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The American Board of Orthopaedic Surgeons (ABOS) has integrated Maintenance of Certification process to ensure continued physician education and improved clinical performance. The purpose of this study was to evaluate overall change in complication rates for foot and ankle (FA) procedures by surgeons seeking board recertification (BRC) to initial board certifiers (IBC) using ABOS case lists. The ABOS database and case list was reviewed from January, 2006 to December, 2010 for the most commonly performed FA procedures as indicated by current procedural terminology codes (27600-28899; 29893-29907) by 2 distinct groups: (1) those seeking their IBC, and (2) those seeking their BRC. The 15 most common FA procedural codes were identified and complications reported from these codes were tallied and recorded. The 15 most commonly reported procedures comprised 8 traumatic and 7 elective procedures. There was a statistically significant difference of cases reporting at least 1 complication from IBC compared with BRC (14.5% vs. 9.9%, P<0.001). All rates were significantly less (P<0.001) in BRC versus IBC for infection (2.3% vs. 3.8%), wound dehiscence (1.6% vs. 3.0%), skin ulcer/blister (0.9% vs. 1.8%), implant fracture (0.2% vs. 1.0%), pulmonary embolus/deep vein thrombosis (0.4% vs. 0.8%), nerve injury (0.3% vs. 0.8%), iatrogenic bone fracture (0.01% vs. 0.3%). There was a significant overall reduction in the complication rates, both collectively and individually for BRC compared with IBC. Continued efforts to collect and analyze cross-sectional data could be useful in designing customized risk-reduction programs and monitoring surgeon practice performance.Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.