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Certification Examination Logistics


Testing Security, identity verification and process standardization

  • The test is taken online.
  • The test is 100 Multiple Choice & True/False questions
  • 10 questions will come from each of the ten categories below
  • You will have a time limit of 120 minutes (2 hours) to complete the 100 question test once you begin
  • You must complete each question before progressing to the next question.
  • Any questions left unanswered will be graded as incorrect answers
  • You must achieve a passing score of at least 70% during the allotted time
  • If you do not pass on your first attempt, you may take the test 1 additional time at no extra fee
  • You will receive your test score immediate after you complete the test
  • To log on to the testing site you will receive an individual access link, testing number and password 
  • Your identity will be confirmed at sign-on with virtual presentation of a government issued photo id
  • There will be continuous identity verification conducted at all times as you take the test
  • The test will be proctored virtually to assure compliance and integrity of exam content
  • There will be virtual tracking and recording of the testing environment 
  • Full proctoring reports will be issued to AFCNA by our IT proctoring partner

Certification Examination Contents


1. Lower Extremity Anatomy & Physiology

  1. Identify (name) major structures of the four systems represented in the lower extremity
  2. Describe the function of major structures of the four systems represented in the lower extremity

Four systems:
  1. Neurology – major nerves in foot/leg, dermatomes
  2. Vascular – major vessels in foot/leg, basics of venous disease, basics of arterial disease, vasculotomes
  3. Dermatology – skin structures, hair, nail structure/components
  4. Musculoskeletal – major muscles/bones


2. Lower Extremity Examination

  1. Normal exam findings of four systems represented in the lower extremity
  2. Objective and subjective signs of pathology in four systems represented in the lower extremity

Four systems:
  1. Neurology – sensory changes, monofilament testing, motor & autonomic  skin changes due to nerve damage/neuropathy
  2. Vascular – hair growth, pulses, capillary refill, dependent rubor, elevation pallor, edema, stasis dermatitis
  3. Dermatology – thin, atrophic, dry, flaky, maceration, fissures, ulcers, blisters, color changes, rashes
  4. Musculoskeletal – strength, balance, range of motion, deformities, injuries


3. Common Foot Pathologies

Describe the cause (etiology) and treatment options for:

  1. Plantar Fasciitis
  2. Morton’s Neuroma
  3. Bunions
  4. Hammertoes, claw-toes, contracted digits
  5. Metatarsalgia
  6. Ingrown toenails
  7. Hyperkeratotic lesions (corns & calluses)
  8. Macerated Innerspaces of toes
  9. Ulcerations and pre-ulcerative lesions
  10. Lower Extremity edema/lymphedema (swelling)


4. Toe Nails

  1. Identify the structures (anatomy) of the nail unit
  2. Identify and name toenail deformities from pictures
    eg. Onychomycosis, onychogryphosis (omega/rams horn), lytic nails
  3. Identify changes to the nail from systemic disease from pictures
    eg, Clubbed nails, Beaus lines, Mees lines
  4. List the categories of onychomycosis. eg distal subungual, proximal subungual
  5. List the pathogens frequently isolated from onychomycotic toenails.
    eg, dermatophytes, t. mentagrophytes, t. rubrum
  6. List topical and oral treatments for onychomycosis including:
    Methods of use, effectiveness, dangers/interactions of oral antifungal medications
  7. List common injuries to toes and toenails, their cause and treatment options.
    eg subungual hematoma, fracture, ulcer, ingrown, blisters
  8. Describe two different mechanisms that create ingrown toenails.
    eg, wide and thin nails lacerate lateral or medial nail fold, incorrect nail trimming leading to the
    lateral or medial distal nail edge cutting into tissue.
  9. List common toenail procedures/surgeries and why you would refer a patient to have it performed.
    eg. Matrixectomy, avulsion, biopsy.


5. Dermatology

  1. Identify the structures (anatomy) of the skin
  2. Identify and name common skin conditions from pictures. eg hemosiderin, psoriasis, cellulitis
  3. List common lower extremity skin conditions and their treatment options.
    eg, warts, tinea pedis, xerosis (dry skin), pressure marks/preulcerative skin changes
  4. Discuss the cause (etiology) of various types of hyperkeratotic lesions (corns, calluses) on the foot
  5. Discuss various treatment options for hyperkeratotic lesions on the foot.
    eg. Debridement (sanding/sharp,) exfoliation (urea or ammonium lactate creams),
    moleskin, felt pads, silicone pads, shoe/insert modification
  6. Discuss various topic products and their uses.
    eg. Skin moisturizers (with humectants, emollients), barrier products for protection from
    moisture (petrolatum, zinc or dimethicone products), keratolytic/exfoliative products
    (urea creams, ammonium lactate creams)
  7. Identify areas of high pressure (preulcerative lesions) caused by shoes, deformities, other pressure.



6. The High Risk Foot – Diabetic, Vascular, Aging

  1. List health issues which lead to the development of “high risk” foot problems.
    eg, diabetes, vascular disease, aging, nutrition, smoking, edema/swelling
  2. List skin changes that can lead to easily injured skin.
  3. List skin changes that can indicate the presence of vascular disease.
  4. Discuss changes you might make in your care for a patient with thin, atrophic skin.
    eg. Perhaps use manual sander instead of powered sander, handle the skin very gently
    to avoid trauma from pressure or pulling (shear) forces.
  5. Discuss important patient teaching points of skin care.
    eg. Appropriate/safe products for cleansing and moisturizing, daily observation
  6. Discuss the importance of examining the patient’s shoes, socks & inserts at every visit.
  7. Discuss exam findings that would lead you to refer the patient to their primary
    medical provider for further evaluation and care.


7. Care for iatrogenic lesions (cuts, scratches, etc. caused during foot care visit)

  1. List various types of iatrogenic lesions that can occur during foot care.
    eg. Scratches with sander, cuts with scalpel or clippers
  2. List different methods of bleeding control and their advantages.
    eg. Direct pressure, chemical cautery (silver nitrate sticks, Monsels, styptic, aluminum chloride)
  3. List different ways to provide antimicrobial cleaning to the area.
    eg. Betadine, alcohols pads, chlorhexidine pads, antimicrobial sprays
  4. List different choices for dressings and their advantages.
    eg. Bacitracin, polysporin, Bandaid, gauze/tape
  5. List important issues to discuss with the patient/caregiver.
  6. Discuss follow-up care options.
  7. List charting requirements for iatrogenic lesions.


8. Shoes, socks, inserts/orthotics, pads/strapping/taping

  1. Features of shoes which make them appropriate for diabetic/high risk feet
  2. Features of socks which make them appropriate for diabetic/high risk feet
  3. Features of inserts/orthotics which make them appropriate for diabetic/high risk feet
  4. Methods of padding or taping that helps relieve problem areas on feet/toes
  5. Adjustments to shoes and inserts that helps relieve problem areas on feet/toes

9. Infection Control

  1. Steps to avoid cross contamination during patient care
  2. Instruments -  appropriate cleaning methods, single use instruments
  3. Techniques to avoid cross-contamination if using foot soaks
  4. Procedure to avoid cross-contamination in the environment
    eg. Floor coverage, cleanup, dust management, personal protective equipment 


10. Patient Education

  1. Check feet daily for… skin changes, nail changes
  2. Skin care – cleanse, moisturize, Innerspace care, observe for problems
  3. Shoes, socks, compression



All of the above can be downloaded:  

Cut and paste the following link into your browser:

https://rainiermed.sharefile.com/d-s541ed81de7a4adea


Examination Objectives


  1. Identify what Nursing Foot Care is and the role of the Nurse in Providing foot care treatment within the nurses’ scope of practice.
  2. Describe presenting symptoms, potential causes, diagnostic methods, and treatment plans related to problems that may be present with feet.
  3. Describe the role of the multidisciplinary team in referring clients with diabetic ulcers and amputation to wound care nurses or a specialist.
  4. Describe strategies to prevent foot problems and complication including shoe gear, socks, pads, taping, cleansing and moisturizing.
  5. Identify common foot and nail disorders of the diabetic and geriatric foot.
  6. Identify common conditions of the feet such as corns, calluses, warts, ulcers, hallux valgus, tissue changes, and nail changes.
  7. Describe and identify safe techniques of cutting the toe nails and removing hyperkeratotic lesions.
  8. Identify techniques for proper use of nail nippers, curettes, stainless steel rasp or file, manual sanding files, powered rotary tool (sanders).
  9. Identify the safe use of protective equipment when providing foot care treatment including; goggles, face masks, gloves, hand sanitizer, barrier towels, dust evacuators.
  10. Describe the use of testing modalities such as the 5.07/9-gram Monofilament, tuning fork, Doppler.
  11. Describe proper sterilization/disinfection protocols for instruments and equipment used in foot care.
  12. Describe techniques and protocols which will prevent cross contamination of instruments, equipment, environment, patient exposure.
  13. Describe potential chronic complications of diabetes in terms of pathology, associated risk factors, frequency, recommendations for screening, prevention, management, and foot care education.



Sample Questions


Which of the following are objective signs of venous disease?

  1. Lower extremity edema
  2. Hemosiderin discoloration
  3. Varicosities
  4. All of the above


Which of the following tests is performed to determine the patient’s ability to feel light touch or protective sensation?

  1. 5.07 (10 g) monofilament
  2. Deep tendon reflexes
  3. Vibration testing
  4. Proprioception testing


Which of the following refer to movement of the foot up and down?

  1. Eversion and inversion
  2. Dorsiflexion and plantarflexion


Which of the following skin changes might indicate the presence of arterial disease?

  1. Atrophic skin
  2. Dry, flaky skin
  3. Thin, fragile skin
  4. Decreased hair growth
  5. 1 and 2 above
  6. All of the above


Which of the following can be a contributing factor to the formation of bunions?

  1. Pronation
  2. Ligamentous laxity
  3. Family history
  4. All of the above


Which of the following are risk factors for developing a foot ulceration?

  1. Bony deformity
  2. Vascular insufficiency
  3. Diabetes
  4. All of the above


Macerated inner spaces/web spaces are areas of excess moisture between toes that can lead to an infection.

  1. True
  2. False


Which of the following is the most important treatment for ingrown toenails?

  1. Prescription antibiotics
  2. Removal of the ingrown portion of the toenail
  3. Soaking the foot in Epson salts


What education would you provide to a patient with the following condition?
(picture of hammertoe with ulceration)

  1. Even if the “corn” on the tip of their toe does not hurt, it is a serious finding because it can become ulcerated and infected
  2. They should consult with their podiatrist or medical provider about the possibility of corrective surgery to straighten the toe
  3. Inform them of beneficial shoe gear changes such as changing to extra depth shoes to allow more room for the toe deformities
  4. All of the above


A patient who continues to develop ingrown great toenails should consider having which of the following procedures performed by a podiatrist, dermatologist or other practitioner?

  1. Total matrixectomy of the nail.
  2. Partial matrixectomy of the side of the nail, which becomes ingrown.
  3. Topical medication to make the nail healthier
  4. 1 or 2 above.
  5. None of the above


What is the name of the skin condition/disorder shown in the picture below?  (picture of a red area over a bony prominence)

  1. Plantar verruca
  2. Tinea pedis
  3. Pre-ulcerative skin changes
  4. Cellulitis
  5. Hemosiderin staining


What condition would you expect this patient has based on the picture below?  (picture of thin, atrophic, hairless skin on leg)

  1. Psoriasis
  2. Cellulitis
  3. Arterial disease
  4. Tinea pedis


Successful Completion of Examination

*  Complete the CFCS Competency Exam on-line with a passing score is 70% or better.

*  Testing failure: If you should fail your exam, you will have 1 additional opportunity to re-take and pass the Exam. 

*  The test is time limited and must be completed within 2 hours.

*  You will be able to immediately download your Certificate.

*  A Formal, numbered Certificate will be mailed to you.

*  You can immediately use the credentials CFCS after your name and other medical credentials such as RN.

*  CFCS certification is valid for five years.
    (see Re-certification Requirements for maintaining your certification thereafter.)


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