The 3 Point Pivot system concentrates around how the actions of the weight bearing foot can vary around 3 key pivotal points during the gait cycle. The relationship between these 3 points, otherwise known as the Supra Navicular Angle, determines whether the patient has a low, medium or high arched foot.
The 3 Point Pivot System foot orthotic brands; Trio, Equiflex and Prostep are tailored to suit these 3 arch profiles, incorporating the features required to maximise functionality and improve biomechanical response. The orthoses can then be further posted to suit patient requirement. Postings are included with the products for your convenience.
The 3 Point Pivot System is a comprehensive, effective prescription system incorporating high quality great value products designed and manufactured by professional experts.
Selecting the correct orthosis
Latest research has proven that changes in the Supra Navicular Angle (SNA) before and during weight bearing are a more accurate and reliable method of assessing foot function than other techniques, including Subtalar-Neutral. Furthermore, it is imperative to assess the mobility of the 1st MPT joint, as this is a clear factor related to heel lift and achieving functional propulsion.
The 3 Point Pivot System concentrates around how the actions of the weight bearing foot can vary between patients as they attempt to walk using 3 key pivotal points.
Patient assessment system
Using our understanding of these differences you can apply 3 key tests to help decide which orthotic model they require.
This part of the examination will tell you which orthosis to choose. With the leg in a vertical position and the foot resting lightly on the floor, assess the category of arch height for the patient. This can be done precisely using the Supranavicular Angle (SNA) or approximately; The 3 points on the foot (medial malleolus, tip of the navicular and the 1st metatarsal head) may lie almost in a straight line, appear to be L-shaped or between the two. This decision will be helped by how the foot changes when the patient stands.
As the patient stands it is normal for the medial arch to deform a little: The navicular will drop and the 1st metatarsal head lifts slightly as it resists force from the ground. The leg will twist inwards slightly and as it does so the heel will tend to roll over so that it is less tilted in toward the other foot.
This change can vary according to the foot type that the patient has:
||Medium arch feet are what most people have (on average). There will be an equal amount of leg twist and heel roll.
||Many high arch feet show no arch deformation on standing. If movement does occur as the patient stands, there will be more leg rotation than heel roll.
||Low arch feet will tend to demonstrate more heel roll than leg twist. This tends to cause the talo-navicular joint to bulge significantly.
This test will demonstrate whether the patient requires remedial or physical therapy to the limb in conjunction with their orthoses. Once the patient is standing, they should be able to stand on one leg and perform a short series (usually 5) of knee bends. This does not apply to elderly or infirm patients. The patient may show signs of instability that are the cause (or the result) of faulty foot mechanics.
This test will demonstrate excessive loading of the medial forefoot and a score can be obtained to measure how able the patient can extend the 1st MTP joint for propulsion. A firm but gentle upward rotating force should be applied to the underside of the first toe.
Scoring the Result:
- If it is impossible to easily lift the 1st toe into extension, the score is 0.
- If extension is possible but the medial arch does not lift, the score is 1.
- If 1st toe extension does lift the arch but no change in heel position occurs, the score is 2.
- If 1st toe extension does lift the arch and the heel tilts inward so that the underside of the heel turns toward the medial aspect, the score is 3. This is considered normal.
N.B. It is important to ensure no arthritic damage has occurred to the 1st MTP joint and that the plantar fascia has not tightened prior to performing this test.
"A normal outcome for the Stand-Bend-Extend test would be a mild to moderate arch shape change, a stable knee bend test and a score of 3 for the 1st toe extension test. Any result other than this can indicate that the patient will benefit from an orthosis. The correct device can now be selected".
Customising a 3 Point Pivot orthosis
The next stage is to select how the orthosis can be customised to the specific needs of your patient. After carrying out the Stand-Bend-Extend tests you will have selected one orthosis from the 3PP system family of products. The model you have selected will help to return the foot type you have identified to function correctly. This is because each of the models are shaped to normalise pronation (natural arch deformation) and encourage propulsion from the medial side of the forefoot (primarily from the 1st MTP joint).
Having selected the correct model, it can now be modified to provide a customised prescription for your patient. This is achieved by using the additional components that are provided with each pair of 3PP orthoses. By following the simple instructions for each model, you can adjust your prescription to carefully match the requirements of each patient. Please remember that each foot may require a different combination of components.
Products in the 3 Point Pivot range include:
Please note: the products on this page are available as prescription only and so cannot be sold directly to the public without referral from a Health Professional.