100+ Free CTSF Practice Questions

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Which of the following is the MOST common reason patients with diabetes require therapeutic shoes?

Cosmetic appearance

Prevention of foot ulcers due to peripheral neuropathy

Correction of leg length discrepancy

Treatment of plantar warts

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2026 Statistics

Key Facts: CTSF Exam

100

Exam Questions

Multiple-choice, CBT

2 hrs

Time Limit

Computer-based

$265

Total Cost

$80 app + $185 exam

125

Clinical Hours Required

Supervised experience

Max Attempts

Within 3-year period

5 yr

Certification Cycle

CE credits required

The ABC Therapeutic Shoe Fitter exam is a 100-question, 2-hour computer-based test offered at 600+ test centers or via remote proctoring through Meazure Learning. Candidates must complete an ABC-approved pre-certification course and 125 hours of supervised clinical experience. The exam is offered every other month with a $185 exam fee and $80 application fee. Up to 4 attempts are allowed within a 3-year eligibility period.

Sample CTSF Practice Questions

Try these sample questions to test your CTSF exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which of the following is the MOST common reason patients with diabetes require therapeutic shoes?

A.Cosmetic appearance

B.Prevention of foot ulcers due to peripheral neuropathy

C.Correction of leg length discrepancy

D.Treatment of plantar warts

Explanation: Peripheral neuropathy is the most common complication leading to therapeutic shoe needs in diabetic patients. Loss of protective sensation allows repetitive trauma and pressure injuries to go unnoticed, eventually leading to ulceration. Therapeutic shoes with accommodative inserts redistribute pressure and reduce shear forces, serving as a primary prevention strategy against diabetic foot ulcers.

2During a Semmes-Weinstein monofilament test, which filament size is used to assess loss of protective sensation in diabetic patients?

A.4.17 (1 gram)

B.5.07 (10 gram)

C.6.10 (75 gram)

D.3.61 (0.4 gram)

Explanation: The 5.07 (10-gram) Semmes-Weinstein monofilament is the standard tool for assessing loss of protective sensation (LOPS) in diabetic patients. Inability to feel this monofilament at designated plantar sites indicates significant neuropathy and elevated risk for foot ulceration. This test is quick, inexpensive, and a cornerstone of diabetic foot screening protocols.

3What is the primary purpose of a multi-density insert in a therapeutic shoe?

A.To increase the height of the patient

B.To redistribute plantar pressure away from high-risk areas

C.To improve the aesthetic appearance of the shoe

D.To replace the need for proper shoe fitting

Explanation: Multi-density inserts are designed with varying densities of material to redistribute plantar pressure away from bony prominences and areas at risk for ulceration. Softer materials are placed under high-pressure areas to absorb force, while firmer materials provide structural support. This pressure redistribution is the primary mechanism for preventing diabetic foot ulcers in at-risk patients.

4Under the Medicare Therapeutic Shoe Program, how many pairs of therapeutic shoes is a qualifying patient entitled to per calendar year?

A.Two pairs

B.One pair

C.Three pairs

D.Unlimited pairs

Explanation: Under the Medicare Therapeutic Shoe Program (also known as the Therapeutic Shoe Bill), qualifying diabetic patients are entitled to one pair of depth-inlay shoes (or one pair of custom-molded shoes if medically necessary) and three pairs of multi-density inserts per calendar year. This benefit is designed to provide adequate protective footwear and accommodate the need for insert replacement due to material compression over time.

5Which foot deformity is characterized by collapse of the midfoot arch due to weakened bones and joints, often seen in patients with diabetic neuropathy?

A.Hallux valgus

B.Charcot foot (Charcot neuroarthropathy)

C.Hammer toe

D.Pes cavus

Explanation: Charcot foot (Charcot neuroarthropathy) is a progressive, destructive condition affecting the bones and joints of the foot, most commonly the midfoot. It occurs in patients with peripheral neuropathy, particularly from diabetes. The combination of sensory loss, continued weight-bearing, and weakened bone structure leads to fractures, dislocations, and eventual collapse of the arch into a rocker-bottom deformity.

6Which of the following signs would indicate peripheral vascular disease during a patient foot evaluation?

A.Warm, well-perfused skin with strong pedal pulses

B.Absent or diminished pedal pulses, cool skin, and loss of hair on the lower extremity

C.Excessive sweating on the plantar surface

D.Full range of motion at the ankle joint

Explanation: Peripheral vascular disease (PVD) presents with characteristic signs of reduced blood flow to the lower extremities. Absent or diminished dorsalis pedis and posterior tibial pulses, cool skin temperature, trophic changes (loss of hair, thin shiny skin), delayed capillary refill, and pallor on elevation are hallmark findings. Recognizing PVD is critical because impaired circulation significantly affects wound healing and increases amputation risk.

7When fitting a therapeutic shoe for a patient with a Charcot foot deformity, which shoe type is MOST appropriate?

A.Standard off-the-shelf athletic shoe

B.Custom-molded shoe

C.Dress shoe with a narrow toe box

D.Open-toed sandal

Explanation: Custom-molded shoes are most appropriate for Charcot foot deformity because they are fabricated from a model (cast or scan) of the patient's foot, accommodating the unique shape changes caused by the deformity. The rocker-bottom or other irregular contours of a Charcot foot cannot be adequately accommodated by standard depth shoes. Custom-molded shoes provide total contact, reduce focal pressure areas, and prevent skin breakdown.

8How many pairs of multi-density inserts is a qualifying patient entitled to per calendar year under the Medicare Therapeutic Shoe Program?

A.One pair

B.Two pairs

C.Three pairs

D.Four pairs

Explanation: The Medicare Therapeutic Shoe Program provides qualifying diabetic patients with three pairs of multi-density inserts per calendar year, along with one pair of therapeutic shoes. The three pairs account for the gradual compression and breakdown of insert materials with use, ensuring that pressure redistribution effectiveness is maintained throughout the year. Patients should rotate inserts and replace them as they lose their cushioning properties.

9Which healthcare professional must certify the medical necessity for therapeutic shoes under the Medicare Therapeutic Shoe Program?

A.Certified Therapeutic Shoe Fitter

B.Podiatrist only

C.The treating physician (MD or DO) managing the patient's diabetes

D.Any registered nurse

Explanation: Under the Medicare Therapeutic Shoe Program, the treating physician (MD or DO) who is managing the patient's systemic diabetes must certify that the patient meets the medical necessity criteria. This physician must document that the patient has diabetes and at least one qualifying condition such as peripheral neuropathy with callus, history of pre-ulcerative callus, history of foot ulceration, foot deformity, previous amputation, or poor circulation.

10What is the recommended method for measuring a patient's foot for a depth-inlay shoe?

A.Estimate size based on the patient's current shoes

B.Measure both feet while the patient is standing and weight-bearing

C.Measure one foot while the patient is seated

D.Use only the patient's reported shoe size

Explanation: Both feet should be measured while the patient is weight-bearing (standing) because feet spread and elongate under body weight. The foot is typically longer and wider during standing than when non-weight-bearing. Measuring both feet is essential because foot sizes frequently differ, and the shoe should be fitted to the larger foot. Accurate measurement is the foundation of proper therapeutic shoe fitting.

About the CTSF Exam

The CTSF (CFts) credential certifies healthcare professionals to fit non-custom therapeutic shoes and multi-density inserts for diabetic patients under the Medicare Therapeutic Shoe Program. The exam covers patient evaluation, treatment planning, shoe fitting techniques, follow-up care, and practice management.

Questions

100 scored questions

Time Limit

2 hours

Passing Score

Criterion-referenced (set by expert panel)

Exam Fee

$185 (plus $80 application fee) (ABC (American Board for Certification in Orthotics, Prosthetics & Pedorthics))

CTSF Exam Content Outline

30%

Patient Evaluation

Physical assessment, circulation evaluation, skin integrity, protective sensation testing, neuropathy screening, pain assessment, and therapeutic shoe requirements

25%

Formulation of the Treatment Plan

Shoe selection, insert recommendations, Medicare Therapeutic Shoe Program compliance, prescription interpretation, and treatment goals

25%

Implementation of the Treatment Plan

Shoe fitting techniques, modification procedures, insert fitting, patient education, proper documentation, and delivery verification

10%

Continuation of the Treatment Plan

Follow-up assessment, shoe and insert evaluation, patient compliance monitoring, outcome measurement, and referral criteria

10%

Practice Management

Medicare billing and documentation, inventory management, infection control, ethics, professional development, and regulatory compliance

How to Pass the CTSF Exam

What You Need to Know

Passing score: Criterion-referenced (set by expert panel)
Exam length: 100 questions
Time limit: 2 hours
Exam fee: $185 (plus $80 application fee)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CTSF Study Tips from Top Performers

1Focus heavily on Patient Evaluation (30% of the exam) — master vascular assessment, neuropathy screening with monofilament testing, and skin integrity evaluation

2Understand the Medicare Therapeutic Shoe Program rules thoroughly — know the qualifying conditions, coverage limits (1 pair of shoes + 3 pairs of inserts per year), and documentation requirements

3Study foot anatomy and common diabetic foot deformities including Charcot foot, hammertoes, bunions, and partial amputations

4Practice identifying when to refer patients — know the red flags for peripheral vascular disease, infection, and acute Charcot

5Master shoe fitting techniques including measuring, last selection, depth shoe features, and proper insert fitting

6Review billing and documentation requirements — proper use of HCPCS codes and prescriber certification forms

Frequently Asked Questions

What is the CTSF (CFts) certification?

The Certified Fitter-therapeutic shoes (CFts) credential is awarded by ABC (American Board for Certification in Orthotics, Prosthetics & Pedorthics). It certifies healthcare professionals to provide non-custom therapeutic shoes and non-custom multi-density inserts, primarily for diabetic patients under the Medicare Therapeutic Shoe Program.

How many questions are on the CTSF exam?

The CTSF exam consists of 100 multiple-choice questions with a 2-hour time limit. It is administered via computer-based testing (CBT) at over 600 test center locations nationwide or online with a live remote proctor through Meazure Learning.

What are the prerequisites for the CTSF exam?

You need a high school diploma (or GED/college degree), completion of an ABC-approved therapeutic shoe fitter pre-certification education course, and 125 hours of supervised therapeutic shoe fitting patient care experience. Experience must be supervised by an ABC Certified Orthotist (CO), CPO, Certified Pedorthist (C.Ped.), CFts, or professional referral source.

How much does the CTSF exam cost?

The application fee is $80 (non-refundable) and the exam fee is $185. Retake exams cost $185 each. Late applications incur an additional $100 fee. Once certified, the annual renewal fee is $150 (prorated for the first year).

What topics are covered on the CTSF exam?

The exam covers five domains: Patient Evaluation (30%), Formulation of the Treatment Plan (25%), Implementation of the Treatment Plan (25%), Continuation of the Treatment Plan (10%), and Practice Management (10%). Key topics include diabetic foot assessment, neuropathy screening, Medicare Therapeutic Shoe Program regulations, shoe fitting techniques, and documentation.

How often is the CTSF exam offered?

The CTSF exam is offered every other month (approximately 6 cycles per year). Each cycle has a two-week testing window. Applications must be submitted by the deadline, typically two months before the exam window opens. You can take the exam at a test center or online with remote proctoring.

What happens if I fail the CTSF exam?

You can re-register 24 hours after your exam for the next available exam cycle. You are eligible to take the exam a maximum of 4 times within a 3-year eligibility period. If you fail 4 times or your eligibility period expires, you must reapply for eligibility with a new application.

What is the Medicare Therapeutic Shoe Program?

The Medicare Therapeutic Shoe Program (also called the Therapeutic Shoe Bill or DMEPOS benefit) provides coverage for therapeutic shoes and inserts for Medicare beneficiaries with diabetes. It covers one pair of depth shoes and three pairs of multi-density inserts per calendar year. A physician must certify the patient has diabetes and a qualifying foot condition.

How should I prepare for the CTSF exam?

ABC recommends using the Therapeutic Shoe Fitter Practice Analysis, Test Content Outline, Reading & Reference List, and sample exam questions available on abcop.org. Complete your 125 hours of supervised patient care experience and use the Self-Assessment Checklist to identify knowledge gaps. Review courses are also available from approved providers.