Early diagnosis and treatment of compartment syndrome of the leg or foot is invaluable in avoiding a chronic and often debilitating course. In cases where an ischemic contracture results in pain, disability or soft tissue compromise, surgical intervention is indicated. Thorough physical examination of patients and a thorough understanding of pathomechanics of the foot and ankle are paramount. These combined with a comprehensive preoperative plan and meticulous execution can often provide improved function and decrease pain in patients affected by this debilitating problem.