Anatomy of foot Compartments: a systematic review

•A systematic review of anatomical foot compartment studies. The risk of bias assessment helps clarify discrepancies to establish a basis for the treatment of their pathology.•Most authors agree on three compartments for the plantar region.•The two studies with a low risk of bias, who study the whole foot, agree on 9 total foot compartments. There are discrepancies regarding the anatomy of the foot which complicate standardizing foot compartment treatment. We synthesized the existing evidence regarding the compartmental anatomy of the foot A systematic review was performed evaluating the anatomy of the foot compartments in non-pathologic specimens. The search strategy was performed in MEDLINE, Scopus, Web of Science, and EMBASE. Three reviewers worked independently and in duplicate to screen all references via a title/abstract and full-text phase. The risk of bias was assessed with the Anatomical Quality Assurance (AQUA) checklist. Ten studies were included. All were performed in cadavers except one. Half of them evaluated the plantar section of the foot and the other half evaluated the whole foot. Methods employed across studies tended to vary: anatomical dissections, dye infusion, imaging studies, or a combination of these. Five studies directly addressed the anatomic limits of each compartment and eight addressed the anatomical structures inside each of them. There seems to be an agreement regarding the number of compartments in the plantar region (three major compartments divided by the medial and lateral intermuscular septum), nevertheless, disagreements across authors tend to arise when describing its dorsal section. Only two studies were ranked with an overall low risk of bias, agreeing on nine compartments. This review provides the best available anatomical evidence regarding the anatomy of the foot compartments for compartment syndrome management. Future research should focus on settling the discrepancies highlighted to reach a more accurate anatomical description.