LEAD Assessment Overview
Assessment Structure
Each quarterly LEAD assessment consists of 20 multiple-choice questions, including some based on visual presentations.
Each question includes at least four possible answers. Each question has only one best answer. You have three minutes to answer each question, and the questions assess existing knowledge relevant to foot and ankle surgery. After you answer each question, rate how confident you are in your response to the question, as well as how relevant the question content is to your practice. You then see whether you answered the question correctly, an explanation of why the current answer is the best answer, and references that support the answer.
You can take as many or as few questions at one time as you like within the quarter. All 20 questions must be completed by the end of the quarter for that quarter’s assessment to count toward the required number of quarters within each five-year period. See the LEAD Program Requirements for more information.
Foot Surgery Assessment Structure
For Diplomates who hold only a Foot Surgery Certification
Assessment Type: Continuous.
Assessment Objective: Demonstrates the physician has the fundamental diagnostic skills, medical knowledge, and clinical judgment to provide quality care.
Time Allotted: Three minutes per question.
Item Type: Didactic/Multiple-choice.
Number of Questions per Quarter: 20 Foot Surgery questions. You can answer all or some questions at any time throughout the quarter.
Foot & RRA Surgery Combined Assessment Structure
For Diplomates who hold Foot Surgery and RRA Surgery Certifications and/or Lifetime Certificates
Assessment Type: Continuous.
Assessment Objective: Demonstrates the physician has the fundamental diagnostic skills, medical knowledge, and clinical judgment to provide quality care.
Time Allotted: Three minutes per question.
Item Type: Didactic/Multiple-choice.
Number of Questions per Quarter: 20 questions per quarter: 10 Foot Surgery questions and 10 RRA Surgery questions. You can answer all or some questions at any time throughout the quarter.
Assessment Design
Starting in 2025, you may select a focus area each quarter to tailor your LEAD questions to content relevant to your practice or interest. No matter what you choose, all Diplomates will receive questions each quarter covering core concepts related to foot and ankle surgery. The four focus areas are:
- General Foot and Ankle Concepts
- Diabetic Limb Salvage
- Trauma
- Reconstruction
Assessment Topics
The first step to successful preparation for the LEAD assessment is to understand the topics or subject areas the assessment covers. The assessment topics table below details what is covered on the LEAD assessments, along with the percentage of questions in each topic.
You are welcome to prepare for the assessment as you feel necessary. ABFAS does not prohibit Diplomates from referencing documentation when taking the assessment. Through a performance tracker and pointed references and rationales after each question you answer, you will have the opportunity to see which areas require more attention to develop your knowledge and in which areas you have improved.
Foot and RRA Surgery Subject Areas
Questions per quarter:
- Foot Assessment: At least 3 questions
- Foot/RRA Assessment: At least 1 Foot Surgery question
Topics may include:
Podiatric History and Physical: The technique, the pertinent elements, and the interpretation of the history and physical exam.
For example, questions in this topic may assess your knowledge on:
- Diagnosis from a particular examination element
- Pertinence of a particular examination
- Non-lower extremity pathology
- Making a diagnosis based on multiple findings of a history and physical examination
- Pathoanatomy, pathomechanics, and/or pathophysiology
Procedural Perioperative Management: Procedure-specific and preoperative or postoperative in nature (not intraoperative). RRA subject areas may be assessed on Foot Assessment.
For example, questions in this topic may assess your knowledge on:
- Selection of a specific procedure based on findings
- Diagnosis that requires a surgical management decision
- Postoperative management of a specific procedure
General Medicine: All general medical diagnostics and treatments exclusive of lower-extremity pathology.
For example, questions in this topic may assess your knowledge on:
- Systemic complications
- Diagnosis that requires a medical management decision
- Medical management: diagnosis and treatment of diseases, disorders, and conditions exclusive of the lower extremity
- Interpretation of history and physical examination and diagnostic studies relating to non-lower extremity pathology
- Anesthesia: local, regional, spinal, epidural, IV sedation, and general anesthesia topics, including related peri-anesthesia assessment and pharmacologic management
- Emergency medicine: diagnosis and treatment of urgent or emergent diseases, disorders, and conditions exclusive of lower extremity
Questions per quarter:
- Foot Assessment: At least 4 questions
- Foot/RRA Assessment: At least 2 Foot Surgery and 3 RRA Surgery questions
Topics may include:
Diagnostic Studies/Medical Imaging: Interpretation of specific studies of diseases, disorders, and conditions of the lower extremity. RRA subject areas may be assessed on the Foot Assessment.
For example, questions in this topic may assess your knowledge on:
- Diagnosis or differential based on laboratory studies, imaging, or other diagnostic studies
- Diagnosis based on a specific imaging study
Differential Diagnosis: A differential diagnosis based on multiple elements, including history and physical, and diagnostic studies.
For example, questions in this topic may assess your knowledge on:
- Diagnosis based on multiple elements
- Diagnosis based on findings of a study or studies with no imaging study shown
Questions per quarter:
- Foot Assessment: At least 7 questions
- Foot/RRA Assessment: At least4 Foot Surgery and 7 RRA Surgery questions
Topics may include:
Surgical Principles: General principles standard to all surgical disciplines and applicable to podiatric surgery. RRA subject areas may be assessed on the Foot Assessment.
For example, questions in this topic may assess your knowledge on preoperative, intraoperative, or postoperative decision-making or management that is not specific to a procedure.
Surgical Procedures/Techniques: Intraoperative aspects of specific surgical procedures.
For example, questions in this topic may assess your knowledge on:
- Relevant (normal or abnormal) anatomy encountered and surgically altered during the performance of a surgical procedure
- Anatomy that is encountered and surgically altered
- Incision placement and dissection technique
- The orientation of bone cuts
- Selection and application of fixation devices and bioimplants
- Placement and fixation of tissue transfers
- Selection and application of closure materials, drains, and surgical dressings
- Complications that are assessed and/or managed intraoperatively
Complications: Procedure-specific or injury-specific postoperative or post-traumatic conditions. RRA subject areas may be assessed on Foot Assessment.
For example, questions in this topic may assess your knowledge on:
- Identification and/or management of lower extremity procedure-specific postoperative complications
- All-inclusive subject categories dealing with diagnosis and/or treatment
Foot Surgery Subtopics
- Acquired digital deformities
- Hallux abductovalgus
- Hallux limitus
- Central metatarsal deformities
- Fifth metatarsal deformities
- Other common forefoot deformities
- Congenital digital deformities (polydactyly, syndactyly, marcrodactyly, overlapping digits)
- Congenital forefoot deformities (brachymetatarsia, clawfoot, hallux varus)
- Metatarsus adductus
The following subcategories are covered in all Subject Areas except “Surgical Procedures/Techniques”:
- Metatarsus adductus
- Soft tissue
- Bone/joint
- Systemic
- Soft tissue
- Bone
- Vascular disorders
- Focal neuropathies (entrapments, neuroma, TTS) and RSD
- Neuropathic bone, joint, or soft-tissue derangements
- Neuromuscular disorders
- Arthritic disorders
- Metabolic bone disease
- Tendinopathies
- Other soft-tissue disorders (plantar fasciitis)
- Nail and dermatologic disorders
- Chronic post-traumatic disorders
- Osteochondroses/AVN
- Digital and sesamoidal fractures/dislocations
- Metatarsophalangeal joint dislocations
- Metatarsal fractures
- Tarsometatarsal fractures/dislocations
- Acute tendon ruptures/lacerations
- Acute nerve/vascular injury (including compartment syndrome)
- Miscellaneous acute trauma (degloving injury, foreign body, gunshot wounds, crush injury, contusions, burns)
- Pediatric fractures/growth-plate injuries
- Joint implants
- Fixation devices
- Bone grafts/bone substitutes/bone healing
- Suture materials
- Soft tissue/anchor/skin graft/healing
- Anatomy
- Medicine (illnesses/therapeutics)
- Anesthesia
- Other
RRA Surgery Subtopics
- Metatarsus adductus/skewfoot
- Pes planus
- Pes cavus
- Clubfoot
- Tarsal coalition
- Vertical talus
- Calcaneovalgusli>
- Equinus deformities
- Complex leg/ankle deformities
The following subcategories are covered in all Subject Areas except “Surgical Procedures/Techniques”:
- Skewfoot
- Pes planus
- Pes cavus
- Clubfoot
- Tarsal coalition
- Vertical talus
- Calcaneovalgus
- Equinus deformities
- Complex leg/ankle deformities
- Soft tissue
- Bone/joint
- Systemic
- Soft tissue
- Bone
- Vascular disorders
- Focal neuropathies (entrapments, neuroma, TTS) and RSD
- Neuropathic bone, joint, or soft-tissue derangements
- Neuromuscular disorders
- Arthritic disorders
- Metabolic bone disease
- Tendinopathies
- Other soft-tissue disorders (plantar fasciitis)
- Nail and dermatologic disorders
- Chronic post-traumatic disorders
- Osteochondroses/AVN
- Digital and sesamoidal fractures/dislocations
- Metatarsophalangeal joint dislocations
- Metatarsal fractures
- Tarsometatarsal fractures/dislocations
- Acute tendon ruptures/lacerations
- Acute nerve/vascular injury (including compartment syndrome)
- Miscellaneous acute trauma (degloving injury, foreign body, gunshot wounds, crush injury, contusions, burns)
- Pediatric fractures/growth-plate injuries
The following subcategories are covered in all Subject Areas except “Surgical Procedures/Techniques”:
- Midfoot fractures/dislocations
- Rearfoot fractures/dislocations
- Ankle fractures
- Acute soft-tissue ankle injuries
- Acute tendon ruptures/lacerations
- Acute nerve/vascular injury (including compartment syndrome)
- Miscellaneous acute trauma (degloving injury, foreign body, gunshot wounds, crush injury, contusions, burns)
- Pediatric fractures/growth-plate injuries
- Joint implants
- Fixation devices
- Bone grafts/bone substitutes/bone healing
- Suture materials
- Soft tissue/anchor/skin graft/healing
- Anatomy
- Medicine (illnesses/therapeutics)
- Anesthesia
- Other
Assessment Performance
The LEAD program is not a pass/fail examination. Instead, ABFAS uses the science of Measurement Decision Theory (MDT) to analyze the probability that you are keeping up with topics relevant to the practice of foot and ankle surgery. See the LEAD Program MDT Requirement webpage for the LEAD performance requirement and standard.