The road heads east into farmland with some woods and homes, becoming Green Acre Road and passing through Amesville. The route continues into Woodward Township and becomes West Hannah Street, passing homes. PA 53 enters the borough of Houtzdale and heads southeast on Hannah Street, turning south onto McAteer Street as it continues through residential areas. At an intersection with the northern terminus of PA 253, the route turns east onto Elizabeth Street and comes to a junction with PA 153 near some businesses. PA 53 curves northeast onto Spring Street and passes through residential areas. The road crosses back into Woodward Township and passes a few commercial establishments near Sterling. The route heads into Decatur Township and runs through wooded areas with some homes, passing through Moshannon and Beaverton. In Coal Run Junction, PA 53 becomes Sarah Street and heads east through rural areas of commercial development to the north of a R.J. Corman Railroad line before crossing into the borough of Osceola Mills. Here, the route heads east-southeast into residential areas, turning north-northeast onto Stone Street. The road turns northeast and heads back into Decatur Township, becoming Walton Street and passing through wooded areas with some fields and homes. PA 53 runs through more woodland with some residences, passing through New Liberty and Hudson before crossing into the borough of Chester Hill. In this area, the road passes homes and businesses.