Worldwide productivity in the field of foot and ankle research from 2009–2013: a bibliometric analysis of highly cited journals

Foot and ankle research has recently experienced a considerable evolution, which can be attributed to the contributions by researchers and surgeons from all over the world. To assess the research contributions around the world, biomedical research publication has been used as an index for scientific research productivity [2-7]. Recently, many studies using bibliometric methods have evaluated worldwide research productivity in several biomedical fields [2-7]. However, as far as we know, this study is the first bibliometric evaluation on worldwide productivity in the field of foot and ankle research.

The present study found that the authors originating from the United States published far more articles than any other country. It is no surprise that the United States leads the rankings, which also had been found in many fields of medicine [2-7]. Therefore this result confirms the major influence of the United States in the field of foot and ankle research.

Besides the most number of articles, the United States also had the highest total citation. Most importantly, the United States also had high mean citations, which suggested that publications originating from the United States had not only large quantity but also high quality. Based on these large number of high-quality studies, policy makers and healthcare practitioners could inform successful interventions and may further improve clinical practice [11]. Although the United States has a large population, the per capita numbers of articles from the United States remained one of the most numbers per capita. These results suggest that the United States is the most productive country in the field of foot and ankle research in the world.

Regarding the contributions of different countries, a “10/90” divide was used to described the proportion between non-high and high income countries [12], which had been demonstrated in some medical fields [3-5,7]. It also holds true for the field of foot and ankle research. Only three non-high income countries, including China, Turkey and India, are listed in the main productive countries. The increasing importance of these countries has been shown in previous studies [3,4,13,14]. Moreover, our results demonstrate that GDP is also a positive factor related to research productivity besides population size [6]. The high research productivity can be a suggestive reflection of the rapid development of society and economy in these middle income countries [3,4]. It may be forecasted that these countries with rapid economic development could further improve their foot and ankle research and promote their ranks in the future. The lack of research productivity in low income countries was observed in this study for only three articles identified. This may be affected by a combination of factors, such as government policy, medical infrastructures, research fund and researchers [4,12]. This result indicates the underrepresentation of non-high income countries in publications of foot and ankle research, despite these countries have the largest burden of musculoskeletal disease [11]. In these countries, establishing strategies to increase the number of high-quality researches may improve the evidence-based health policies and patient care [11].

When the total number of articles adjusted by population and GDP, Australia, some European countries such as the United Kingdom and Switzerland, and Asian countries such as South Korea are more productive. Although it may make more sense to normalize by the number of researchers and GDP invested in foot and ankle research in each country, not the population size and total GDP, it is rather difficult to obtain these data in the field of foot and ankle research in each country. Nonetheless, this result demonstrates the high scientific research output of these smaller countries.

The United States was the most productive country in 3 journals, including FAI, JFAS and FAC. It should be recognized that these journals are all published in the United States. More submissions might therefore be from the United States than from other countries. In addition, the United States and the United Kingdom appears in the top 3 countries in all the 4 journals, indicating the important influence of these two countries in the field of foot and ankle research.

Besides the most number of articles in 4 of the top 5 countries, FAI published the largest number of foot and ankle research worldwide, which indicated the importance of FAI in the body of foot and ankle publications [15].

There are some limitations in this study. Although the journals were selected from the orthopedics category of the JCR, some general orthopedics and basic research journals, which also published some articles related to foot and ankle research, were not included in this study. In addition, citations are only one measure of research impact, and may not reflect the influence of each article. Finally, 3 of the 4 journals included in our study (FAI, JFAS and FAC) have a strong surgical focus, so our findings may not translate to research into conservative interventions for foot and ankle disorders.