Fiber-optic sensing (FOS) technology has emerged as a cutting-edge research focus in the sensor field due to its miniaturized structure, high sensitivity, and remarkable electromagnetic interference immunity. Compared with conventional sensing technologies, FOS demonstrates superior capabilities in distributed detection and multi-parameter multiplexing, thereby accelerating its applications across biomedical, industrial, and aerospace fields. This paper conducts a systematic analysis of the sensing mechanisms in fiber-optic pressure sensors, with a particular focus on the performance optimization effects of fiber structures and materials, while elucidating their application characteristics in different sensing scenarios. This review further examines current manufacturing technologies for fiber-optic pressure sensors, covering key processes including fiber processing and packaging. Regarding practical applications, the multifunctional characteristics of fiber-optic pressure sensors are thoroughly investigated in various fields, including biomedical monitoring, industrial and energy monitoring, and wearable devices, as well as aerospace monitoring. Furthermore, current challenges are discussed regarding performance degradation in extreme environments and multi-parameter cross-sensitivity issues, while future research directions are proposed, encompassing the integration and exploration of novel structures and materials. By synthesizing recent advancements and development trends, this review serves as a critical reference bridging the gap between research and practical applications, accelerating the advancement of fiber-optic pressure sensors.