a focused, clinical approach to evaluating the patient who complains of leg pain. Adequate clinical evaluation will assure appropriate use of noninvasive and duplex examination methods.