Sometime overnight, Google Scholar ticked over to 95,006 citations.
It is a strange number to look at. Round-ish, big-ish, the kind of thing that shows up on a digital odometer. But the number is not what is interesting. What is interesting is what produced it.
If you do the math, an h-index of 134 means there are at least 134 papers, each cited 134 or more times. An i10-index of 568 means there are at least 568 papers cited at least 10 times. Those numbers do not represent one person’s productivity. They represent 568 conversations — 568 small communities of authors, reviewers, statisticians, residents, fellows, patients, families, nurses, vascular colleagues, infectious disease colleagues, biomechanists, engineers, data scientists, and friends — who took something we wrote and decided it was worth building on.
That is what a citation actually is. Someone else’s hand on the work.
A team sport, on the record
I have said it on this blog before, and I will keep saying it: limb preservation is a team sport. Two years ago I sat down with the @AudibleBleeding podcast crew and made exactly this argument — that healing a heel, salvaging a limb, and bending the curve on diabetic foot disease cannot be done alone (post here). The American Heart Association said the same thing in their 2023 advocacy statement on team-based PAD care (covered here). The science of this disease will not move forward in single-author papers. It moves forward in groups of weird people who like each other enough to keep arguing about it.
Speaking of weird people. The “Lennon and McCartney of the diabetic foot” — Larry Lavery and yours truly, as Andrew Boulton dubbed us at Malvern in 2008 — turned that toast into a remastered video archive last week (see post). A huge fraction of those 95,006 citations have Larry’s fingerprints on them. Same for Prof Boulton. Same for Sicco Bus. Same for Bijan Najafi, Caitlin Hicks, Joe Mills, Nick Giovinco, Brian Schmidt, Lee Rogers, José Luis Lázaro Martínez, Bob Frykberg, Dane Wukich, Vickie Driver, Suzanne Kell, and a couple of hundred others I am insulting by leaving off this list.
The same goes for the people who never appear on a paper but make the papers possible: my SALSA team at USC; my Hopkins, UTSA, and worldwide collaborators; the C2SHiP NSF center co-investigators; the ALPS board; the DFCon faculty; the Keck nursing and vascular and ID and rehab and prosthetics teams. And — embarrassingly often forgotten in these lists — the patients themselves, who keep showing up and letting us measure things.
Weird ideas, weird people
The thing I am most proud of is not the citation count. It is that the work itself was made by putting weird ideas next to weird people and seeing what happened. That philosophy now has a literal map (the Weird Ideas & Weird People Engine), and it is what makes me get out of bed at 4 AM most days. Cancer-as-remission framing for diabetic foot ulcers. Walking-as-a-drug, dose-titrated. Smart insoles. AI chatbots. Plantar pressure as an outcome. Wound thermometry as a vital sign. None of those ideas were mine alone, and none of them would have made it past the napkin without a hundred other people sharpening them.
A note on the chart
Look at the right side of that bar chart. 2025 was the highest single-year citation count in our group’s history — over 10,000 in one year. 2026 is sitting at about 3,300 four months in, which is on pace to break 2025. That acceleration is not because anyone is writing better papers. It is because the field is finally getting the attention it has always deserved. Diabetic foot disease fills more hospital beds than heart attacks (we covered the data here), and the citation graph is one small reflection of a global community waking up to that fact.
“Top-ranked” is also team-ranked
Over the last few years a number of independent ranking systems have, kindly and embarrassingly, named me the world’s top-ranked scholar or expert in diabetic foot disease — Expertscape ran the numbers from 2011–2021 and put us at #1 globally (post); ScholarGPS did the same in 2024 (post); around the same time we became the first podiatric surgeon to cross 700 peer-reviewed publications (post); and several independent bibliometric analyses since 2022 have placed our group in the top 10 worldwide for diabetic foot research output and collaboration density (2025, 2023, 2022).
I want to be very direct about what those rankings actually measure. They measure the gravity of a network. Expertscape and ScholarGPS do not score one person — they score a person’s connections, the durability of those connections, and the willingness of other authors to cite back into a body of work. The “leading person” label is, by construction, a measure of how much weight a community has decided to put on a shared corpus. The corpus is shared. So is the label. The BEST-CLI multidisciplinary subgroup analysis last year (“Teamwork Saves Limbs”) made the same point with patient outcomes: the team beats the individual, every time, on the metric that matters.
The honors are also team sport
Every honor that has come our way over the last couple of years has the same shape. The 2025 Global PAD Patient Champion of the Year award (post). The Samuel Merritt University Distinguished Alumnus award at the 2025 Health Impact Awards (post). The Sjef van Baal keynote in the Netherlands (post). The Dean’s Chat conversation about a “storied career” (post). The 2023 reflection on training in podiatric surgery (post). Each of those is, in reality, an award shared with everyone whose name appears in the bibliography that produced 95,006 citations. They are mine to accept on behalf of the team — nothing more.
Onward
The interesting question is not how we got to 95,006. It is what the next 5,000 will be about. REBOOT (the MIFMO RCT). The C2SHiP center. ALPS. DFCon26 in Los Angeles. The chatbot dosing protocol. The AnGes/Collategene work. The Bremen meeting next week. China later in May. A handful of grants in the queue. A handful of collaborators I have not met yet who will end up being central to the next decade.
To everyone whose hand has been on this work — including the readers of this blog, who have helped these papers find audiences they would not have found otherwise — thank you. The number is yours.
Now, back to it.
#ActAgainstAmputation #LimbPreservation #DiabeticFoot #TeamSport #Collaboration #ALPSLimb #DFCon #AmputationPrevention #WeirdIdeasWeirdPeople #Citations #Milestone #Research #ToeAndFlow #DFU #PAD @ALPSLimb @KeckSchool_USC @USC_Vascular @ResearchatUSC @USC #diabeticfootonline
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