Twenty Five–Year Publication Trends in Foot and Ankle Literature: Improved Methodological Quality and Internationality With Time

BACKGROUND: Methodological quality and author internationality are increasing in orthopaedic surgery. The purpose of this study was to evaluate the methodological quality and author geography trends from 1994 to 2019 in high-quality foot and ankle journals. METHODS: Analyses of 1,242 foot and ankle publications in Foot and Ankle International, American Journal of Bone and Joint Surgery, and American Journal of Sports Medicine were done for 1994, 1999, 2004, 2009, 2014, and 2019. Articles were classified according to study type, level of evidence (LOE), and author's country of publication. RESULTS: The most common clinical study was therapeutic (65.4). Significant increases were noted in the proportion of therapeutic (P < 0.01) and prognostic (P < 0.01) articles. The average LOE increased from 3.96 ± 1.01 to 3.19 ± 0.97 (P < 0.01). The proportion of Level I (P = 0.29) and level IV articles (P = 0.21) remained constant, level II (P < 0.01) and level III (P < 0.01) articles increased, and level V (P < 0.01) articles decreased. United States authorship decreased from 78.1% in 1994 to 44.8% in 2009, then remained constant through 2019 (P < 0.01). CONCLUSION: This study demonstrated an improvement in LOE of foot and ankle publications across a 25-year period in three high-quality orthopaedic journals. Increasing internationality was also observed.