In order to allow it to support the weight of the body in the erect posture with the least expenditure of material, the foot is constructed of a series of arches formed by the tarsal and metatarsal bones, and strengthened by the ligaments and tendons of the foot.
The main arches are the antero-posterior arches, which may, for descriptive purposes, be regarded as divisible into two types—a medial and a lateral. The medial arch (see Fig. 290, page 276) is made up by the calcaneus, the talus, the navicular, the three cuneiforms, and the first, second, and third metatarsals. Its summit is at the superior articular surface of the talus, and its two extremities or piers, on which it rests in standing, are the tuberosity on the plantar surface of the calcaneus posteriorly and the heads of the first, second, and third metatarsal bones anteriorly. The chief characteristic of this arch is its elasticity, due to its height and to the number of small joints between its component parts. Its weakest part, i. e., the part most liable to yield from overpressure, is the joint between the talus and navicular, but this portion is braced by the plantar calcaneonavicular ligament, which is elastic and is thus able to quickly restore the arch to its pristine condition when the disturbing force is removed. The ligament is strengthened medially by blending with the deltoid ligament of the ankle-joint, and is supported inferiorly by the tendon of the Tibialis posterior, which is spread out in a fanshaped insertion and prevents undue tension of the ligament or such an amount of stretching as would permanently elongate it. The arch is further supported by the plantar aponeurosis, by the small muscles in the sole of the foot, by the tendons of the Tibialis anterior and posterior and Peronæus longus, and by the ligaments of all the articulations involved. The lateral arch (see Fig. 291, page 277) is composed of the calcaneus, the cuboid, and the fourth and fifth metatarsals. Its summit is at the talocalcaneal articulation, and its chief joint is the calcaneocuboid, which possesses a special mechanism for locking, and allows only a limited movement. The most marked features of this arch are its solidity and its slight elevation; two strong ligaments, the long plantar and the plantar calcaneocuboid, together with the Extensor tendons and the short muscles of the little toe, preserve its integrity.
While these medial and lateral arches may be readily demonstrated as the component antero-posterior arches of the foot, yet the fundamental longitudinal arch is contributed to by both, and consists of the calcaneus, cuboid, third cuneiform, and third metatarsal: all the other bones of the foot may be removed without destroying this arch.
In addition to the longitudinal arches the foot presents a series of transverse arches. At the posterior part of the metatarsus and the anterior part of the tarsus the arches are complete, but in the middle of the tarsus they present more the characters of half-domes the concavities of which are directed downward and medialward, so that when the medial borders of the feet are placed in apposition a complete tarsal dome is formed. The transverse arches are strengthened by the interosseous, plantar, and dorsal ligaments, by the short muscles of the first and fifth toes (especially the transverse head of the Adductor hallucis), and by the Peronæus longus, whose tendon stretches across between the piers of the arches.
The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States. The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) sponsors USMLE.
The Three Steps of the USMLE
Step 1 tests the important concepts of basic sciences basic to the practice of medicine. It also places special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of the sciences that provide a foundation for the safe and competent practice of medicine. It also tests the scientific principles required for maintenance of competence through lifelong learning.
Step 2 CK tests the medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. It also includes emphasis on health promotion and disease prevention. Step 2 CK ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills.
Step 2 CS tests your capacity to practice and provide good medical service in real-life situations. It also tests your communication skills.
Step 3 tests your medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.
