6–8 Week Preparation Guide

Certifying Body: Wound, Ostomy and Continence Nursing Certification Board (WOCNCB)

Exam: Certified Foot Care Nurse (CFCN)

Format: Computer-based, multiple choice; 120 questions

Time: 120 minutes (2 hours)

Prerequisites: Active RN license (unencumbered) + 24 CE credits + 40 clinical hours in foot care, all within the past 5 years; completion of a WOCNCB-approved or equivalent foot care nursing education program

Cost: ~$395 (verify at wocncb.org)

Validity: 5 years; recertification via continuing education or re-examination

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About the Exam

The CFCN validates specialized knowledge in assessment, diagnosis, and management of foot conditions across the lifespan. Certified foot care nurses work in hospitals, long-term care, home health, podiatry offices, wound care centers, and community health.

Exam Content Domains (per WOCNCB)

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Week-by-Week Study Plan

Weeks 1–2: Anatomy, Physiology & Assessment of the Foot

Goal: Build comprehensive foot anatomy knowledge

Key Topics — Anatomy & Physiology:

• •Foot structure: 26 bones, 33 joints, 100+ tendons/ligaments/muscles
• •Bone groups: tarsals (7), metatarsals (5), phalanges (14)
• •Key tarsals: calcaneus (heel), talus, navicular, cuboid, cuneiforms (3)
• •Arches: medial longitudinal, lateral longitudinal, transverse
• •Muscle compartments: anterior, lateral, superficial posterior, deep posterior
• •Innervation: tibial nerve, deep peroneal, superficial peroneal, sural, saphenous nerves
• •Blood supply: dorsalis pedis artery, posterior tibial artery, perforating peroneal artery
• •Venous and lymphatic drainage
• •Skin anatomy: epidermis, dermis, subcutaneous tissue; nail structure (matrix, bed, plate, cuticle, lunula)

Key Topics — Assessment:

• •Comprehensive foot assessment: inspection, palpation, neurological testing
• •Vascular assessment:
• •Dorsalis pedis pulse palpation
• •Posterior tibial pulse palpation
• •Capillary refill time (normal <3 seconds)
• •Ankle-Brachial Index (ABI): normal 0.91–1.30; PAD <0.90; critical <0.40
• •Toe pressures and TcPO2
• •Neurological assessment:
• •Semmes-Weinstein 5.07 monofilament (10g) testing — standardized sites
• •Vibration sense (128 Hz tuning fork on bony prominence)
• •Temperature discrimination
• •Proprioception
• •Dermatological assessment: skin color, temperature, moisture, lesions, calluses, corns, fissures
• •Nail assessment: thickness, color, curvature, fungal changes, ingrown toenails
• •Musculoskeletal assessment: gait, deformities, ROM
• •Footwear assessment: fit, wear patterns, appropriateness

Daily Schedule (2 hours/day):

• •Week 1, Days 1–3: Foot anatomy — bones, joints, muscles, arches
• •Week 1, Days 4–5: Neurovascular anatomy — arteries, nerves, blood supply
• •Week 1, Days 6–7: Nail and skin anatomy; review & quiz
• •Week 2, Days 1–3: Vascular assessment techniques (ABI, pulses, capillary refill)
• •Week 2, Days 4–5: Neurological assessment (monofilament, vibration, tuning fork)
• •Week 2, Days 6–7: Comprehensive foot exam practice; review & quiz

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Weeks 3–4: Common Foot Pathology & Diagnosis

Goal: Recognize and differentiate common foot conditions

Key Topics — Dermatological Conditions:

• •Tinea pedis (athlete’s foot): fungal infection; interdigital, moccasin, vesicular types
• •Onychomycosis: fungal nail infection; dystrophic, thickened, discolored nails
• •Corns: heloma durum (hard), heloma molle (soft), heloma milliare (seed) — on toes
• •Calluses: hyperkeratosis on plantar surface (metatarsal heads, heels)
• •Plantar warts: viral (HPV); distinguish from calluses by presence of black dots (thrombosed capillaries), disruption of skin lines
• •Fissures: cracked skin, common on heels; risk for infection
• •Blisters: friction-related

Key Topics — Musculoskeletal Conditions:

• •Hallux valgus (bunion): lateral deviation of great toe at MTP joint
• •Hallux rigidus: limited ROM at 1st MTP joint (osteoarthritis)
• •Hammertoe: flexion deformity at PIP joint
• •Claw toe: hyperextension at MTP, flexion at PIP and DIP
• •Mallet toe: flexion deformity at DIP joint
• •Flatfoot (pes planus): collapsed medial longitudinal arch
• •High arch (pes cavus): excessive arch; increased plantar pressure at heel and metatarsal heads
• •Metatarsalgia: pain in ball of foot
• •Morton’s neuroma: thickening of tissue around digital nerve (usually between 3rd and 4th metatarsals)
• •Charcot foot/neuropathic arthropathy: progressive joint destruction in neuropathic patients; Eichenholtz stages

Key Topics — Vascular Conditions:

• •Peripheral arterial disease (PAD): intermittent claudication, rest pain, pallor, cool skin, hair loss, delayed capillary refill
• •Chronic venous insufficiency (CVI): edema, hemosiderin staining (brown skin), stasis dermatitis, venous ulceration
• •Deep vein thrombosis (DVT): unilateral swelling, pain, warmth, positive Homan’s sign (unreliable)
• •Diabetic foot: neuropathy + vasculopathy = high risk; Wagner classification (Grade 0–5)

Key Topics — Nail Conditions:

• •Ingrown toenail (onychocryptosis): nail plate grows into lateral nail fold
• •Subungual hematoma: blood under nail from trauma
• •Nail psoriasis: pitting, oil-drop discoloration, onycholysis
• •Paronychia: infection of nail fold (acute vs. chronic)

Daily Schedule (2 hours/day):

• •Week 3, Days 1–3: Dermatological conditions — presentation, diagnosis, differentiation
• •Week 3, Days 4–5: Musculoskeletal conditions — deformities, biomechanical causes
• •Week 3, Days 6–7: Vascular conditions — PAD, CVI, diabetic foot; quiz
• •Week 4, Days 1–2: Nail pathology — ingrown nails, fungal, trauma
• •Week 4, Days 3–4: Diabetic foot syndrome — comprehensive review (neuropathy, PAD, ulceration, Charcot)
• •Week 4, Days 5–7: Differential diagnosis practice scenarios; review & quiz

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Weeks 5–6: Plan of Care & Management

Goal: Develop evidence-based management skills

Key Topics — General Foot Care:

• •Nail care techniques: straight-cut technique, filing, pincer nail management
• •Callus/corn reduction: safe debridement techniques, contraindications
• •Skin care: moisturizing (urea-based creams), avoiding interdigital moisture
• •Foot hygiene: daily washing, thorough drying, appropriate moisturizer application

Key Topics — Wound Management:

• •Wound assessment: size, depth, tissue type, exudate, periwound skin
• •Ulcer classification:
• •Wagner (diabetic): Grade 0 (intact) through Grade 5 (whole foot gangrene)
• •University of Texas Classification (for diabetic ulcers)
• •Offloading: total contact casting (TCC), removable cast walkers, therapeutic footwear, felted foam
• •Wound dressings: hydrogel, foam, alginate, hydrocolloid, antimicrobial
• •Sharp debridement: indications, contraindications, technique basics
• •Negative pressure wound therapy (NPWT) indications

Key Topics — Vascular Management:

• •PAD management: exercise therapy, smoking cessation, antiplatelet therapy, statins, revascularization
• •CVI management: compression therapy (contraindicated if ABI <0.5), elevation, skin care
• •Compression bandaging: Unna boot, multi-layer compression (4-layer)
• •When to refer: ABI <0.5, gangrene, critical limb ischemia, acute DVT

Key Topics — Footwear & Orthotics:

• •Proper shoe fitting: width, depth, toe box, heel counter
• •Therapeutic footwear for diabetic patients: extra-depth shoes, custom molded shoes
• •Orthotic devices: metatarsal pads, arch supports, heel cups
• •Socks: moisture-wicking, seamless, non-constricting

Key Topics — Pharmacology (Foot Care Relevant):

• •Antifungal agents: topical (clotrimazole, terbinafine) and oral (terbinafine, itraconazole)
• •Analgesics: acetaminophen, NSAIDs, neuropathic pain agents (gabapentin, pregabalin, duloxetine)
• •Antimicrobials for foot infections: empirical coverage, culture-directed therapy

Daily Schedule (2 hours/day):

• •Week 5, Days 1–3: Nail care, skin care, callus/corn management techniques
• •Week 5, Days 4–5: Wound care — assessment, classification, dressing selection
• •Week 5, Days 6–7: Offloading strategies, therapeutic footwear; quiz
• •Week 6, Days 1–3: Vascular management — compression, PAD interventions, referral criteria
• •Week 6, Days 4–5: Pharmacology review for foot care
• •Week 6, Days 6–7: Case study practice; review & quiz

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Weeks 7–8: Education, Professional Practice & Comprehensive Review

Goal: Complete knowledge integration; exam readiness

Key Topics — Patient Education:

• •Diabetic foot care education: daily self-inspection, proper nail care, appropriate footwear, when to seek care
• •Peripheral neuropathy precautions: avoid hot water, check bath temperature, no heating pads on feet
• •Fall prevention strategies
• •Smoking cessation counseling
• •When to contact provider: new wounds, signs of infection (redness, warmth, swelling, drainage, fever)
• •Health literacy considerations: teach-back method, visual aids, culturally appropriate materials

Key Topics — Professional Practice:

• •Scope of practice for CFCN vs. podiatrist vs. other providers
• •Interdisciplinary collaboration: podiatrists, vascular surgeons, endocrinologists, orthotists
• •Documentation standards: objective assessment, wound measurements, plan of care
• •Evidence-based practice: current guidelines (ADA foot care guidelines, IWGDF guidelines)
• •Quality improvement in foot care programs

Key Topics — Special Populations:

• •Geriatric foot care: aging skin, decreased vision, mobility limitations, polypharmacy
• •Pediatric foot considerations: developmental milestones in walking, flat foot normal in young children
• •Immunocompromised patients: heightened infection risk
• •Patients on anticoagulants: increased bleeding risk with nail care/debridement

Daily Schedule (2 hours/day):

• •Week 7, Days 1–3: Patient education strategies, health literacy, special populations
• •Week 7, Days 4–5: Professional practice, scope of practice, documentation, guidelines
• •Week 7, Days 6–7: Full-length practice exam #1; review incorrect answers
• •Week 8, Days 1–2: Targeted review of weakest areas from practice exam
• •Week 8, Days 3–4: Full-length practice exam #2; review
• •Week 8, Days 5–6: Final review — mnemonics, classifications, key measurements, referral criteria
• •Week 8, Day 7: REST. Trust your preparation.

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Test-Taking Tips

1. Think like a nurse AND a foot specialist — patient safety and evidence-based care are the lens for every question
2. ABI interpretation is high-yield — know normal, borderline, PAD, and severe PAD ranges
3. Monofilament testing details — know the 5.07/10g monofilament, standardized sites, what constitutes loss of protective sensation
4. Know referral criteria cold — when to escalate to podiatry, vascular surgery, or emergency care
5. Diabetic foot questions are heavily tested — understand the neuropathic vs. ischemic foot
6. Wagner classification — memorize all grades and their clinical descriptions
7. Compression therapy — know indications AND contraindications (ABI <0.5)
8. Read questions carefully — “MOST appropriate,” “FIRST action,” “BEST response” are common qualifiers
9. Eliminate obviously wrong answers — usually 2 can be eliminated quickly
10. Manage your time — don’t spend more than 90 seconds on any single question; flag and return

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Key Classifications to Memorize

ABI Interpretation:

• •1.0–1.3: Normal
• •0.9–0.99: Borderline
• •0.5–0.89: Mild to moderate PAD
• •<0.5: Severe PAD
• •<0.3: Critical limb ischemia
• •>1.3: Calcification (consider toe pressures)

Wagner Classification (Diabetic Foot):

• •Grade 0: Intact skin
• •Grade 1: Superficial ulcer
• •Grade 2: Deep ulcer to tendon/capsule
• •Grade 3: Deep ulcer with abscess/osteomyelitis
• •Grade 4: Localized gangrene
• •Grade 5: Extensive gangrene

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Recommended Resources

Primary:

• •WOCNCB CFCN Candidate Handbook and Exam Content Outline (wocncb.org)
• •Foot Care Nursing: A Comprehensive Guide — relevant WOCN text
• •WOCN Society foot care resources and position papers

Supplementary:

• •Skin and Soft Tissue Diseases: An Illustrated Guide — Wound Care Society
• •Wound, Ostomy and Continence Nurses Society Core Curriculum: Wound Management
• •International Working Group on the Diabetic Foot (IWGDF) Guidelines — iwgdfguidelines.org
• •American Diabetes Association Standards of Care (foot care chapter)

Free Resources:

• •IWGDF Guidelines (free download at iwgdfguidelines.org)
• •ADA Standards of Medical Care in Diabetes (diabetes.org)
• •WOCN Society clinical resources

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Sources

• •Wound, Ostomy and Continence Nursing Certification Board (WOCNCB) — wocncb.org
• •WOCNCB CFCN Examination Content Outline
• •American Diabetes Association — Standards of Care in Diabetes (current year)
• •International Working Group on the Diabetic Foot (IWGDF) — Practical Guidelines
• •Wound, Ostomy and Continence Nurses Society (WOCN) — Core Curriculum
• •Lipsky, B.A. et al. “IWGDF Guidelines on the Diagnosis and Treatment of Foot Infection in Persons with Diabetes”