ACFAS Position Statement on The Education, Training & Certification of ACFAS Foot & Ankle Surgeons
Approved by the ACFAS Board of Directors, February 2019
Foot and Ankle Surgeons (DPMs) who are Board Certified in Foot and Ankle Surgery, Foot Surgery, and/or in Reconstructive Rearfoot/Ankle Surgery by the American Board of Foot and Ankle Surgery (ABFAS) are the only board-certified physicians specifically trained to diagnose and treat surgical problems of the foot and ankle. They are an integral part of the healthcare team, and combined with all other podiatric physicians, treat the majority of foot and ankle related medical issues in the U.S.
Each ABFAS Board Certified Foot and Ankle Surgeon has:
Identical in length to allopathic and osteopathic medical schools, the podiatric medical school curriculum covers basic and clinical sciences, including, but not limited to: general anatomy; pathology; biochemistry; pharmacology; general medicine; surgery; pediatrics; behavioral sciences; and ethics. Unlike allopathic and osteopathic medical schools, the podiatric medical school curriculum also provides intensive foot and ankle specialty specific education beginning in the first year.
Similar to, and often integrated with residencies for MDs and DOs, podiatric surgical residency programs require training in multiple areas of general medicine and surgery as well as non-podiatric specialties. The critical difference, though, is in the volume of cases and time spent in foot and ankle specific training. Podiatric surgical residency programs, which are a minimum of three years, provide significantly more foot and ankle training than any other specialty (Council for Podiatric Medical Education).
A foot and ankle surgeon (DPM) will have demonstrated a cognitive knowledge of podiatric surgery, including the diagnosis and treatment of general medical problems and surgical management of foot and ankle diseases, deformities, and/or trauma, and those structures that affect the foot, ankle, and leg (ABPS 110).
Multiple general orthopaedic resident surveys have shown that graduating general orthopaedic surgeons feel their program was deficient in foot and ankle surgery and that they are least prepared to treat the foot and ankle upon entering into private practice (Dailey, et al., August 1998; American Journal of Orthopedics 563-570).
The Board Certification Difference
The American Board of Foot and Ankle Surgery (ABFAS) certifies foot and ankle surgeons who have successfully completed an intense certification process.
To qualify for surgical certification examination, candidates must have already passed the American Podiatric Medical Licensing Examinations Part I and II. Candidates then complete Part I and Part II of the surgical certification examination(s), in addition to submitting surgical case logs. ABFAS requires four years of post-DPM degree clinical experience and completion of an appropriate Council on Podiatric Medical Education (CPME)-approved residency program before taking the certification examination(s). Additionally, Diplomats must re-certify every 10 years to maintain their board-certified status. All Fellows of the American College of Foot and Ankle Surgeons (ACFAS) are certified by ABFAS.
Prerequisites for board qualification in foot surgery require successful completion of a CPME-approved PMSR (formerly PM&S-24 residency program) and passage of Part I of the Certification in Foot Surgery Examination. Board qualification in reconstructive rearfoot/ankle surgery requires successful completion of a CPME-approved PMSR/RRA (PSR-24 or PM&S-36 residency program) and passage of Part I of the Certification in Reconstructive Rearfoot/Ankle Surgery Examination. Board Qualified in Foot Surgery is a prerequisite for Board Qualified in Reconstructive Rearfoot/Ankle Surgery.
A candidate must pass Part II of the Certification in Foot Surgery Examination for board certification in foot surgery and Part II of the Certification in Reconstructive Rearfoot/Ankle Surgery Examination for board certification in reconstructive rearfoot/ankle surgery. ABFAS certification in foot surgery is a prerequisite for board certification in reconstructive rearfoot/ankle surgery.
The critical differences between Board Certified Foot and Ankle Surgeons (DPMs) and Board-Certified Orthopedists (MD/DOs) are:
- The ABFAS certification process involves examination specific to the foot and ankle. The vast majority of the ABFAS board certification examination is relevant to the foot, ankle and lower leg. Only a small percentage of the American Board of Orthopaedic Surgery (ABOS) certification examination is specific to the foot and ankle.
- The ABFAS certification process involves proving experience specifically in the performance of foot and ankle surgical procedures, whereas the ABOS does not.
- The ABFAS certification process certifies podiatric physicians specifically in foot and ankle surgery. There is no foot and ankle specific certification process for orthopaedic surgeons.
The Practice Difference
All surgical specialists including the foot and ankle surgeon (DPM) are credentialed and privileged by hospitals, surgery centers, medical centers and educational institutions in a standardized process, specified by recognized accrediting organizations.
Recognized accrediting organizations include the Joint Commission; the Accreditation Association for Ambulatory Health Care; the American Osteopathic Association; the American Association for Accreditation of Ambulatory Surgery Facilities, Inc.; National Committee for Quality Assurance; the organization formerly known as URAC, and others.
This standardized process mandates requirements that both groups must meet orexceed; and provides for an equitable peer review process. This process, however, may not require board-certified orthopaedists to demonstrate any special skills or training in foot and ankle surgery, whereas foot andankle surgeons (DPMs) must demonstrate training and experience specific to the foot and ankle to obtainprivileges.
Podiatric Surgeons Board Certified in Foot and Ankle Surgery, or Board Qualified/Certified in Foot Surgery, or Board Qualified/Certified in Reconstructive Rearfoot/Ankle Surgery exclusively limit their practice to the care of the foot and ankle, whereas the majority of general orthopaedists treat a multitude of musculoskeletal complaints throughout the entire body.
Podiatric Surgeons Board Certified in Foot and Ankle Surgery, or Board Qualified/Certified in Foot Surgery, or Board Qualified/Certified in Reconstructive Rearfoot/Ankle Surgery and orthopaedists are both required to attend Continuing Medical Education courses on a yearly basis to maintain state licensure. Only podiatric foot and ankle surgeons are required to attend foot and ankle specific courses, whereas orthopaedists, including those that specialize in foot and ankle, may complete their Continuing Medical Education requirement entirely in areas outside the foot and ankle.
The American College of Foot and Ankle Surgeons is a professional society of 7,800 foot and ankle surgeons. Founded in 1942, the College’s mission is to promote research and provide continuing education for the foot and ankle surgical specialty, and to educate the general public on foot health and conditions of the foot and ankle through its patient education website, FootHealthFacts.org.