The 100 Most Impactful Articles in Foot and Ankle Surgery: An Altmetric Analysis

Research Type: Level 4 – Case series Introduction/Purpose: Citation count (CC) and impact factor of the publishing journal are two historically utilized metrics to determine an article’s impact in its research field. However, these metrics are limited given the rise in research dissemination through social media. Across other orthopedic specialties, the Altmetric Attention Score (AAS) has been used to determine which articles are most impactful. Methods: The Altmetric Explorer database (Digital Science; Holtzbrinck Publishing, Stuttgart, Germany) was queried for articles relating to foot and ankle surgery on a single day in September 2024. Search terms were selected and only articles after 2010 were included. Abstracts were stratified by AAS score in descending order, and the top articles were reviewed by four investigators.Of the 4262 articles that were retrieved, the top 100 articles based on the highest AAS that pertained to foot and ankle surgery were analyzed for secondary bibliometric factors including journal, journal impact factor, the highest degree of the first author, number of authors, number of institutional affiliations, level of evidence, conflict of interest presence, open access status, study design, study subject, and number of referenced studies. Results: Ultimately, 3713 articles were identified and the top 100 articles pertaining to foot and ankle surgery were analyzed. The median (IQR) AAS was 18.0 (14, 42.5). All articles came from one of 18 journals, with 75% of articles coming from The Journal of Foot and Ankle Surgery (JFAS) (N=45) and Foot and Ankle Surgery (FAS) (N=30) (Table 2). The Level of Evidence (LOE) assigned to the articles was generally evenly distributed with 13 Level I articles, 16 Level II, 23 Level III, 28 Level IV, and 20 Level V. The most common types of articles were were original clinical research articles (N=54), systematic review/meta-analysis (N=17), and review articles (N=16). Among the top 100 articles, correlations were assessed between article characteristics and AAS (Table 1). Conclusion: In the present study’s evaluation of the top 100 most influential foot and ankle research articles published after 2010, it was determined that CC does not correlate with the AAS. Mentions on news platforms and Facebook were predictive of a higher AAS composite. Within the foot and ankle community, LOE, study subject, and study type should not be utilized as predictors of influence. Future studies evaluating research impact with the AAS should focus on the lack of high-impact articles in high-impact journals and the long-term impact of AAS on an article’s viewership. From the top 100 articles, there were a total of 7966 Mendeley readers (median 36), 3690 referenced studies (median 31), 2716 citations (median 15.5), 2036 X mentions (median 13), 446 news mentions (median 1), 156 Facebook mentions (median 0), 30 blog mentions (median 0), 14 patent mentions (median 0), eight policy mentions (median 0), and seven Google+ mentions (median 0) (Table 5).