What Is RRA Certification?

What RRA Certification Actually Is

RRA certification is the board credential for Reconstructive Rearfoot/Ankle Surgery, issued by the American Board of Foot and Ankle Surgery (ABFAS). It documents that a podiatric surgeon has demonstrated advanced competence in operating on the rearfoot and ankle, including the complex reconstructive procedures, complication management, and perioperative decision-making that define this scope of practice.

It is not a general allied-health credential, and it should not be confused with any other certification that happens to share the same three letters. Everything on this page concerns the ABFAS Reconstructive Rearfoot/Ankle Surgery pathway only. If you are looking for a broader orientation to the acronym itself, our explainers on what RRA stands for and RRA meaning cover the terminology, while this article focuses on how the certification works in practice.

The credential sits on top of Foot certification. In ABFAS terms, you cannot become RRA-qualified without Foot qualification, and you cannot become RRA-certified without Foot certification. That sequencing shapes nearly every planning decision a resident or early-career surgeon makes.

The Two-Part Pathway: Part I and Part II

The structure is easiest to hold in your head as two stages, with Part I containing two separate components.

Passing Part I earns Board Qualified status. Completing Part II, once the Foot requirements are also met, leads to Board Certified status. Certification is normally required within seven years of qualification, with exceptions for certain pre-2014 residency cohorts, so the clock matters.

For a candidate-level view of eligibility mechanics, see our dedicated guide to RRA requirements and how to qualify.

Who Can Pursue It

The issuer's requirements are specific. A candidate needs:

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

Prerequisite Foot examinations and their fees are additional to the RRA costs, which catches some candidates off guard when budgeting. Eligible passed final-year in-training examination components may be converted for a fee, but this does not change the scope of the RRA credential itself.

Practical note for current residents: the documentation you log during residency is not paperwork to defer. It underpins both your Part I eligibility and the case pool you will later draw from for Case Review.

Inside the RRA Didactic Exam

The RRA Didactic is delivered at Pearson VUE test centers and consists of 80 computer-adaptive multiple-choice questions in 120 minutes. A few details deserve attention:

• Adaptive delivery: Question selection responds to your performance as you go.
• No revisiting: Completed CAT items cannot be revisited. You commit to an answer and move forward, so pacing and decisiveness are part of the skill being tested.
• Possible field-test items: Some questions may be unscored field-test items, but the issuer does not assign a fixed scored/unscored split. Treat every item as if it counts.
• Test-day rules: Two valid matching IDs are required, and books or study materials are prohibited in the testing room.

Because you cannot flag and return, the exam rewards candidates who can recognize a clinical pattern and commit. That is a different skill from slowly working through a question bank with your notes open. Our breakdown of how hard the RRA exam is discusses where candidates tend to struggle.

The NEW RRA CBPS Simulations

Alongside the Didactic, Part I includes the NEW RRA CBPS: 12 clinical simulations at 15 minutes each, for 180 minutes in total. This is a separate component with its own fee and its own scaled-score requirement. Where the Didactic tests knowledge recall and application through multiple-choice items, the simulations test how you manage a patient case from presentation through decision-making.

The CBPS framework is organized differently from the Didactic. It uses Case Management Areas (Physical Examination, Diagnostic procedures/labs/imaging, Diagnosis, and Treatment) with ranges, plus overlapping Content Areas covering topics such as complications and revision, congenital disorders, deformities, neoplastic disorders, neurovascular disorders, trauma, wound and infection, and metabolic, rheumatologic, and inflammatory disorders. We map these out in the domains section below.

Do not import lengths or structures from legacy CBPS formats you may have heard about from colleagues. The current NEW RRA CBPS is the 12-simulation, 15-minutes-each design described here.

Part II: RRA Case Review

Case Review is not a timed exam. You do not sit in a room; instead, eight selected surgical cases are evaluated through PLS. What makes this stage demanding is the preparation that precedes it: the logging.

For 2027 RRA Case Review, the issuer requires that at least 30 logged cases contain an RRA-eligible procedure, including eight selectable RRA core-procedure cases from unique patients. Several practical points follow:

1. Log everything required. Log all required post-residency surgeon-of-record cases, not just the minimum. Selection quality depends on a deep pool.
2. Unique patients matter. The eight core-procedure cases must come from different patients, so a single complex patient with many procedures does not satisfy the requirement.
3. An exception exists. The issuer has an RRA-only logging exception for candidates who are already Foot-certified.
4. Do not backdate. The 2027 changes should not be assumed to apply to Spring 2026.

For the current governing document, use the issuer's September 2026 Information and Requirements for Board Certification (for 2027 Case Review) alongside the current eligibility and calendar pages. Older summaries and stale renderings of the document can show conflicting content, so verify against the versioned source. See our guide to RRA exam dates and scheduling for how the calendar fits together.

How Scoring Works

Each Part I component requires a scaled score of 500 on a 200-800 scale. This is explicitly not a 62.5% correct threshold, and you should not try to convert raw percentages into a pass or fail estimate. Adaptive delivery and scaling mean the relationship between items answered correctly and your reported score is not a simple fraction.

Our dedicated page on the RRA passing score goes deeper on interpretation.

What the historical pass data says

The issuer publishes cumulative historical pass rates through Spring 2025. They are useful for context but come with real caveats:

These are not first-attempt rates and not 2026 rates. They are cumulative figures for specific residency classes, which means repeat attempts are folded in. The Didactic figure is notably lower than the CBPS figure, which tells you where candidates have historically found the most friction. For a fuller discussion, see what the RRA pass rate data shows.

Fees and Registration Mechanics

The fee structure from the issuer breaks down as follows:

Remember that prerequisite Foot examinations and their associated fees are additional. The application fee applies once per examination calendar year, so planning your Didactic and CBPS in the same calendar year can avoid paying it twice. For the full budgeting picture, including how these costs stack, read our RRA certification cost breakdown.

Content Areas and Weights

This is the section where many candidates and many third-party sites get confused, so precision matters. The nineteen items you may see listed are the number of serialized source headings, not a single official 19-domain exam blueprint. They fall into three different classifications, and their percentages must never be added together across classifications.

Domains 1-5: RRA Didactic topics

These are the weighted topics for the multiple-choice Didactic, with official target weights and allowable ranges:

Surgical Procedures/Techniques is the largest at the 25% target, which makes it the anchor of Didactic preparation. Complications at 20% is also a heavy lift, because it demands you know not just the procedures but what goes wrong with them and how to respond.

Domains 6-9: CBPS Case Management Areas

These are separate from the Didactic topics and carry their own official ranges:

• Domain 6: Physical Examination (20-40%)
• Domain 7: Diagnostic procedures/labs/imaging (15-35%)
• Domain 8: Diagnosis (10-30%)
• Domain 9: Treatment (15-35%)

Domains 10-19: overlapping, unweighted CBPS Content Areas

These describe the clinical territory the simulations can draw from, without assigned weights:

• Domain 10: Complications/Revision
• Domain 11: Congenital disorders (pediatrics)
• Domain 12: Congenital disorders (adult)
• Domain 13: Deformities
• Domain 14: Perioperative management
• Domain 15: Neoplastic disorders
• Domain 16: Neurovascular disorders
• Domain 17: Trauma
• Domain 18: Wound/Infection
• Domain 19: Metabolic, rheumatologic, and inflammatory disorders

Because these overlap, a single simulation can touch several of them at once. A trauma case with a wound infection in a patient with a rheumatologic condition is entirely plausible. For the long-form treatment, see our complete guide to the RRA content areas.

After Certification: Ten Years and Maintenance

Initial certification lasts ten years, and keeping it requires ongoing work rather than a single renewal exam. Maintenance includes:

• Annual fees ($205 Board Qualified or $440 Board Certified).
• Unrestricted licensure and surgical privileges.
• A recent-surgery attestation.
• 100 Category 1 and/or CPME-approved CME hours per five-year period.
• LEAD participation.

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 Foot. Older cohorts have transition schedules, so check which applies to you using the issuer's LEAD requirement pages.

Whether all of this is worth the investment depends on your practice setting and goals. Our analysis of whether RRA certification is worth it walks through the tradeoffs, and the RRA salary guide covers the compensation side qualitatively.

Sequencing Your Preparation

Generic study technique matters less than sequencing your effort against the actual structure of the exam. Since the Didactic and CBPS reward different skills, schedule them differently.

Official practice material is login-gated, so supplement it with timed question work in a format that mimics adaptive, no-return delivery. You can try that on our RRA practice test, and our RRA study guide lays out a fuller plan. For quick end-of-week recall, the RRA cheat sheet condenses the must-know facts, and the main practice site offers additional timed sets.

Frequently Asked Questions