What Is RRA?

What RRA Means on This Site

On this site, RRA stands for Reconstructive Rearfoot/Ankle Surgery. It is the advanced surgical credential offered by the American Board of Foot and Ankle Surgery (ABFAS) to podiatric surgeons who want board recognition for complex surgery of the hindfoot and ankle. If you have landed here searching for another credential that happens to share the same three letters, this is a different subject entirely, and nothing on this page applies to it.

Reconstructive rearfoot and ankle surgery covers the operations surgeons perform when conservative care has failed or when trauma, deformity, or degenerative disease has compromised the hindfoot and ankle: arthrodesis, ankle arthroplasty considerations, tendon and ligament reconstruction, deformity correction, and the management of complications that follow. The credential is designed to confirm that a surgeon can diagnose, plan, execute, and manage these cases at a board-recognized standard.

If you want terminology variations covered in more depth, our companion pages on what RRA stands for and RRA meaning walk through the vocabulary, and the broader RRA certification overview frames the credential as a whole.

Who Issues It and Who Qualifies

ABFAS is the issuing body. The RRA pathway is built on top of the Foot pathway, which creates a dependency chain that candidates sometimes overlook: Foot qualification is required for RRA qualification, and Foot certification is required for RRA certification. You do not pursue RRA in isolation.

Baseline requirements include:

• A DPM degree from a CPME-accredited four-year podiatric college
• At least three years of accredited residency, including required PMSR/RRA training and surgical documentation
• Unrestricted licensure
• Applicable surgical privileges

Certification is normally required within seven years of qualification, with exceptions for certain pre-2014 residency cohorts. Eligible passed final-year in-training examination components may be converted for a fee, which speeds the Part I process for some residents without changing what the credential covers. For a full walkthrough of eligibility details, see RRA requirements: eligibility, prerequisites and how to qualify.

The Three Components of the Pathway

RRA is not a single exam. The full pathway spans Part I and Part II, and the pieces test very different skills.

The distinction between the first two is worth internalizing early. The Didactic rewards recall and applied reasoning in a multiple-choice format. The CBPS (clinical and basic problem simulation) rewards stepwise clinical judgment under time pressure, where you move through history, exam, workup, diagnosis, and treatment decisions in simulated patient encounters. Candidates who prepare only for multiple-choice recall often feel exposed when the simulations begin.

Inside the RRA Didactic Blueprint

The RRA Didactic is organized into five official Topics, each with a target weight and an allowable range. These are the first five entries in the content outline, and they are the only domains that function as a weighted multiple-choice blueprint.

Because the exam is computer-adaptive, difficulty adjusts as you respond, and some items may be unscored field-test questions. No fixed split between scored and unscored items is published, so you should treat every item as if it counts. For a deeper breakdown, our complete guide to the RRA exam domains maps each topic to the skills it expects.

CBPS Case Management and Content Areas

The NEW RRA CBPS uses a different classification. Its structure splits into Case Management Areas, which carry official ranges, and overlapping Content Areas, which are unweighted.

The practical takeaway: in a CBPS simulation, a trauma case or a wound/infection case still requires you to perform well in physical examination, workup, diagnosis, and treatment. The Content Areas tell you what kinds of patients you will meet; the Case Management Areas tell you what skills are being scored. Full explanations live in our domains guide.

How RRA Case Review Works

Part II is where RRA diverges most sharply from a conventional exam. There is no timed sitting. Instead, your logged surgical cases are reviewed, and eight selected cases are evaluated through the PLS (Prospective Logging System).

For 2027 RRA Case Review, the rules are specific:

• At least 30 logged cases must contain an RRA-eligible procedure
• That total must include eight selectable RRA core-procedure cases from unique patients
• You should log all required post-residency surgeon-of-record cases, not just the minimum, because the selection process draws from your full log
• The issuer has an RRA-only logging exception for candidates who are already Foot-certified

Do not backdate the 2027 changes to Spring 2026; the updated case requirements apply to the 2027 cycle. The authoritative reference is the issuer's versioned certification information document for September 2026, used alongside the current eligibility and calendar pages. Older summaries and an unversioned copy of that document render conflicting content, so verify against the versioned source before you plan your logging.

Fees, Scoring, and Pass Rate Context

Fee Structure

Remember that prerequisite Foot examinations and their fees are additional. Our RRA certification cost breakdown shows how these line items combine across the full pathway.

Scoring

Each Part I component requires a scaled score of 500 on a 200-800 scale. This is not the same as answering 62.5% of questions correctly, and candidates should not try to convert the scaled score into a raw percentage. Because the Didactic is adaptive, the scaled score reflects both what you answered and the difficulty of the items you were served. See RRA passing score explained for more detail.

Historical Pass Rate Context

ABFAS publishes cumulative pass rates through Spring 2025. For the 2025 residency class, RRA Didactic stands at 54% (211 of 394) and CBPS at 89% (353 of 398). For the 2023 residency class, RRA Case Review stands at 79% (19 of 24). These are cumulative figures, not first-attempt rates and not 2026 rates, so interpret them cautiously. The contrast is still instructive: the Didactic is the component where candidates most often struggle. Our pass rate analysis and difficulty guide discuss what that gap means for preparation.

Exam-Day Rules That Affect Strategy

Part I is delivered by Pearson VUE in test centers. Two practical rules shape how you should prepare:

• Two valid matching IDs are required. A mismatch in name formatting can end your appointment before it begins, so check your IDs against your registration well ahead of time.
• No books or study materials are permitted in the testing room. Everything must be in your head.

On the Didactic specifically, completed computer-adaptive items cannot be revisited. That changes your pacing and your mindset. You cannot flag a question, skip ahead, and return with fresh eyes; each response is final. Practicing with that constraint, committing to an answer after careful reading rather than leaning on a second pass, is one of the most RRA-specific preparation habits you can build. Scheduling details and testing windows are covered in RRA exam dates and deadlines.

Official practice is login-gated, and paid or gated question banks were not reviewed for this article. If you want a way to simulate the pressure of committed answers, our RRA practice test is built around that discipline.

After Certification: Maintenance and Careers

Initial certification lasts ten years, but it is not a set-and-forget credential. Maintenance requires:

• Annual status fees
• Unrestricted licensure and surgical privileges
• A recent-surgery attestation
• 100 Category 1 and/or CPME-approved CME hours per five-year period
• Participation in LEAD

New time-limited cohorts complete at least 12 LEAD quarters in each five-year period and meet the applicable performance standard. RRA requires its own MDT standard but no participation quarters beyond those already required for Foot. Older cohorts follow transition schedules, which are detailed on the issuer's LEAD requirement pages.

As for who values the credential, the people most likely to care are surgical employers and referral networks: orthopedic and podiatric group practices, hospital-affiliated surgical departments, and credentialing committees that grant or restrict privileges for complex reconstruction. Specific compensation figures are not covered here; for earnings context see the RRA salary guide, for position types see RRA jobs, and for a cost-benefit view see whether RRA certification is worth it.

Sequencing Your Preparation Around the Blueprint

Generic study methods matter less than matching your time to this specific blueprint. A reasonable approach is to sequence preparation by dependency rather than by chapter order:

For a fuller plan, see the RRA study guide, and keep the RRA cheat sheet handy for last-pass review. Our practice questions let you test each block as you finish it.

Frequently Asked Questions