The dorsal fascial complex of the foot: A systematic review of anatomy, variations, and clinical implications.

The dorsal fascia of the foot has historically received less attention than plantar and crural fascial structures, despite its importance in tendon stabilization, compartmental organization, and surgical procedures around the ankle. Anatomical descriptions have often focused on isolated components, such as the extensor retinacula, without considering their structural continuity. This study aimed to provide a comprehensive overview of the dorsal fascia, including the superior and inferior extensor retinacula, distal fascial thickenings, and their relationships with the tarsal sinus structures. A systematic literature review was conducted according to PRISMA guidelines to identify anatomical and morphometric studies based on morphological data from cadaveric dissections, imaging, or surgical observations. Twelve studies involving 372 ankles and feet met the inclusion criteria. The findings revealed significant morphological variability of the inferior extensor retinaculum, with Y-shaped, cruciform, and accessory band configurations. Multiple distal fascial thickenings and midfoot retinacular structures were identified, although descriptions were inconsistent across studies. Evidence also supports continuity between the dorsal fascial system and the tarsal sinus structures through medial, intermediate, and lateral roots. This compartmental organization contributes to tendon guidance, neurovascular protection, and biomechanical stabilization. Overall, the dorsal fascia of the foot should be considered an organized and continuous anatomical system rather than a collection of isolated structures. Recognizing this integrated framework may enhance anatomical understanding, support surgical planning, and guide future research integrating imaging, histology, and biomechanics to clarify its clinical and functional significance.