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Quality perioperative management encompasses 2 primary goals: treatment efficacy and patient safety. Central to patient safety is protection from adverse outcome, and entails reduction of complications. The purpose of this study was to accurately identify the most common complications and characterize their incidence to better direct current practice improvement initiatives and preventative care. We searched the American Board of Orthopaedic Surgeons database from January 2006 to December 2010 for the most commonly performed foot and ankle procedures as indicated by CPT codes (27600-28899; 29893-29907). The 10 most frequently performed procedures were identified and the “Surgical (or Medical) Unspecified” free text associated with each complication was read, interpreted, categorized, and tallied. We quantified the incidence of complications associated with (a) each procedure individually; (b) for the 10 most common procedures; and (c) for all procedures cumulatively. A total of 56,786 total foot and ankle codes were reported by 2970 orthopedic surgeons seeking certification. The 10 most commonly reported procedures accounted for 46% of all CPT codes logged. Infection was the most common overall complication (3.7%) and the most often reported adverse event among 9 of the top 10 procedures performed. Improving patient safety and avoiding adverse events requires an accurate picture of the incidence of complications after individual procedures that can be used to design customized risk-reduction programs and monitor their successive impact. Comprehensive databases can be a valuable tool to enhance practice improvement within the Maintenance of Certification initiative.Level of Evidence: Diagnostic Level III—retrospective review. See Instructions for Authors for a complete description of levels of evidence.