Adult Acquired
Flatfoot
Controls rearfoot pronation, supports arch collapse, and halts posterior tibial tendon deterioration — custom congruent to every patient's foot model.
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Adult acquired flatfoot starts at the tendon, not the arch.
The posterior tibial tendon is the primary dynamic stabilizer of the medial arch. When it weakens or fails, the arch collapses progressively inward. Left untreated, what begins as a flexible deformity becomes rigid and irreversible.
The root cause is structural, not just inflammatory. Without supporting the arch mechanically, rest and therapy alone rarely halt progression.
Progressive arch collapse
As the posterior tibial tendon elongates, the medial arch flattens under load — each step accelerates the deformity.
Tendon degeneration
Repetitive overload causes microtears that repair incompletely — leading to chronic tendinosis and eventual rupture.
Chain-reaction misalignment
Rearfoot valgus and forefoot abduction alter the entire kinetic chain — affecting the knee, hip, and lower back over time.
The P2 supports the arch from the first step.
Custom-fabricated to your patient's exact foot shape and clinical positioning.
Three interventions.
One precise solution.
The P2 doesn't mask pain — it arrests the structural collapse driving it.
Arch support via medial flange
A medium medial flange, built directly from the patient's foot model, controls pronation at its source — providing the structural support the failing posterior tibial tendon can no longer deliver.
Rearfoot control
The 18mm deep heel cup controls inversion and eversion of the calcaneus, stabilizing the foot at the subtalar joint throughout the gait cycle.
Congruent shape
Precise fit distributes load across the entire plantar surface, provides neurological feedback, and changes the muscle firing sequence — genuinely supporting the arch at every step.
It's not just alignment. It's how your muscles fire.
The shape of what's under your foot determines how hundreds of muscles sequence during every gait cycle. Change that shape precisely — and you change the neuromuscular pattern that stabilises the body.
- Neurological feedback — congruent shape provides continuous proprioceptive input, improving muscle activation quality throughout gait.
- Muscle sequence in gait — hundreds of muscles fire differently based on what's under your foot. Root shape corrects this sequence, reducing caloric demand and improving efficiency.
- True arch support — the P2's medial flange provides structural support the failing posterior tibial tendon can no longer deliver. Less collapse means less pain, and slower progression.
- Load distribution — volume congruency distributes pressure evenly across the plantar surface, eliminating the concentrated medial overload that accelerates arch collapse.
Shape is everything.
What separates Root from generic supports is the precise morphological shape captured from the patient's foot — held in the exact clinical position the clinician chose.
The Root orthotic matches the precise alignment the clinician held the foot in during scanning. This congruency supports the arch and redistributesutes load across the correct structures.
Modern Root
Width adjusted considering both borders. Default for all Root models.
Traditional Root
Justified to the lateral border. Medial width reduced. Used for specific clinical indications.
Modern Root shape process
- Forefoot balanced to rearfoot — the forefoot-to-rearfoot relationship is optimised as the first step in shape modification.
- Fat pad expanded ~3mm — expanding the fat pad in the heel ensures the device fills the calcaneal contour precisely.
- Arch lowered ~3mm — creates optimal heel-to-arch-to-met-head geometry. Not applied to foam impressions.
- Width tuned to both borders — medial and lateral widths are both considered, giving a foundation that matches the patient's actual foot width.
*Subtalar joint neutral is found by palpating the talus head against the navicular. The neutral position can present many joint-on-joint and bone-on-bone relationships and varies from person to person. An everted or inverted calcaneus may be a neutral position for an individual person. Biomechanical evaluation required.
How you hold the foot is what we build.
Root is not just the orthotic — it's the clinician's positioning, captured and preserved in the device. After scanning, FootID Pro asks the questions no other lab asks.
After every scan, we need to know:
- Was the subtalar joint held in neutral?
- Was the midtarsal joint maximally pronated — loading the 5th metatarsal head?
- Was the midtarsal joint maximally supinated — loading the 1st metatarsal head?
- Was the forefoot brought perpendicular to the rearfoot?
- Was a forefoot-to-rearfoot balance bisection achieved at 90° relative to the calcaneal bisection?
The positioning of those 19 joints in the foot is what gives us the shape.
CAD/CAM fabrication
- Scan or cast captured — clinician captures foot morphology via FootID Pro, holding the subtalar joint in the chosen clinical position.
- Shape modification applied — forefoot balanced to rearfoot, fat pad expanded, arch adjusted using Root's design.
- Technical staff review — every device reviewed against Traditional Root, Modern Root, Blake Inverted, or Accommodative principles.
- Fabricated to the shape — the polypropylene frame and EVA post are fabricated to match the submitted shape precisely.
See how the scan becomes an order.
Watch Kevin capture a foot, confirm the clinical position, and send a Root order — start to finish.
Variation converted to anatomy-match accuracy by impression & fabrication method
How closely each method preserves the patient’s intended foot shape. Scale: 0–100%, where 100% = optimal congruence.
Plaster bandage is wrapped around the foot in the clinician’s prescribed corrected position, setting into a precise negative of the foot’s contour.
The foot is pressed into a crushable foam box, leaving a negative impression of the plantar surface.
An existing positive model from the patient’s previous orthotics is reused — KevinRoot accepts models from any lab, with frame-contour variance as low as 1%.
A digital scanner such as FootID Pro captures the foot surface as a 3D model.
A fiberglass casting sock is applied over the foot and cures to capture its contour.
Pedobarography captures the patient’s plantar pressure distribution (static or dynamic) at 1:1 scale — used with arch height and shoe size to select a redimold positive model, not to capture true 3D contour.
A direct-molding system using prefabricated, size- and arch-based positive models (33 in total) rather than an individual foot impression.
Heated material is vacuum-pressed over a plaster positive model, drawing it intimately into every contour.
The frame is 3D printed by selective laser sintering (SLS) directly from the CAD-designed digital frame.
A positive model is CNC-milled (CAD/CAM) from an STS, 3D scan, plaster, or foam impression, then the frame is vacuum formed over it.
A CNC machine subtractively mills the frame from a block of polypropylene or EVA per the digital design.
*Redimold has no physical or digital foot impression — patient-foot-to-cast congruent accuracy is unavailable. Variation from positive model to frame is low.
How your foot shape becomes a precision frame.
The journey from clinical capture to finished orthotic frame is where Root's expertise lives. Every step preserves the shape and position the clinician chose.
- Foot impression captured — the clinician captures the foot using their preferred method. The fashion in which the foot is held directly affects the outcome of the Root Shape congruency against the foot.
- Positive model created — the impression becomes a physical plaster model or a digital CAD/CAM model via FitFoot360. Digital models are stored indefinitely.
- Root technicians modify the shape — using FitFoot360, technicians apply the Modern Root shape process. Every modification is reviewed against the clinical prescription.
- Orthotic frame fabricated — the frame is vacuum formed over the positive model or 3D printed, pressing the material precisely to the shape. Covers, postings, and modifications are then applied.
FitFoot360 Foot Model
- Root digital model stored indefinitely → recalled for future pairs
- Root technicians modify the digital shape in real-time: arch, heel, width, postings
- Vacuum formed over CAD/CAM positive model, direct milled or 3D printed Root Frame — replicable, consistent, precise
Real-time control over shape, function, and fit.
FitFoot360 gives Root's technicians complete digital control over every dimension of the orthotic frame — in real time. What once required physical carving and guesswork is now precise, repeatable, and stored permanently for every patient.
Digital positive model
Stored indefinitely. Future pairs, replacements, or modifications can be fabricated from the exact same shape without a new impression.
Real-time shape modification
Root technicians control arch, heel, width, and postings directly in the software.
Every parameter visible
Heel cup depth, frame reinforcement, ray cut-outs, flanges, and more are set per patient, not per template.
Plaster and foam digitisation
Physical models can be digitised for permanent storage. Note: digitising may not perfectly replicate the intimate contours achieved when vacuum forming directly over plaster.
Built to their spec. Built for their foot.
Every parameter of the P2 is set to the individual patient — material, posting, heel-cup depth, and covers are all chosen for their anatomy and gait, never an average.
Rigidity is selected per patient weight — so the shell supports the collapsing arch exactly as much as that specific patient's structure demands.
Balanced forefoot to rearfoot and built into the positive model of the patient's foot — not added after. Congruent to their anatomy, not a generic post.
Cast directly from the patient's calcaneus, the deep cup fits their heel precisely — controlling their specific degree of pronation and inversion, not an average.
Trimmed to the patient's toe line, so contact and pressure distribution match their exact foot geometry.
Selected for shoe compatibility — keeps the device stable inside the shoe while the custom shell does the structural work above.
Fills the arch to the patient's exact geometry — eliminating the voids that off-the-shelf devices compensate for with generic materials.
What changes when your foundation is corrected.
Addressing adult acquired flatfoot biomechanically creates cascading improvements across the entire kinetic chain.
- Arrested arch collapse — the medial flange and rigid frame provide the structural support the failing posterior tibial tendon can no longer deliver.
- Reduced pain and inflammation — controlling pronation at its source removes the mechanical driver of tendon overload and medial ankle pain.
- Full kinetic chain relief — corrected rearfoot alignment reduces compensatory strain in the knee, hip, and lumbar spine.
- Preserved treatment window — early structural support keeps the deformity flexible and reducible, preventing progression to a rigid, irreversible state.
Designed to support the arch.
A medium medial flange, built directly from the patient's foot model, controls pronation at its source. The rigid polypropylene frame provides the structural support the failing posterior tibial tendon can no longer deliver. Less collapse means less pain, and slower progression. The deep 18mm heel cup controls inversion and eversion of the calcaneus, stabilizing the foot at the subtalar joint throughout the gait cycle.
The full picture.
Everything you need to prescribe.
- Posterior Tibial Tendon Dysfunction (PTTD)
- Flexible and reducible adult acquired flatfoot
- Symptomatic overpronation
- Adult acquired flatfoot with arch collapse
Recommended for
- Stage 1 adult acquired flatfoot
- Grade I & II posterior tibial tendon dysfunction
Designed to provide maximum arch support for adult acquired flatfoot — most commonly caused by posterior tibial tendon dysfunction — this device arrests arch collapse and reduces symptomatic pain.
A rigid polypropylene frame and medium medial flange control pronation at the source. A deep heel cup stabilizes the calcaneus, restoring biomechanical control throughout the gait cycle.
- L3000 (UCB)
- L3010 (longitudinal/metatarsal support)
- L3020 (arch support)
- L5000 (filler)
Final coding and billing are the provider's responsibility
Delivery Time
- Standard: 2 weeks
- Expedited: Available upon request
Adult Acquired Flatfoot
The posterior tibial tendon is the primary dynamic stabilizer of the medial arch — supporting the foot through every step. When it weakens or fails, the arch collapses progressively inward. Left untreated, what begins as a flexible, reducible deformity becomes rigid and irreversible.
A Progressive Condition With a Narrow Treatment Window
Adult acquired flatfoot advances in stages. In the early stages the deformity is flexible and fully reducible — this is the window where orthotic intervention is most effective. As the condition progresses, the soft tissue structures elongate permanently and conservative treatment loses its ability to reverse the damage.
PTTD — Degeneration or rupture of the posterior tibial tendon, the primary driver of adult acquired flatfoot. Presents as medial ankle pain, progressive arch collapse, and a characteristic “too many toes” sign on observation.
Arthritis — Inflammatory or degenerative joint disease in the midfoot or hindfoot can accelerate arch collapse independent of tendon integrity. Often presents alongside PTTD in later stages.
Acute Injury — Traumatic disruption of the posterior tibial tendon or supporting ligaments can trigger rapid onset flatfoot deformity, requiring early orthotic intervention to prevent progression.
Staging Determines Treatment
Stage 1 — Tendon intact but inflamed. Foot architecture preserved. The P2 is most effective here — supporting the arch before structural deformity sets in.
Stage 2 — Tendon elongated or partially ruptured. Flexible flatfoot deformity present but reducible. The P2 addresses Grade I and II presentations at this stage.
Diagnosis
Clinical assessment includes physical examination, gait analysis, and the single heel rise test to evaluate tendon integrity and arch collapse. X-ray under load assesses the degree of deformity. MRI is used to evaluate tendon condition and guide staging when conservative treatment planning requires a clearer picture.
Treatment Pathway
First-line treatment includes orthotics, NSAIDs, rest, and physical therapy. Custom orthotics are most effective when introduced early — before the flexible deformity becomes fixed and irreversible. If little progress is seen at 2–3 months, immobilization or bracing is indicated. Surgical reconstruction becomes a consideration after 6 months without meaningful recovery.
The P2 is designed to be part of the first-line response — supporting the arch from the first step, slowing progression while the tendon recovers.
The right device
for the right diagnosis.
P2 is indicated for posterior tibial tendon dysfunction, adult acquired flatfoot, and equinus.
Prescribe with confidence across these conditions.
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