Global Research Trends and Healthcare Innovations in Plantar Pressure Management for Diabetic Foot Ulcers: A 25-Year Bibliometric and Visual Analysis
Summary: Published March 19, 2026 in Healthcare (MDPI), this comprehensive bibliometric and visual analysis from Capital Medical University Affiliated Beijing Shijitan Hospital (China), led by Dehua Wei, Boya Li, Jiangning Wang, and Lei Gao (Orthopedic Department), maps the global landscape of plantar pressure research in the context of diabetic foot ulcers across 2000–2024. Using Web of Science Core Collection data (2,110 articles after screening from 2,518 initial records), and analysis tools including VOSviewer, CiteSpace, and Scimago Graphica, the study provides the first dedicated bibliometric synthesis of this specific subdomain. Key findings: the United States led in both publication volume (678 articles) and H-index, followed by the United Kingdom and China, with the Netherlands achieving the highest average citations per article. David G. Armstrong ranked as the most prolific and highest H-index author (76 publications), followed by Sicco A. Bus (52) and Lawrence A. Lavery (40). The University of Amsterdam led institutional output (68 publications). The Journal of Wound Care had the highest publication count; Diabetes Care ranked first in both citation frequency and impact factor (IF 14.8). Keyword co-occurrence analysis identified 12 major clusters spanning: diabetic foot pathophysiology and amputation risk, microcirculation and vascular management, evidence-based management and guidelines, ischemia and regenerative repair, biomechanical risk factors, foot biomechanics and modeling, prevention and offloading interventions, NPWT and therapeutic technology, wound nursing and efficacy evaluation, chronic wounds and biofilm, ulcer classification and regenerative medicine, and population-level epidemiology. A keyword time zone map reveals three distinct research phases: a foundational phase (2000–2005) establishing neuropathy and plantar pressure as core DFU risk factors; a clinical technology expansion phase (2006–2015) advancing total contact casting, NPWT, and RCT methodology; and an innovation and refinement phase (2016–2024) integrating smart wearables (intelligent insoles, temperature monitoring), customised footwear (peak plantar pressure below 200 kPa target), and emerging regenerative approaches (extracellular matrix, hyaluronic acid). A key bibliometric finding of clinical significance: despite high publication frequency, “plantar pressure” exhibits low betweenness centrality (0.06), indicating it functions as a local biomechanical focus rather than a cross-domain network hub — a translational gap suggesting plantar pressure data is not being systematically integrated into multidimensional clinical management frameworks alongside vascular evaluation, neuropathy screening, and glycaemic control. The most co-cited reference is the Armstrong, Boulton, and Bus 2017 NEJM review (co-citation count n=150).
Key Highlights:
- 25-year dataset: 2,110 articles (WoS, 2000–2024); sustained growth from ~50 publications/year (2000) toward 150+/year (2024); US, UK, and Netherlands as dominant contributors; China and India showing rapid recent acceleration
- Key opinion leaders: David G. Armstrong (76 publications, highest H-index), Sicco A. Bus (52), Lawrence A. Lavery (40), Andrew J.M. Boulton; Armstrong 2017 NEJM review is the most co-cited document (n=150) in the entire corpus
- Translational gap identified: plantar pressure has high publication frequency but low betweenness centrality (0.06) in the co-occurrence network — meaning it functions as a local biomechanics topic rather than bridging to broader clinical outcome, vascular, or care-coordination frameworks; the authors call for integration of pressure data with comprehensive risk stratification tools
- Offloading evidence: total contact casting remains gold standard for healing neuropathic plantar DFUs; custom diabetic footwear reduces 18-month recurrence by ~50%; Achilles tendon lengthening reduces forefoot ulcer recurrence by 75% in selected cases; peak in-shoe pressure target of <200 kPa for recurrence prevention
- Smart technology trends (2016–2024 burst terms): custom-made footwear (burst 2019–2020), wound care (burst 2021–2024), epidemiology (burst 2022–2024); emerging: continuous plantar temperature monitoring, intelligent insole pressure feedback systems, remote monitoring platforms — all gaining publication volume but still limited by patient acceptance, alert fatigue, and adherence barriers
- Global health equity gap: US and European institutions lead publication output and establish most guidelines; China and India are rapidly expanding contributions; but access to smart insoles, custom footwear, and multidisciplinary foot teams remains inequitable globally — the authors call for locally adaptable, cost-effective offloading solutions
Keywords: plantar pressure diabetic foot, diabetic foot offloading, DFU bibliometric analysis, smart insole wound care, total contact casting DFU, foot biomechanics ulcer prevention
Dehua Wei, Boya Li, Jiangning Wang, Lei Gao