- Why There Are 19 "Domains" but Not One 19-Domain Exam
- Domains 1-5: The RRA Didactic Topics
- Domains 6-9: CBPS Case Management Areas
- Domains 10-19: Overlapping CBPS Content Areas
- Format, Scoring, and Exam-Day Rules
- Where Case Review Fits
- Fees and Eligibility Mechanics
- Sequencing Your Study by Domain
- Frequently Asked Questions
- Nineteen is a count of source headings, not one official blueprint; never add percentages across the three classifications.
- Domains 1-5 are RRA didactic Topics; Surgical Procedures/Techniques is the largest at a 25% target.
- RRA Didactic is 80 adaptive multiple-choice questions in 120 minutes; completed items cannot be revisited.
- Each Part I component needs a scaled score of 500 on a 200-800 scale, not 62.5% correct.
Why There Are 19 "Domains" but Not One 19-Domain Exam
Candidates searching for the RRA exam domains often expect a single tidy pie chart that adds up to 100%. For Reconstructive Rearfoot/Ankle Surgery (RRA), certified through the American Board of Foot and Ankle Surgery (ABFAS), that picture does not exist. The nineteen headings used on this page come from the serialized objective listing on the ABFAS Part I subject-areas page. They fall into three distinct classifications that serve different exam components.
Understanding that split is the single most useful framing step before you open a textbook. If you want the broader certification context first, see What Is RRA Certification? and What Does RRA Stand For?.
| Classification | Domains | Weighting | Component It Serves |
|---|---|---|---|
| Didactic Topics | 1-5 | Official target weights with allowable ranges | RRA Didactic |
| Case Management Areas | 6-9 | Official ranges | NEW RRA CBPS |
| Content Areas | 10-19 | Unweighted, overlapping | NEW RRA CBPS |
Domains 1-5: The RRA Didactic Topics
The first five domains are the Topics that structure the RRA Didactic examination. Each carries an official target weight and an allowable range, which matters because computer-adaptive delivery means your own exam will not necessarily mirror the target exactly.
| Domain | Topic | Target | Allowable Range |
|---|---|---|---|
| 1 | Diagnostic Studies/Medical Imaging | 15% | 10-20% |
| 2 | Surgical Principles | 20% | 15-25% |
| 3 | Surgical Procedures/Techniques | 25% | 20-30% |
| 4 | Procedural Perioperative Management | 20% | 15-25% |
| 5 | Complications | 20% | 15-25% |
Domain 1: Diagnostic Studies/Medical Imaging (15%)
The smallest didactic Topic, but one that bleeds into every case. Expect questions that require you to interpret imaging in the reconstructive rearfoot/ankle setting and choose the next appropriate study.
- Match the imaging modality to the clinical question (osseous detail versus soft-tissue pathology)
- Recognize radiographic findings that drive operative planning for rearfoot and ankle deformity
- Know what a study can and cannot rule out before committing to surgery
Domain 2: Surgical Principles (20%)
This is the foundation layer: the reasoning that sits underneath any specific procedure. Questions here reward understanding of why, not just how.
- Indications, contraindications, and patient selection for reconstructive surgery
- Fixation and fusion principles, bone and soft-tissue biology, and healing considerations
- Sequencing decisions when multiple rearfoot and ankle corrections are combined
Domain 3: Surgical Procedures/Techniques (25%)
The largest target weight on the didactic exam, with an allowable range of 20-30%. This is where procedural command is tested directly.
- Technique selection for rearfoot and ankle reconstruction, including fusion and realignment options
- Intraoperative steps, positioning, and approach considerations
- Procedure-specific pitfalls that separate a competent answer from a textbook-memorized one
Domain 4: Procedural Perioperative Management (20%)
Preoperative optimization, intraoperative management, and postoperative protocols tied to specific reconstructive procedures rather than generic surgical care.
- Risk assessment and optimization before elective reconstruction
- Postoperative immobilization, weightbearing, and rehabilitation decisions
- Anticoagulation, pain control, and monitoring in the context of rearfoot/ankle procedures
Domain 5: Complications (20%)
Recognition, prevention, and management. This Topic pairs naturally with Domain 3: for nearly every procedure you study, learn what goes wrong and how you respond.
- Nonunion, malunion, hardware problems, and wound complications
- Early versus late complication patterns and their management algorithms
- When a complication calls for observation, revision, or salvage
Because Domains 3 and 5 together command a large share of the didactic exam, studying procedures and their failure modes as paired units is efficient. For the difficulty implications, read How Hard Is the RRA Exam? Complete Difficulty Guide 2026.
Domains 6-9: CBPS Case Management Areas
Domains 6 through 9 belong to the NEW RRA CBPS, a separate component made up of clinical simulations rather than multiple-choice items. Here the structure is a patient-management sequence with official ranges instead of fixed targets.
| Domain | Case Management Area | Official Range |
|---|---|---|
| 6 | Physical Examination | 20-40% |
| 7 | Diagnostic procedures/labs/imaging | 15-35% |
| 8 | Diagnosis | 10-30% |
| 9 | Treatment | 15-35% |
The wide ranges, particularly the 20-40% allowance for Physical Examination, mean that individual candidates will see different emphasis. Prepare for a heavy examination component without assuming any single area is negligible.
Domains 10-19: Overlapping CBPS Content Areas
The final ten domains are CBPS Content Areas. They are unweighted and overlapping: a single simulation can draw on several at once, and no percentage is assigned to any of them. Think of them as the clinical subject matter that the case management areas operate on.
Domain 10: Complications/Revision
Managing failed or problematic prior surgery, including the decision between conservative management and revision.
Domains 11 and 12: Congenital Disorders (Pediatrics and Adult)
Two separate content areas. Pediatric presentations and adult presentations of congenital pathology demand different management reasoning, so study them as distinct bodies of knowledge rather than one topic.
Domain 13: Deformities
Acquired and developmental rearfoot and ankle deformity: assessment, classification, and reconstructive planning.
Domain 14: Perioperative Management
The CBPS counterpart to the didactic perioperative Topic, applied inside a clinical simulation rather than answered as a standalone question.
Domain 15: Neoplastic Disorders
Recognition and appropriate workup of bone and soft-tissue lesions in the rearfoot and ankle, including when to refer or change course.
Domain 16: Neurovascular Disorders
Nerve and vascular conditions that affect diagnosis, surgical risk, and healing potential.
Domain 17: Trauma
Acute and post-traumatic rearfoot and ankle injury, including reconstructive sequelae.
Domain 18: Wound/Infection
Wound healing problems and infection management, which frequently intersect with reconstruction planning and complications.
Domain 19: Metabolic, Rheumatologic, and Inflammatory Disorders
Systemic disease that alters presentation, surgical candidacy, and outcomes. Expect these to appear as modifiers inside cases about other conditions.
Because these areas overlap, a trauma case may require wound management, perioperative judgment, and awareness of a metabolic comorbidity all at once. For a condensed review of the facts that recur across areas, see the RRA Cheat Sheet 2026: One-Page Review of Must-Know Facts.
Format, Scoring, and Exam-Day Rules
The two Part I components differ sharply in structure, and your domain preparation should reflect that.
| Feature | RRA Didactic | NEW RRA CBPS |
|---|---|---|
| Format | 80 computer-adaptive multiple-choice questions | 12 clinical simulations |
| Time | 120 minutes | 15 minutes each, 180 minutes total |
| Delivery | Pearson VUE test center | Pearson VUE test center |
| Domains covered | 1-5 | 6-19 |
| Passing standard | Scaled score of 500 on 200-800 | Scaled score of 500 on 200-800 |
The passing line is a scaled score of 500 on a 200-800 scale for each Part I component. It is not a raw 62.5% correct, so do not convert it into a percentage target. Details are in RRA Passing Score 2026: Exactly What You Need to Pass.
On exam day, Part I requires two valid matching IDs and prohibits books or study materials in the testing room. Historical cumulative data through Spring 2025 show a 54% pass rate (211/394) for 2025-residency-class RRA Didactic and 89% (353/398) for that class's CBPS. These are cumulative figures, not first-attempt or 2026 rates, and are discussed further in RRA Pass Rate 2026: What the Data Shows. The gap between the two components is a reminder that the multiple-choice didactic exam deserves particular respect.
Where Case Review Fits
The RRA pathway does not end with Part I. Part II RRA Case Review evaluates eight selected surgical cases through PLS, and candidates do not attend a timed examination sitting. It is a record-based evaluation of your own surgical work, so the domain knowledge above shows up as the quality of your operative reasoning and documentation.
- For the 2027 RRA Case Review, at least 30 logged cases must contain an RRA-eligible procedure.
- Within those, eight selectable RRA core-procedure cases must come from unique patients.
- Log all required post-residency surgeon-of-record cases, not just the minimum.
- The issuer has an RRA-only logging exception for candidates already Foot-certified.
Historical cumulative data show a 79% pass rate (19/24) for 2023-residency-class RRA Case Review, again not a first-attempt or 2026 figure. Do not backdate the 2027 changes to Spring 2026. The authoritative requirements are in the versioned September 2026 certification document, used alongside the current eligibility and calendar pages. For scheduling, see RRA Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
Fees and Eligibility Mechanics
Knowing the domains is only useful if you can sit for the exam. The mechanics are worth understanding up front.
| Item | Amount |
|---|---|
| Application (once per examination calendar year, nonrefundable) | $225 |
| RRA Didactic | $475 |
| NEW RRA CBPS | $475 |
| RRA Case Review | $550 |
| Annual status fee, Board Qualified | $205 |
| Annual status fee, Board Certified | $440 |
Prerequisite Foot examinations and their associated fees are additional. A complete breakdown lives in RRA Certification Cost 2026: Complete Pricing Breakdown.
Requirements include a DPM from a CPME-accredited four-year podiatric college, at least three years of accredited residency with required PMSR/RRA training and surgical documentation, unrestricted licensure, and applicable surgical privileges. Foot qualification is required for RRA qualification, and Foot certification is required for RRA certification. Certification is normally required within seven years of qualification, with pre-2014 residency exceptions. See RRA Requirements 2026: Eligibility, Prerequisites & How to Qualify for the full path.
Key Takeaway
Initial certification lasts ten years. Maintenance includes annual fees, unrestricted licensure, privileges, recent-surgery attestation, 100 Category 1 and/or CPME-approved CME hours per five-year period, and LEAD. Newer cohorts complete at least 12 LEAD quarters per five-year period. Older cohorts follow transition schedules, so confirm your own cohort's rules.
Sequencing Your Study by Domain
Rather than a generic calendar, order your preparation around how the domains depend on one another. A sample progression for the didactic component:
Foundations: Domains 1 and 2
- Imaging interpretation and surgical principles underpin every later topic, so settle them first
- Build the vocabulary of indications, fixation, and healing
Core Volume: Domain 3 paired with Domain 5
- Study each procedure alongside its characteristic complications
- This is the highest-weighted ground, so give it the most hours
Management: Domain 4
- Layer perioperative decision-making onto the procedures you already know
CBPS Practice: Domains 6-19
- Rehearse the examine-image-diagnose-treat chain on cases drawn from the content areas
- Deliberately mix areas, since real simulations overlap them
Official practice is login-gated, and paid or gated questions were not retrieved for this article, so supplement with independent practice. You can try questions at the RRA practice test site and build a fuller plan using the RRA Study Guide 2026: How to Pass on Your First Attempt. For the full range of domain-by-domain practice, return to the main practice test.
Frequently Asked Questions
No. Nineteen is the number of serialized source headings. They split into didactic Topics (1-5), CBPS Case Management Areas (6-9), and overlapping unweighted CBPS Content Areas (10-19). Percentages should not be added across these groups.
Surgical Procedures/Techniques (Domain 3) has the largest target weight at 25%, with an allowable range of 20-30%.
RRA Didactic has 80 computer-adaptive multiple-choice questions in 120 minutes. Some items may be unscored field-test questions, with no fixed split assigned, and completed items cannot be revisited.
A scaled score of 500 on a 200-800 scale is required for each Part I component. It does not correspond to 62.5% of questions correct.
Case Review is separate from Part I. It evaluates eight selected surgical cases through PLS with no timed sitting, so the domain knowledge is reflected in your operative reasoning and documentation. Read more in RRA Training and Is the RRA Certification Worth It? Complete ROI Analysis 2026.