What Is A RRA?

What "RRA" Means Here

If you searched "What is a RRA?" you may have landed on several unrelated credentials, because the acronym is shared across fields. On this site, RRA means one thing only: Reconstructive Rearfoot/Ankle Surgery. It is the advanced-scope certification pathway for podiatric surgeons who operate on the rearfoot and ankle, issued through the American Board of Foot and Ankle Surgery (ABFAS).

That distinction matters for everything that follows: the exam you sit, the fees you pay, the case logs you keep, and the employers who care about the credential. Other articles on this site cover narrower questions in more depth, including the full expansion of the acronym and the certification itself. This article is the orientation map: what the RRA is, how the pieces fit together, and what you should do first.

Who Issues It and Who Qualifies

The certifying body is the American Board of Foot and Ankle Surgery. ABFAS publishes the content outline, runs the examinations, administers Case Review, and sets the maintenance rules. If a fact about the RRA is not on an ABFAS page or in an ABFAS handbook, treat it with suspicion.

The baseline requirements are straightforward to state, though each carries documentation work:

• A DPM degree from a CPME-accredited four-year podiatric college.
• At least three years of accredited residency, including the required PMSR/RRA training and surgical documentation.
• Unrestricted licensure and applicable surgical privileges.
• Foot qualification, which is required for RRA qualification. Foot certification is then required for RRA certification.

That last point surprises many residents. The RRA is not a standalone credential you can pursue in isolation; it layers on top of Foot. The prerequisite Foot examinations and their fees are additional to the RRA costs described later. For the complete eligibility walkthrough, see RRA Requirements 2026: Eligibility, Prerequisites & How to Qualify.

One practical nuance: eligible passed final-year in-training examination components may be converted for a fee. That is a mechanism for converting past performance, and it does not change what the RRA covers.

The Three-Part Pathway: Didactic, CBPS, and Case Review

The RRA pathway is not a single exam. It has two Part I components and one Part II component, and each is evaluated differently.

The Didactic tests recall and judgment across five weighted topics. The CBPS tests whether you can manage a clinical scenario through simulation, which is a different cognitive task from answering a stem and choosing an option. Case Review then evaluates your actual operative work, drawn from the cases you logged as surgeon of record. Candidates do not attend a timed sitting for Case Review; the evidence is the quality and documentation of your cases.

Many candidates over-focus on the Didactic because it is the most familiar format. The CBPS and Case Review reward a different kind of preparation, so budget time for each.

What the Exam Actually Covers

ABFAS publishes its objectives through the Part I Board Qualification Exam Content page. The source material lists nineteen headings, but that number is the count of serialized source headings, not a single official 19-domain blueprint. The headings fall into three different classifications, and mixing them is the most common way candidates misread the outline. Percentages must not be added across the classifications. For the heading-by-heading breakdown, see RRA Exam Domains 2026: Complete Guide to All 19 Content Areas.

Domains 1-5: RRA Didactic Topics with target weights

These are the weighted topics for the multiple-choice exam. Each has a target weight and an allowable range: Diagnostic Studies/Medical Imaging (10-20%), Surgical Principles (15-25%), Surgical Procedures/Techniques (20-30%), Procedural Perioperative Management (15-25%), and Complications (15-25%).

Domain 1, Diagnostic Studies/Medical Imaging, carries a 15% target. Imaging interpretation is the kind of material that rewards repeated exposure to cases.

Domains 6-9: CBPS Case Management Areas

These are separate from the Didactic topics. They describe how the clinical simulations are organized, with official ranges: Physical Examination (20-40%), Diagnostic procedures/labs/imaging (15-35%), Diagnosis (10-30%), and Treatment (15-35%). Notice that Physical Examination has the widest and highest range, a signal that the simulations care about how you gather information, not only what you decide at the end.

Domains 10-19: overlapping, unweighted CBPS Content Areas

The remaining ten headings are content areas without official weights: Complications/Revision, Congenital disorders (pediatrics), Congenital disorders (adult), Deformities, Perioperative management, Neoplastic disorders, Neurovascular disorders, Trauma, Wound/Infection, and Metabolic, rheumatologic, and inflammatory disorders. They overlap with each other and with the case management areas, so a single simulation can touch several at once. Treat them as the clinical territory your simulations will draw from, not as a checklist of equal slices.

Format, Scoring, and Exam-Day Rules

The Didactic is adaptive

RRA Didactic is computer-adaptive: 80 multiple-choice questions in 120 minutes. Some questions may be unscored field-test items, but no fixed scored/unscored split is assigned, so you cannot figure out which items count. Treat every question as if it does. Critically, completed items cannot be revisited. There is no flagging and returning at the end, which changes your pacing strategy entirely. You commit to each answer and move on.

Scoring is scaled, not percent-correct

Each Part I component requires a scaled score of 500 on a 200-800 scale. That is not the same as 62.5% correct, and you should not convert it that way. The scale accounts for the adaptive nature of the exam and the difficulty of the items you actually received. For a deeper explanation, read RRA Passing Score 2026: Exactly What You Need to Pass.

Test-center rules

Part I is delivered by Pearson VUE in test centers. Bring two valid matching IDs. Books and study materials are prohibited in the testing room. Confirm the ID requirement well before your appointment, since a mismatch can derail an exam you have prepared months for.

Fees and Registration Mechanics

The published fee structure is layered, and the layers matter for budgeting:

Remember that prerequisite Foot examinations and their associated fees are additional to these amounts. A candidate budgeting only for the RRA line items will undercount the true cost of the full journey. The complete pricing picture is in RRA Certification Cost 2026: Complete Pricing Breakdown, and the scheduling side is covered in RRA Exam Dates 2026: Testing Windows, Deadlines & Scheduling.

A note on document currency: the Part I handbook currently linked by ABFAS is titled Board Qualification for Fall 2025 Examinations. It is not a verified 2026 calendar. Always confirm the live eligibility and calendar pages rather than relying on a handbook title.

Case Review and the 2027 Logging Rules

Case Review is where many candidates encounter the most administrative friction. The current authority is the ABFAS document Information and Requirements For Board Certification, September 2026, For 2027 Case Review. Use the versioned document with the current eligibility and calendar pages; an unversioned copy of the same file has produced conflicting content, with a rendered older version differing from the extracted text.

For 2027 RRA Case Review:

• At least 30 logged cases must contain an RRA-eligible procedure.
• Within those, eight selectable RRA core-procedure cases from unique patients must be available. Those are the cases evaluated through PLS.
• Log all required post-residency surgeon-of-record cases, not merely the minimum. Selective logging weakens your ability to choose your strongest eight.
• The issuer provides an RRA-only logging exception for candidates who are already Foot-certified.

The practical lesson: start logging early and log completely. A candidate who reaches the eligibility window with thin documentation has few options. A candidate with a rich log has the freedom to pick the eight cases that best demonstrate sound indications, technique, and follow-through.

After You Certify: Maintenance and LEAD

Initial RRA certification lasts ten years, and maintenance runs continuously inside that period. Requirements include:

• Annual fees ($205 Board Qualified or $440 Board Certified, as listed above).
• Unrestricted licensure and applicable privileges.
• An attestation of recent surgery.
• 100 Category 1 and/or CPME-approved CME hours per five-year period.
• LEAD participation.

For new time-limited cohorts, LEAD means at least 12 quarters in each five-year period and meeting the applicable performance standard. RRA requires its own MDT standard but no participation quarters beyond those required for Foot. Older cohorts follow transition schedules, so a diplomate certified under earlier rules should check the LEAD requirement pages rather than assuming the new-cohort numbers apply. Certification is also normally required within seven years of qualification, with exceptions for certain pre-2014 residency cohorts.

Whether all of this effort pays off professionally is a fair question. Our analyses of whether the RRA certification is worth it and the RRA salary picture take that up directly. Qualitatively, the credential signals advanced reconstructive competence to employers who staff foot and ankle surgical practices, hospital-based programs, and groups that handle complex rearfoot and ankle cases.

What the Historical Pass Data Does and Doesn't Say

ABFAS publishes cumulative historical pass rates through Spring 2025:

Read these carefully. They are cumulative figures for specific residency classes. They are not first-attempt rates, and they are not 2026 rates. The gap between the Didactic and CBPS figures is striking, and it suggests the multiple-choice component is where candidates struggle most. But resist drawing precise conclusions from a single cohort snapshot. For more context, see RRA Pass Rate 2026: What the Data Shows and How Hard Is the RRA Exam?

Sequencing Your Preparation Around RRA Domains

Generic study advice is easy to find, so here is only what is specific to this exam: how to order the material. Because Surgical Procedures/Techniques is the largest Didactic topic and the others share roughly equal weight, a sensible sequence builds foundations first, then technique, then the topics that test your judgment when things go wrong.

Official practice material on the ABFAS site is login-gated, so supplement it with a dedicated question bank and a structured plan. Our RRA study guide lays out a fuller schedule, the RRA cheat sheet condenses the facts worth memorizing, and you can test yourself under timed conditions on the main practice test site.

Frequently Asked Questions

Understanding what the RRA is, and how its three parts, its fee layers, and its logging rules fit together, is the first real step toward earning it. For related orientation, see What Is RRA? and RRA Meaning, then move on to the requirements and domain guides above when you are ready to plan.