We present our experience in the management and treatment of chronic exertional compartment syndrome (CECS) of the legs in 23 adolescents. Twenty-one patients were affected in the anteroexternal compartment, one in the deep posterior compartment, and one in both. Seventeen of the patients were in-line competitive skaters; the rest practiced soccer or athletics. Mean age at the time of diagnosis was 16 (range, 14-18) years, and the age at the onset of symptoms was 15 (range, 13-17) years. After a careful differential diagnosis, the diagnosis was established on the basis of clinical signs and symptoms and confirmed by intracompartmental pressure (ICP) measurements. Based on our results, the following criteria are considered to be adequate: baseline ICP (at rest) >10 mm Hg, >20 mm Hg 1 minute after stopping exercise, >20 mm Hg 5 minutes later, and >15 minutes to achieve ICP normalization. All patients but one accepted surgical treatment (complete subcutaneous fasciotomy). No major complication was observed and only one minor complication occurred. All patients returned to the practice of their sports without any symptomatology 6 weeks after the surgery (mean follow-up, 4.8 years). To date there have been no relapses.