Certified Foot Care Specialist
Education is the key to changing lives
The Importance of Certification
Certifications signal a verified level of expertise and a commitment to quality.
Professional credibility: A certification like CFCS demonstrates to employers, patients, and colleagues that you meet established standards of knowledge and skill.
Enhanced patient safety: Certified nurses are more likely to follow evidence-based practices, reducing the risk of complications and improving outcomes.
Career advancement: Certification can open doors to advanced roles, leadership opportunities, and higher earning potential.
Continued competence: The certification process promotes ongoing learning, ensuring you stay current with the latest guidelines and techniques.
Public trust: Patients feel more confident when they know their healthcare provider has earned a recognized credential.
Commitment to excellence: Achieving and maintaining certification reflects dedication to personal and professional growth, and a patient-centered approach to care.
Test 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.
Certification Examination Contents
Click this link to get a download copy of this sheet.
footcarenurse.org/CFCSExamcontents
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
Bunions
Hammertoes, claw-toes, contracted digits
Metatarsalgia
Ingrown toenails
Hyperkeratotic lesions (corns & calluses)
Macerated Inner spaces 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. e.g., Onychomycosis, onychogryphosis (omega/rams’ horn), lytic nails
Identify changes to the nail from systemic disease from pictures, Clubbed nails, Beaus lines, Mees lines List the categories of onychomycosis. e.g., 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 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, Monsell’s, styptic, aluminum chloride)l
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, Band-Aid, 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 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. (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.
Click this link to get a download copy of this sheet.
footcarenurse.org/CFCSExamcontents
CFCS Sample Test
Click on this link to download a copy of this sample test:
https://footcarenurse.org/cfcsSampleTest
1. Which of the following are objective signs of venous disease?
Lower extremity edema
Hemosiderin discoloration
Varicosities
All of the above (correct answer)
2. Which of the following tests are performed to determine the patient’s ability to feel light touch or protective sensation?
5.07 (10 g) monofilament (correct answer)
Deep tendon reflexes
Vibration testing
Proprioception testing
3. Which of the following refer to movement of the foot up and down?
Eversion and inversion
Dorsiflexion and plantarflexion (correct answer)
4. Which of the following skin changes might indicate the presence of arterial disease?
Atrophic skin
Dry, flaky skin
Thin, fragile skin
Decreased hair growth.
1 and 2 above
All of the above (correct answer)
5. Which of the following can be a contributing factor to the formation of bunions?
Pronation
Ligamentous laxity
Family history
All of the above (correct answer)
6. Which of the following are risk factors for developing a foot ulceration?
Bony deformity
Vascular insufficiency
Diabetes
All of the above (correct answer)
7. Macerated inner spaces/web spaces are areas of excess moisture between toes that can lead to an infection.
True (correct answer)
False
8. Which of the following is the most important treatment for ingrown toenails?
Prescription antibiotics
Removal of the ingrown portion of the toenail (correct answer)
Soaking the foot in Epsom salts
9. 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 (correct answer)
10. 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.
1 or 2 above (correct answer)
None of the above
11.What is the name of the skin condition/disorder shown in the picture below? (picture of a red area over a bony prominence)
Plantar verruca
Tinea pedis
Pre-ulcerative skin changes (correct answer)
Cellulitis
Hemosiderin staining
12. What condition would you expect this patient to have based on the picture below? (picture of thin, atrophic, hairless skin on leg)
Psoriasis
Cellulitis
Arterial disease (correct answer)
Tinea pedis
Click on this link to download a copy of this sample test:
https://footcarenurse.org/cfcsSampleTest