Compartment syndrome of the lower leg or foot is usually seen in the setting of high-energy trauma. However, chronic exertional compartment syndrome (CECS) is most frequently seen in athletes. The diagnosis is largely based on clinical examination, and the most sensitive clinical symptom of compartment syndrome is severe pain. Intracompartmental pressure measurements can be obtained to confirm diagnosis. Once the diagnosis is made, immediate fasciotomy of all involved compartments is required. Fasciotomy of the lower leg can be performed by one lateral incision or by medial and lateral incisions. Endoscopic fasciotomy is also described in cases of CECS. Foot compartment syndrome requires thorough examination of all compartments with special focus on the calcaneal compartment. Depending on the injury, clinical examination, and compartment pressure, fasciotomy is recommended via a dorsal and/or medial plantar approach. Surgical intervention does not eliminate the risk of developing nerve and muscle dysfunction. If left untreated, poor outcomes characterized by sensory deficits, weakness, paralysis, contractures, and toe deformities can be expected.