Table of contents
• Introduction
• Examination Entry Criteria
• Curriculum
• Routes to Eligibility for the EFAS Examination
• Past certifications
Introduction
The primary aim of the development of a European Certification process in Trauma and Orthopaedic Foot and Ankle Surgery is to promote the highest standard of practice in our field of expertise to benefit patients.
There are many secondary benefits. Surgeons who complete this process will have a general understanding of the knowledge and surgical skills required but the standard shall be placed at specialist level providing complete confidence in our art and science for the patients that we treat. The process shall promote educational and scientific research in basic science, paediatric, adult and traumatic foot and ankle surgery. By reinvestment the training of young surgeons interested in pursuing a career in trauma and orthopaedic foot and ankle surgery shall be facilitated. It is the wish of the European Foot and Ankle Society to remain at the forefront of these exciting developments and take our speciality proactively in to the future setting the standards for many years to come. This document outlines the requirements for Certification and the examination process by which its award shall be achieved and sanctioned.
Examination Board
The Examination Board shall include the Certification Committee and all members of EFAS Council when each examination is taking place and shall include co-opted examiners as required. This board shall confirm the eligibility of candidates based on the entry criteria, shall prepare and conduct the examinations and shall be responsible for the award of a pass or fail based on a standard scoring system for the Multiple Choice Question (MCQ) paper and the Oral Examination (Viva). For the candidates who pass the Board shall be responsible for the recommendation to the Union of European Medical Societies (UEMS) for endorsement prior to the award of the Certificate.
Entry criteria
General criteria
Post Basic Trauma and Orthopaedic Examination and Training All candidates shall provide evidence of completion of the relevant Basic Trauma and Orthopaedic Examination and Training Certificate for their country of origin and shall have been in a Consultant Orthopaedic Foot and Ankle post or equivalent for at least 5 years. Logbook A complete logbook of surgical cases shall be required preferably electronically for ratification by the examination board before proceeding to the examination. Knowledge Base and Practical Skills This is discussed and clarified in detail in the section on Curriculum. However, candidates will be expected to maintain a high standard of knowledge and practical skills in the field of Trauma and Orthopaedic Foot and Ankle Surgery.
EFAS criteria
It has been agreed that the following additional EFAS criteria are required:
• Meetings
Evidence of attendance at 3 EFAS meetings shall be required. EFAS currently has Basic Instructional Courses, Cadaver Courses, and an Annual Meeting or Advanced Instructional Course each year. Ideally the candidate shall have attended each of these courses but variations may be acceptable and the final decision about proceeding to sit the examination shall be determined by the Examination Board.
• Publications
Evidence of at least two international publications in appropriate Journals on Foot and Ankle Surgical topics shall be required. Preference shall be given to those publishing in the Journal of the European Foot and Ankle Society.
• Fellowships
Evidence of appropriate Fellowship training in a Foot and Ankle Surgery Centre of Excellence is desirable but not mandatory at present. The Certification Board recognises that this is very variable depending on the country of origin of candidates and would not wish to disadvantage some EFAS members. The final decision shall rest with the Examination Board. However, in the future as the Certificate develops this will become a likely significant component of the proposed Advanced Specialist Certificate. A list of Centres throughout Europe has been collected but consideration may be given to other International Fellowships. The minimum time period is three months but this may include training for shorter periods in several centres.
• Disclaimer
Candidates will be asked to sign a disclaimer before proceeding to the examination that they agree that the Examination Board has the final say regarding pass or fail. There shall be no Appeals process. However, there shall be no limit to the number of times that a Candidate may present for examination.
Examination
Once a candidate has been accepted for examination the following process will occur, preceding the biennial meeting or advanced instructional course.
Written MCQ
The format will be a 1 hour multiple choice questionnaire comprising 50 questions with five options. A bank of questions has been developed by the examination board and shall be reviewed and updated regularly.
Oral examination
These will be aligned to the Curriculum and shall involve 20 minute sessions with two examiners, 10 minutes each. They shall include the following topics:
• Basic science
• Paediatric
• Adult
• Trauma
• Foot and Ankle surgery
This format should allow the whole examination to take place in one day.
Certification process
Examination Pass
Once the candidate has satisfied the examiners and examination board, a pass and Certificate shall be awarded by EFAS. As previously agreed with UEMS this shall be ratified and sanctioned by UEMS.
Individual Countries
The Certificate shall be an EFAS award ratified and sanctioned by UEMS. Medico- legally, or through revalidation and recertification/licence conditions it may not be recognised initially in individual countries. However, it is expected that once established it will be seen as a benchmark in our particular area of expertise.
Honorary Certification
EFAS Council and the Certification Board have agreed that it would be appropriate to consider awarding an Honorary Certificate to European Foot and Ankle Surgeons of merit. This shall be drawn from the previous list of Executive and Council Members who were democratically elected and who have been active in EFAS and its committees.
Fees / Costs
Fees
These shall be determined by the examination board in conjunction with the Honorary Treasurer. An initial fee of €850 has been recommended.
Examination Entry Criteria
Entry criteria
• Post Basic Trauma and Orthopaedic Examination and Training
All candidates shall provide evidence of completion of the relevant Basic Trauma and Orthopaedic Examination and Training Certificate for their country of origin and shall have been in a Consultant Orthopaedic Foot and Ankle post or equivalent for at least 5 years.
• Logbook
A complete logbook of surgical cases shall be required preferably electronically for ratification by the examination board before proceeding to the examination.
• Knowledge Base and Practical Skills
This is discussed and clarified in detail in the section on CURRICULUM. However, candidates will be expected to maintain a high standard of knowledge and practical skills in the field of Trauma and Orthopaedic Foot and Ankle Surgery.
EFAS criteria
It has been agreed that the following additional EFAS criteria are required.
• Meetings
Evidence of attendance at 3 EFAS meetings shall be required. EFAS currently has Basic Instructional Courses, Cadaver Courses, and an Annual Meeting or Advanced Instructional Course each year. Ideally the candidate shall have attended each of these courses but variations may be acceptable and the final decision about proceeding to sit the examination shall be determined by the Examination Board.
• Publications
Evidence of at least two international publications in appropriate Journals on Foot and Ankle Surgical topics shall be required. Preference shall be given to those publishing in the Journal of the European Foot and Ankle Society.
• Fellowships
Evidence of appropriate Fellowship training in a Foot and Ankle Surgery Centre of Excellence is desirable but not mandatory at present. The Certification Board recognises that this is very variable depending on the country of origin of candidates and would not wish to disadvantage some EFAS members. The final decision shall rest with the Examination Board. However, in the future as the Certificate develops this will become a likely significant component of the proposed Advanced Specialist Certificate. A list of Centres throughout Europe has been collected but consideration may be given to other International Fellowships. The minimum time period is three months but this may include training for shorter periods in several centres.
• Disclaimer
Candidates will be asked to sign a disclaimer before proceeding to the examination that they agree that the Examination Board has the final say regarding pass or fail. There shall be no Appeals process. However, there shall be no limit to the number of times that a Candidate may present for examination.
Curriculum
CURRICULUM FOR CERTIFICATION IN TRAUMA AND ORTHOPAEDIC FOOT AND ANKLE SURGERY IN EUROPE
Introduction
The purpose of this curriculum is to provide a basis for the certification of young trainee trauma and orthopaedic surgeons specialising in foot and ankle management and surgery. It is clear that there may be a case for separating trauma and elective foot and ankle surgery but they are quite significantly intertwined and although the emphasis may be different in different countries it has been deemed appropriate to provide this certification across the speciality. A similar case may be made about separating paediatric conditions eg. CTEV from adult conditions but, again, there is a continuum in to adult life and a basic understanding is invaluable to the adult foot and ankle surgeon treating their subsequent effects.
General Principles
The satisfactory practice of Trauma and Orthopaedic Foot and Ankle Surgery involves taking an adequate history, performing a thorough examination (evaluation), requesting appropriate confirmatory diagnostic tests and thereafter providing a comprehensive explanation of the conservative and surgical options available to the patient.
General knowledge may be obtained from relevant Books, Journals and Publications but it is accepted that some will be country dependent, and some generally available.
In addition, it has been suggested that further specific training in a Centre of Excellence or Fellowship Centre with a clinical supervisor would be complimentary to this curriculum with a minimum of 50 CME points over two years in foot and ankle surgery and a minimum of 2 peer reviewed foot and ankle papers in international journals. This is discussed elsewhere.
Evidence that the applicant has fulfilled these criteria shall be required and confirmation that they may proceed shall be determined by the examination board on an individual basis as previously outlined.
The following is a guide to the topics, which are likely to be encountered but is not intended to be exhaustive and is subject to change. It covers Basic Science applied to the Ankle and Foot, Paediatric, Adult Orthopaedic and Traumatic Foot and Ankle Surgery.
Basic Science
• Anatomy
Clinical and functional anatomy with pathological and operative relevance to the foot and ankle, anatomy of the nervous and vascular systems in the foot and ankle including surface markings, surgical approaches to the foot and ankle, bones and articulations, ligamentous structures (ankle, hindfoot, midfoot, forefoot, plantar fascial and MTP anatomy, tendon anatomy and muscle compartments in the foot.
• Biomechanics/Bioengineering/Prosthetics and Orthotics
Function of the lower limb and foot in gait including kinematics and gait analysis, ankle and subtalar joint biomechanics, plantar fascial mechanisms, tendon function, biomaterials, implant design and implant failure, tribology of natural and artificial joints, principles of design of prosthetics/orthotics, prescription and fitting of standard prostheses, principles of orthotic bracing for control of disease, deformity and instability, orthoses and footwear.
• Research and Audit
Design and performance of clinical trials, data analysis and statistics (principles and applications), principles of epidemiology and statistics and audit.
• Medical Ethics
Duties of care, informed consent and medical negligence.
Pathology
• General
Osteoarthritis (primary and secondary), osteoporosis/osteopaenia, metabolic bone disease, rheumatoid arthritis and other poly-arthropathy, inherited musculoskeletal disorders, neuromuscular disorders (inherited and acquired) and osteochondral lesions.
• Neuropathy/Neurological disorders
Diabetic foot, Charcot neuro-arthropathy, Morton’s neuroma, Nerve entrapment eg tarsal tunnel syndrome. neurological foot deformity, neuropathic joint and skin changes.
• Tumours
Knowledge of the presentation, radiological and pathological features, treatment and outcome for common benign and malignant tumours in the foot and ankle. Knowledge of the presenting features, management and outcome of soft tissue lesions including sarcomas.
• Specific
o Ankle and Hindfoot
Hindfoot pain, ankle instability, heel pain, degenerative disease of the ankle, rheumatoid arthritis, osteochondral lesions of the talus.
o Forefoot Disorders
Hallux valgus, hallux rigidus, lesser toe deformities, metatarsalgia, inflammatory arthropathy.
o Complex Foot and Ankle Deformity
Flatfoot deformity (mobile and rigid, childhood and adult acquired), cavus and cavo- varus deformity, residual congenital foot deformity.
Investigation
Relevant blood tests, musculoskeletal imaging: x-ray, contrast studies (arthrography), CT, MRI, ultrasound, radioisotope studies, effects of radiation, bone densitometry, electrophysiological investigation.
• Radiographs
Standard foot and ankle radiographs, additional foot and ankle radiographs.
• CT, MRI, Ultrasound and Nuclear Medicine
Knowledge of the role of these ancillary investigations in certain specific conditions eg. Infection, tumour, tibialis posterior dysfunction, osteonecrosis.
• Electrophysiology
Relevance to foot and ankle disorders.
Management
Non-operative
Prosthetics and orthotics, footwear, physiotherapy, medical podiatry.
Operative
• General
A detailed knowledge of closed and operative methods for the management of fractures and dislocations of the ankle, hindfoot, midfoot and forefoot.
A detailed knowledge of common reconstructive surgical procedures for foot deformity for example hallux valgus, lesser toe deformity, acquired adult flat foot include arthroplasty, arthrodesis, osteotomy and soft tissue reconstruction
Knowledge of common amputations in the foot and ankle
Knowledge of common reconstructive surgical procedures for degenerative and inflammatory disorders of the ankle and foot including arthrodesis, arthroplasty and excision arthroplasty and interventions in the first ray both proximal and distal for the management of hallux valgus and rigidus
• Operative Topics
Tourniquets (thigh and calf), design of theatres, skin preparation, anaesthesia (principles and practice of local and regional anaesthesia and principles of general anaesthesia).
• Infection, VTE and Pain
Infections of bone, joint, soft tissue, including TB, and their prophylaxis, sterilisation, VTE (prophylaxis and bleeding risk), behavioural dysfunction and somatisation, AIDS and surgery in high-risk cases, pain and pain relief, complex regional pain syndromes eg RSD, compartment syndrome in the foot and ankle.
Trauma
• Wound Management
It is considered that a detailed knowledge of plastic surgical techniques is not required but it is appropriate to have a basic understanding of the following:
Free flap, full thickness skin graft, muscle flap, nerve repair, pedicle flap, transpositional flap, split skin graft, wound closure (delayed primary or secondary), wound debridement, removal of foreign body from skin or subcutaneous tissue.
• Tibia and Fibula
It is considered that a detailed knowledge of the following surgical techniques is not required by some practising orthopaedic foot and ankle surgeons but it is appropriate to have a basic understanding of the following:
Diaphyseal tibial fractures external fixation (including frame), diaphyseal tibial fractures intramedullary nailing, diaphyseal tibial fractures MUA and POP, tibial shaft plating, tibial non-union, tibial non-union circular frame management, tibial non-union intramedullary nailing +/- bone graft.
• Ankle
Ankle fracture/dislocation classification (Lauge-Hansen, Weber, AO), ankle fracture/dislocation MUA and POP, ankle fracture/dislocation ORIF, Pilon fracture, Pilon fracture ORIF, Pilon fracture with circular frame, Tendo Achilles (Percutaneous, open).
• Foot
Amputation toe/ ray for trauma, calcaneal fracture (ORIF, external fixation, arthroscopically assisted, minimally invasive), talar fracture (ORIF), metatarsal fracture ORIF eg Jones fracture, phalangeal fracture MUA +/- K wire +/- ORIF, talar, subtalar or midtarsal fracture/dislocation, talar, subtalar or midtarsal fracture/dislocation MUA +/- POP +/- K wires, talar, subtalar or midtarsal fracture/dislocation ORIF
Elective
• Elective – Nonspecific
Aspiration/injection joint, benign tumour excision, biopsy bone (needle, open), bursa excision, ganglion excision, bone cyst curettage +/- bone graft, malignant tumour excision.
• Ankle
Supramalleolar osteotomy, arthrodesis ankle (open or arthroscopic), arthroplasty ankle, arthroscopy ankle diagnostic (anterior and posterior approaches), arthroscopy ankle therapeutic eg talar osteochondral lesions, arthrotomy ankle, ankle instability including medial and lateral ligament reconstruction and repair, subtalar arthrodesis (open or arthroscopic), triple arthrodesis (open or arthroscopic), Choparts arthrodesis, decompression or reconstruction of tendons at the ankle eg. Tibialis posterior dysfunction (FDL transfer, Cobb reconstruction and allied procedures), tendon transfers, dislocation of the peroneal tendons – relocation, Tendo Achilles surgery including late repair, decompression and lengthening.
• Foot
Amputation toe /ray, Calcaneal osteotomy, CTEV correction, Ponseti management, spring ligament reconstruction, plantar fascial reconstruction, repair or release, midfoot arthrodesis including medial column shortening and lateral column lengthening, wedge tarsectomy, first metatarsal osteotomy – proximal (including Lapidus), distal, Scarf, proximal phalangeal osteotomy (Akin), first MTPJ cheilectomy, first MTPJ arthrodesis, first MTPJ excision arthroplasty, first MTPJ soft tissue correction, lesser metatarsal osteotomy, elongation or shortening of metatarsals, lesser toe arthrodesis eg hammer toe, curly toe, clawed toe, lesser toe excision part/all phalanx, lesser toe tenotomy, fifth toe soft tissue correction, bunionette surgery, surgical management Morton’s neuroma, surgical management Freiberg’s disease, forefoot reconstruction and arthroplasty, tendon decompression or repair, tendon transfers, minimally invasive surgery in the foot and ankle.
Ingrowing toenail surgery. It is accepted that this condition may not be treated by Orthopaedic Foot and Ankle Surgeons throughout Europe.
Routes to Eligibility for the EFAS Examination
The EFAS Certificate in Trauma and Orthopaedic Foot and Ankle Surgery represents the highest standard of excellence in foot and ankle surgery in Europe. The certificate has been developed and is organised by the European Foot and Ankle Society (EFAS) with the aim of promoting excellence in patient care, education, and professional development within the specialty.
The certification programme is open to certified orthopaedic surgeons and trauma surgeons who demonstrate a specific and sustained interest in foot and ankle surgery.
By decision of the EFAS Council, the EFAS Certificate is also open to non-EFAS members and international applicants, provided that they fulfil the same training, experience, and eligibility criteria as EFAS members. Applicants accepted through this pathway agree to formally apply for official EFAS membership as part of the certification process.
The EFAS Certificate is fully aligned with the requirements and principles of the Union Européenne des Médecins Spécialistes (UEMS). Adherence to these criteria is essential to safeguard the integrity of the EFAS Certificate as a protected quality label and to ensure its recognition at the European level.
The EFAS Certification Programme evaluates not only theoretical knowledge and clinical competence, but also continuous professional development, academic engagement, and structured progression within foot and ankle surgery. Final eligibility and admission to the examination remain under the authority of the EFAS Certification Committee.
1. Traditional Route (as published on EFAS.net)
The traditional route is intended for experienced orthopaedic surgeons and trauma surgeons with established clinical practice in foot and ankle surgery. Candidates must fulfil the established EFAS eligibility criteria, including:
- Completion of a recognised orthopaedic or trauma surgery training programme,
- A minimum of five years of professional activity as a certified orthopaedic or trauma surgeon with a specific interest and dedicated clinical practice in foot and ankle surgery,
- Submission of a validated surgical logbook documenting a broad spectrum of foot and ankle procedures,
- Participation in relevant educational activities and sufficient independent clinical exposure within the specialty,
- A minimum of two peer-reviewed scientific publications in the field of foot and ankle surgery.
Following approval of eligibility by the EFAS Certification Committee, candidates may proceed to the formal EFAS examination, consisting of a written component and an oral (viva) examination.
2. Curriculum-Based Route (effective from 2026)
In addition to the traditional route, a second, curriculum-based route has been developed. This route has been formally approved by the EFAS Council and will commence in 2026. It is designed to prospectively follow candidates within a structured educational framework, enabling progressive learning, early EFAS engagement, and transparent competency development over time. This pathway is particularly suited to younger orthopaedic and trauma surgeons with a dedicated interest in foot and ankle surgery.
The requirements for the curriculum-based route include:
- Participation in a minimum of five EFAS-recognised cadaveric courses, completed over a minimum period of two years.
EFAS cadaveric courses are organised according to five recurring core modules, all of which are mandatory and must be successfully completed:
- Forefoot
- Hindfoot
- Ankle osteoarthritis
- Sports-related foot and ankle pathology
- Minimally invasive foot and ankle surgery
These five core modules are complemented by biannually organised specialised topics, allowing candidates to broaden, update, and deepen their surgical exposure in focused areas of foot and ankle surgery.
EFAS-recognised cadaveric courses include EFAS-organised courses as well as externally organised cadaveric courses that have received formal EFAS recognition. A maximum of two externally organised cadaveric courses covering identical or overlapping topics may be accepted, provided that these courses are organised exclusively by EFAS National Membership Societies.
Such externally organised cadaveric courses will be evaluated jointly by the EFAS Certification Committee and the relevant National Membership Societies. Approved courses will be published on the EFAS website to ensure transparency and uniform application of recognition criteria.
Repetition of identical cadaveric modules shall not be considered eligible and will not be counted toward the mandatory requirements. Each completed module must represent a distinct educational component ensuring adequate diversity, progression, and comprehensive surgical exposure.
- Attendance at EFAS Instructional Courses and EFAS Congresses.
- Provision of a structured surgical logbook, documenting specific foot and ankle procedures, which will be reviewed by the EFAS Certification Committee as part of the overall assessment of clinical exposure and progression.
- Participation in the EFAS Fellowship Programme is not mandatory within the curriculum-based route. However, successful completion of an EFAS Fellowship constitutes a strong supporting factor in the evaluation of a candidate’s clinical maturity, technical skills, and readiness for the EFAS examination.
- Submission of a formal written letter of recommendation, preferably from an EFAS Fellowship Supervisor or another recognised senior foot and ankle surgeon, confirming that the candidate demonstrates appropriate surgical skills, clinical judgement, and professional conduct consistent with EFAS standards.
Entry into the curriculum-based route is possible from the moment a candidate participates in an EFAS-recognised cadaveric course, at which point formal curriculum-based monitoring begins. Applicants must clearly indicate the route through which they apply. Transition between routes may be considered on an individual basis but requires formal review and approval by the EFAS Certification Committee.
Through these two complementary routes, EFAS combines flexibility with strict quality assurance, thereby reinforcing the EFAS Certificate as a leading European quality standard in trauma and orthopaedic foot and ankle surgery.