Examination Content

The test is 100 Multiple Choice & True/False questions

10 questions will come from each of the categories below

The test is taken online with a time limit of 2 hours.
If you do not achieve a passing score (70%) on the first attempt, you may
take the test 2 additional times.

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Competency Examination Contents

1. Lower Extremity Anatomy & Physiology

Identify (name) major structures of the four systems represented in the lower extremity

Describe the function of major structures of the four systems represented in the lower extremity

Four systems:

Neurology – major nerves in foot/leg, dermatomes

Vascular – major vessels in foot/leg, basics of venous disease, basics of arterial disease, vasculotomes

Dermatology – skin structures, hair, nail structure/components

Musculoskeletal – major muscles/bones

2. Lower Extremity Examination

Normal exam findings of four systems represented in the lower extremity

Objective and subjective signs of pathology in four systems represented in the lower extremity

Four systems:

Neurology – sensory changes, monofilament testing, motor & autonomic

                skin changes due to nerve damage/neuropathy

Vascular – hair growth, pulses, capillary refill, dependent rubor, elevation pallor, edema, stasis dermatitis

Dermatology – thin, atrophic, dry, flaky, maceration, fissures, ulcers, blisters, color changes, rashes

Musculoskeletal – strength, balance, range of motion, deformities, injuries

3. Common Foot Pathologies

Describe the cause (etiology) and treatment options for:

Plantar Fasciitis

Morton’s Neuroma


Hammertoes, claw-toes, contracted digits


Ingrown toenails

Hyperkeratotic lesions (corns & calluses)

Macerated Innerspaces of toes

Ulcerations and pre-ulcerative lesions

Lower Extremity edema/lymphedema (swelling)

4. Toe Nails

Identify the structures (anatomy) of the nail unit

Identify and name toenail deformities from pictures

                eg. Onychomycosis, onychogryphosis (omega/rams horn), lytic nails

Identify changes to the nail from systemic disease from pictures

                eg, Clubbed nails, Beaus lines, Mees lines

List the categories of onychomycosis. eg distal subungual, proximal subungual

List the pathogens frequently isolated from onychomycotic toenails. 

                eg, dermatophytes, t. mentagrophytes, t. rubrum

List topical and oral treatments for onychomycosis including:

                Methods of use, effectiveness, dangers/interactions of oral antifungal medications

List common injuries to toes and toenails, their cause and treatment options

                eg subungual hematoma, fracture, ulcer, ingrown, blisters

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.

List common toenail procedures/surgeries and why you would refer a patient to have it performed.

                eg. Matrixectomy, avulsion, biopsy,

5. Dermatology

Identify the structures (anatomy) of the skin

Identify and name common skin conditions from pictures. eg hemosiderin, psoriasis, cellulitis

List common lower extremity skin conditions and their treatment options.

                eg, warts, tinea pedis, xerosis (dry skin), pressure marks/preulcerative skin changes

Discuss the cause (etiology) of various types of hyperkeratotic lesions (corns, calluses) on the foot

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

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)

Identify areas of high pressure (preulcerative lesions) caused by shoes, deformities, other pressure.

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

List health issues which lead to the development of “high risk” foot problems.

                eg, diabetes, vascular disease, aging, nutrition, smoking, edema/swelling

List skin changes that can lead to easily injured skin.

List skin changes that can indicate the presence of vascular disease.

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.

Discuss important patient teaching points of skin care. 

                eg. Appropriate/safe products for cleansing and moisturizing, daily observation

Discuss the importance of examining the patient’s shoes, socks & inserts at every visit.

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)

List various types of iatrogenic lesions that can occur during foot care.

                eg. Scratches with sander, cuts with scalpel or clippers

List different methods of bleeding control and their advantages.

                eg. Direct pressure, chemical cautery (silver nitrate sticks, Monsels, styptic, aluminum chloride)

List different ways to provide antimicrobial cleaning to the area.

                eg. Betadine, alcohols pads, chlorhexidine pads, antimicrobial sprays

List different choices for dressings and their advantages.

                eg. Bacitracin, polysporin, Bandaid, gauze/tape

List important issues to discuss with the patient/caregiver.

Discuss follow-up care options.

List charting requirements for iatrogenic lesions.

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

Features of shoes which make them appropriate for diabetic/high risk feet

Features of socks which make them appropriate for diabetic/high risk feet

Features of inserts/orthotics which make them appropriate for diabetic/high risk feet

Methods of padding or taping that helps relieve problem areas on feet/toes

Adjustments to shoes and inserts that helps relieve problem areas on feet/toes

9. Infection Control

Steps to avoid cross contamination during patient care

Instruments -  appropriate cleaning methods, single use instruments

Techniques to avoid cross-contamination if using foot soaks

Procedure to avoid cross-contamination in the environment

                eg. Floor coverage, cleanup, dust management, personal protective equipment 

10. Patient Education

Check feet daily for… skin changes, nail changes

Skin care – cleanse, moisturize, Innerspace care, observe for problems

Shoes, socks, compression


10 sections

10 questions for each = 100 questions

    Examination Objectives

    Identify what Nursing Foot Care is and the role of the Nurse in Providing foot care
    treatment within the nurses’ scope of practice.

    Describe presenting symptoms, potential causes, diagnostic methods, and treatment
    plans related to problems that may be present with feet.

    Describe the role of the multidisciplinary team in referring clients with diabetic
    ulcers and amputation to wound care nurses or a specialist.

    Describe strategies to prevent foot problems and complication including shoe gear,
    socks, pads, taping, cleansing and moisturizing.

    Identify common foot and nail disorders of the diabetic and geriatric foot

    Identify common conditions of the feet such as corns, calluses, warts, ulcers,
    hallux valgus, tissue changes, and nail changes.

    Describe and identify safe techniques of cutting the toe nails and removing
    hyperkeratotic lesions.

    Identify techniques for proper use of nail nippers, curettes, stainless steel rasp or file,
    manual sanding files, powered rotary tool (sanders).

    Identify the safe use of protective equipment when providing foot care treatment
    including; goggles, face masks, gloves, hand sanitizer, barrier towels, dust evacuators.

    Describe the use of testing modalities such as the 5.07/9-gram Monofilament,
    tuning fork, Doppler.

    Describe proper sterilization/disinfection protocols for instruments and equipment
    used in foot care.

    Describe techniques and protocols which will prevent cross contamination of instruments, equipment, environment, patient exposure.

    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?
    Lower extremity edema
    Hemosiderin discoloration
    All of the above

    Which of the following tests is performed to determine the patient’s ability to feel light touch or protective sensation?
    5.07 (10 g) monofilament
    Deep tendon reflexes
    Vibration testing
    Proprioception testing

    Which of the following refer to movement of the foot up and down?
    Eversion and inversion
    Dorsiflexion and plantarflexion

    Which of the following skin changes might indicate the presence of arterial disease?
    Atrophic skin
    Dry, flaky skin
    Thin, fragile skin
    Decreased hair growth
    A and B above
    All of the above

    Which of the following can be a contributing factor to the formation of bunions?
    Ligamentous laxity
    Family history
    All of the above

    Which of the following are risk factors for developing a foot ulceration?
    Bony deformity
    Vascular insufficiency
    All of the above

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

    Which of the following is the most important treatment for ingrown toenails?
    Prescription antibiotics
    Removal of the ingrown portion of the toenail
    Soaking the foot in Epson salts

    What education would you provide to a patient with the following condition?
    (picture of hammertoe with ulceration)
    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
    They should consult with their podiatrist or medical provider about the possibility of corrective surgery to straighten the toe
    Inform them of beneficial shoe gear changes such as changing to extra depth shoes to allow more room for the toe deformities
    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?
    Total matrixectomy of the nail.
    Partial matrixectomy of the side of the nail, which becomes ingrown.
    Topical medication to make the nail healthier
    a or B above.
    None of the above.

    What is the name of the skin condition/disorder shown in the picture below?
    Plantar verruca
    Tinea pedis
    Pre-ulcerative skin changes
    Hemosiderin staining

    What condition would you expect this patient has based on the picture below?
    Arterial disease
    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, there
          will be an additional charge of $50.00 to retake the Exam. 
          You will have 3 opportunities to re-take and pass the
          Exam for the additional $50.00 administrative fee

    *  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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