Injury and repair in limb deformities associated with peripheral neuropathy: Visualization analyses of research trends and hotspots

Limb deformities have a close pathological link with peripheral nerve injuries; however, there is currently a lack of analysis and summary of research trends in this field aimed at elucidating the close relationship between limb deformities and peripheral nerve repair. Based on the Web of Science Core Collection database, this study retrieved 897 articles published between 2001 and 2025. A bibliometric analysis using CiteSpace and VOSviewer was therefore conducted to comprehensively map the research landscape, hotspots, and evolving trends in this field, revealing a sustained annual upward trend in research output. The University of Washington (UW, Seattle) was the institution with the most publications and the greatest impact. The Journal of Pediatric Orthopaedics was the journal with the most publications, while the Journal of Bone and Joint Surgery-American Volume was the journal with the greatest academic impact. Keyword analysis identified two major clusters of interest: diabetic peripheral neuropathy and foot deformities, involving studies on Charcot neuroarthropathy, diabetic foot ulcers, and amputation prevention; and birth-related brachial plexus palsy and its secondary shoulder and elbow deformities, focusing on functional reconstruction strategies such as tendon transfer and osteotomy. Burst keyword analysis revealed a clear shift in the research focus. From 2003 to 2013 (the early period), studies primarily focused on single-site functional impairments and conservative treatments (such as botulinum toxin). From 2014 to 2025 (the recent period), the focus shifted toward investigating “prevalence” and “risk factors,” as well as conducting in-depth studies on “reconstructive” surgery, diabetic foot ulcers, and molecular mutation mechanisms. Current research in this field focuses on the bidirectional relationship between “malformations” and “nerves,” exploring how nerve injuries cause malformations and investigating secondary nerve compression and damage following malformations. Peripheral neuropathies, such as diabetic peripheral neuropathy, Charcot-Marie-Tooth disease, and obstetric brachial plexus palsy, are the key direct or indirect causes of specific limb deformities (such as foot deformities, talipes, and forearm supination deformities). Research on the mechanical effects of deformities on nerves focuses on how skeletal deformities (such as elbow valgus/varus or knee valgus) result in or exacerbate nerve entrapment syndromes (such as ulnar nerve or common peroneal nerve injuries) through abnormal biomechanical mechanisms (such as excessive traction or dynamic compression). During surgeries for correcting complex deformities, the use of intraoperative nerve monitoring provides real-time early warning to avoid iatrogenic brachial plexus injuries and ensure patient safety, which has become a prominent technical focus. Previous studies have established the criteria for early monitoring of shoulder deformities and Mallet functional assessment following obstetric paralysis. Research over the past 5 years has focused on the mechanisms by which deformities exert mechanical effects on nerves, as well as the application of precision surgical techniques and intraoperative nerve monitoring. Surgical repair strategies for cubital tunnel syndrome and ulnar nerve palsy-induced claw hand are also among the key clinical areas of interest. Overall, these findings indicate that research on limb deformities associated with peripheral neuropathy and injury repair has evolved into two major research domains, focusing on nerve repair for deformities caused by diabetic peripheral neuropathy and limb deformities resulting from obstetric paralysis. Current research trends are moving toward precision, minimally invasive approaches, and multidimensional efficacy assessments. Future research should deepen the understanding of the “deformity-nerve” interaction mechanisms, focus on early warning systems, intraoperative nerve monitoring, and individualized functional reconstruction, and thereby improve patient outcomes and surgical safety.