Leg pain in athletes has many aetiologies. The clinician must strive to specifically define the clinical problem in order to administer the appropriate treatment for the athlete's condition. Clinical conditions in the leg causing symptoms in athletes include chronic exertional compartment syndrome (CECC), tendinitis, medial tibial stress syndrome, stress fractures, fascial defects, musculotendinous junction disruptions (tennis leg), popliteal artery entrapment syndrome, effort-induced venous thrombosis and nerve entrapment. Appropriate diagnostic studies are needed to allow accurate diagnosis. A work-up might include radiographs, bone scans and compartment pressure measurement. Many of these conditions relate to overuse and training errors. Conservative measures including rest, activity modification and rehabilitation will permit a gradual return to participation in sports. Some problems such as CECC, popliteal artery entrapment syndrome and nerve entrapment may require surgical intervention to allow the resolution of symptoms. Clinicians should be familiar with the range of problems causing leg pain in order to prescribe specific treatment for each athlete.