A new bibliometric analysis from Wei and colleagues at Capital Medical University in Beijing maps 25 years (2000–2024) of global research on plantar pressure and diabetic foot ulcers — over 2,100 publications indexed in the Web of Science Core Collection.
The findings tell a story that will feel familiar to many of us who have been in this arena for decades — but they also quantify some things worth paying attention to.
The United States leads in total output (678 articles), citation impact, and H-index. The University of Amsterdam ranks first by institutional publication count. And the most prolific author? Your humble correspondent, with 76 publications and the highest H-index among listed authors. (Sicco Bus, Larry Lavery, and Andrew Boulton round out the top contributors.)
But the most interesting part of this analysis isn’t who published the most. It’s what the keyword clustering reveals about where the field has been — and where it’s going.
The authors identified 12 keyword clusters that essentially partition the field along four dimensions: complications, pathophysiology, management strategies, and technological innovation. “Diabetic foot” and “diabetic foot ulcer” anchored the network, as expected. But here’s a telling finding: while “plantar pressure” appeared with high frequency (290 occurrences), it exhibited remarkably low centrality (0.06). In network science terms, that means plantar pressure is widely studied but surprisingly siloed — it hasn’t been well-integrated into the broader clinical management conversation.
That’s a problem worth fixing.
We’ve known for decades that abnormal plantar pressure is a critical mechanical trigger for ulceration and recurrence. The biomechanical triad of peripheral neuropathy, foot deformity, and focal high pressure remains the primary pathway to plantar ulceration. And yet, only about 30% of ulcer locations correspond to peak pressure zones — meaning shear stress, microcirculation, and neuropathy also play critical roles that are often underrepresented in the pressure-centric literature.
The temporal keyword mapping is also instructive. The field moved through distinct phases: a foundational period (2000–2005) establishing core constructs like neuropathy and plantar pressure; a clinical technology expansion (2006–2015) driven by total contact casting, negative pressure wound therapy, and the rise of RCTs; and an innovation phase (2016–2024) marked by regenerative medicine (human skin equivalents, growth factors), precision wound care (biofilm, microcirculation), and personalized prevention (custom footwear, smart offloading).
Recent burst detection highlights some emerging frontiers: IWGDF guidance, microcirculation, custom-made footwear, wound dressings, and epidemiology all show recent or ongoing citation bursts. Cold atmospheric plasma even made an appearance in 2023.
The reference co-citation analysis centers, not surprisingly, on our 2017 NEJM review (“Diabetic Foot Ulcers and Their Recurrence”), which had the highest co-citation count (n = 150) in this dataset. That paper introduced the concept of treating a healed DFU as “remission” rather than “cure” — a framing that has reshaped how many of us think about long-term foot care. The recurrence numbers remain sobering: 40% at one year, 65% at five years.
The bottom line? Plantar pressure research has matured enormously over a quarter century, but it remains insufficiently woven into the multidisciplinary fabric of diabetic foot care. The next frontier isn’t just better insoles or smarter sensors — it’s genuine integration of biomechanical data with vascular assessment, neuropathy screening, glycemic control, and regenerative strategies. The field needs more bridges and fewer silos.
Citation: Wei D, Li B, Wang J, Gao L. “Global Research Trends and Healthcare Innovations in Plantar Pressure Management for Diabetic Foot Ulcers: A 25-Year Bibliometric and Visual Analysis.” Healthcare. 2026;14(6):780. doi: 10.3390/healthcare14060780
#DiabeticFoot #PlantarPressure #DFU #Offloading #Biomechanics #WoundHealing #LimbPreservation #IWGDF #Bibliometric #Remission #SmartFootwear #WearableSensors #PrecisionMedicine
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