Changes to Case Review Requirements for 2017

The podiatry profession continues to evolve with more podiatrists performing rearfoot reconstruction, trauma, and limb salvage procedures. These changes reflect three major factors:

• Development of three-year surgical residency programs, providing advanced surgical exposure and training of current and future residents. 

• More podiatrists are joining orthopedics, sports medicine, and wound care practices.

• There has been an expansion in the scope of practice with 47 states allowing podiatric physicians to perform rearfoot/ankle surgery. 

With continuous changes such as these, and to allow podiatric surgeons to participate in the Part II examination in a timely manner, an expansion in current case selection was necessary. ABFAS formed a task force to examine the need to expand the case review categories. The ABFAS board of directors unanimously approved the recommendations of the task force, which state:

1) Candidates will log all surgical procedures in all categories (one through five). The candidate must log a minimum of 65 cases for eligibility to submit cases for review for foot surgery certification—similar to the 2016 exam cycle.

2) Thirty (30) out of the 65 logged cases must be in designated subcategories, shown below. Only cases logged in categories 2, 4, and 5 will be counted toward the minimum 30 procedures—different than the 2016 exam cycle as the list of cases is expanded to allow practitioners with an RRA focus to sit for the Foot Certification exam.

3) There will be a limit on maximum number of procedures in each sub-category that is used toward the “minimum 30 procedures.” The limits are based on complexity and/or degree of surgical skills for that specific procedure. For example, the maximum number of procedures that is eligible toward “minimum 30 procedures” under subcategory 2.2.1 Cheilectomy is 2, whereas the maximum number of procedures that is eligible toward the “minimum 30 procedures” for sub-category 2.2.6 MTPJ fusion is 15.

4) The RRA cases selected for review for Part II Foot certification process will not be available for the RRA portion of the Part II certification process.

Reminders: Please log ALL cases and continue to log even if you believe you have met the requirement. The PLS system will be able to show the status of your logged cases vs. the requirements, beginning in July 2016.

Expanded List of Categories for Case Review

Each category in italics has an allowable maximum of 2 of the 30 required cases.
Each category in “non-italics” has an allowable maximum of 15 of the 30 required cases.

Hallux Valgus Surgery 
2.1.3 bunionectomy with phalangeal osteotomy 
2.1.4 bunionectomy with distal first metatarsal osteotomy 
2.1.5 bunionectomy with first metatarsal base or shaft osteotomy
2.1.6 bunionectomy with first metatarsocuneiform fusion
2.1.7 MTPJ fusion 
2.1.8 MTPJ implant

Hallux Limitus Surgery 

2.2.1 cheilectomy 
2.2.2 joint salvage with phalangeal osteotomy (Kessel- Bonney, enclavement)

2.2.3 joint salvage with distal metatarsal osteotomy 
2.2.4 joint salvage with first metatarsal shaft or base osteotomy 
2.2.5 joint salvage with first metatarsocuneiform fusion 
2.2.6 MTPJ fusion 
2.2.7 MTPJ implant 

Other First Ray Surgery
2.3.2 osteotomy (e.g., dorsiflexory)
2.3.3 metatarsocuneiform fusion (other than for hallux valgus or hallux limitus)
2.3.4 amputation 
2.3.5 management of osseous tumor/neoplasm (with or without bone graft) 
2.3.6 management of bone/joint infection (with or without bone graft)
2.3.7 open management of fracture or MTPJ dislocation with fixation 
2.3.8 corticotomy with callus distraction 
2.3.9 revision/repair of surgical outcome (e.g., nonunion, hallux varus) 

Osseous Foot Surgery
4.5 lesser MTPJ implant 
4.6 central metatarsal osteotomy 
4.7 bunionectomy of the fifth metatarsal with osteotomy 
4.8 open management of lesser metatarsal fracture(s) 

4.10 amputation (lesser ray, transmetatarsal amputation (TMA)
4.11 management of bone/joint infection distal to the tarsometatarsal joints (with or without bone graft)
4.12 management of bone tumor/neoplasm distal to the tarsometatarsal joints (with or without bone graft) 
4.13 open management of tarsometatarsal fracture/dislocation 
4.14 multiple osteotomy management of metatarsus adductus

4.15 tarsometatarsal fusion 
4.16 corticotomy/callus distraction of lesser metatarsal 

Elective – Soft-tissue
5.1.1 plastic surgery techniques involving the midfoot, rearfoot or ankle
5.1.2 tendon transfer involving the midfoot, rearfoot, ankle, or leg
5.1.4 soft-tissue repair of complex congenital foot/ankle deformity (clubfoot, vertical talus)

5.1.5 delayed repair of ligamentous structures
5.1.6 ligament or tendon augmentation/supplementation/restoration

Elective - Osseous

5.2.2 detachment/reattachment of Achilles tendon with partial ostectomy
5.2.4 midfoot, rearfoot, or ankle fusion
5.2.5 midfoot, rearfoot, or tibial osteotomy
5.2.6 coalition resection
5.2.7 open management of talar dome pathology (with or without osteotomy)
5.2.8 ankle arthrotomy with removal of loose body or other osteochondral debridement 5.2.9 ankle implant
5.2.10 corticotomy or osteotomy with callus distraction/ correction of complex deformity of themidfoot, rearfoot, ankle, or tibia
Nonelective – Soft tissue 
5.3.1 repair of acute tendon injury 
5.3.2 repair of acute ligament injury 
5.3.3 microscopic nerve/vascular repair of the midfoot, rearfoot, or ankle 
5.3.4 excision of soft-tissue tumor/mass of the foot (with reconstructive surgery) 

5.3.6 open repair of dislocation (proximal to tarsometatarsal joints)

Nonelective – Osseous
5.4.1 open repair of adult midfoot fracture 
5.4.2 open repair of adult rearfoot fracture 
5.4.3 open repair of adult ankle fracture 
5.4.4 open repair of pediatric rearfoot/ankle fracture or dislocation 
5.4.5 management of bone tumor/neoplasm (with or without bone graft) 
5.4.6 management of bone/joint infection (with or without bone graft) 

5.4.7 amputation proximal to the tarsometatarsal joints