A 28-year-old male athlete presented with increasing difficulty running, resulting in severe bilateral calf cramping. He consulted with orthopedics and neurosurgery with no definite etiology identified. Vascular surgery was consulted with a provisional diagnosis of a compartment syndrome. On physical examination he had normal pulses at rest. Diminution of dorsalis pedis and posterior tibial pulses was appreciated on both plantar flexion and dorsiflexion. Duplex ultrasound examination showed normal signals at rest, obliteration of arterial signals on plantar flexion, and reactive hyperemia on a neutral foot position.