Chronic exertional compartment syndrome is a common problem among running athletes. A complete history and physical are essential, and radiographic workup can distinguish between other types of leg pain. Intracompartmental pressure testing can accurately confirm the diagnosis. Nonoperative management is largely unsuccessful for those athletes unwilling to cease the inciting activity. Surgical management of the affected compartments with fasciotomy yields a high rate of satisfactory outcome and return to play. Techniques for fasciotomy in chronic exertional compartment syndrome have progressed from a complete open incision to minimally invasive “semi-blind” subcutaneous fasciotomy, and most recently, endoscopic techniques have been described. Although endoscopic methods have demonstrated improved cosmesis and visualization, there remains a risk of damage to neurovascular structures and recurrent symptoms due to incomplete fascial release. Postoperative course involves immediate weight bearing and early range of motion. With an accurate diagnosis, a meticulous surgical technique, and an aggressive early rehabilitation protocol, good outcomes can be expected with a return to play around 8 to 12 weeks.