Neuroma
Decompresses the intermetatarsal nerve, reduces transverse pressure, and eliminates neuroma pain — custom congruent to every patient's foot model.
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Neuroma pain starts at the nerve, not the shoe.
Every step transmits compressive force through the forefoot. When the common digital nerve — typically in the third interspace — is subjected to repetitive transverse compression, it responds with fibrosis and thickening. That thickened nerve becomes the source of sharp, burning pain that worsens with every push-off.
The root cause is mechanical compression — a nerve pinched between the metatarsal heads. Without reducing that pressure, the fibrosis advances and the pain becomes harder to reverse.
Transverse metatarsal compression
Narrow footwear, splayed metatarsal heads, and forefoot loading concentrate pressure on the interdigital nerve — the mechanical trigger for perineural fibrosis.
Progressive nerve thickening
Repetitive compression stimulates fibrous tissue growth around the nerve. Each step without decompression advances the pathology, making conservative treatment less effective over time.
Propulsive phase pain
Peak intermetatarsal pressure occurs at toe-off — exactly when the nerve is most compressed. The sharp, electric pain on push-off is the hallmark of an active neuroma.
The P9 decompresses the nerve, not just the pain.
Custom-fabricated to your patient's exact foot shape with a targeted teardrop neuroma pad precisely positioned to the affected interspace.
Three interventions.
One precise solution.
The P9 doesn't simply cushion the forefoot — it targets the exact mechanical source of nerve compression.
Teardrop neuroma pad
A teardrop-shaped pad precisely positioned in the affected interspace separates the toes on either side of the neuroma — directly decompressing the nerve by spreading the metatarsal heads apart rather than pushing them together.
Minimal forefoot profile
The slim forefoot design reduces bulk beneath the metatarsal heads — fitting in low-volume shoes and eliminating the transverse compression that narrow, dress, or pointed footwear exerts on the interspace.
Congruent shape
The custom-fabricated shell matches the patient's plantar surface precisely — distributing load evenly, providing proprioceptive feedback, and ensuring the neuroma pad lands exactly at the correct interspace anatomy.
It's not just padding. It's targeted nerve decompression.
The shape of what's under the forefoot determines the transverse force experienced by the interdigital nerves. The P9's teardrop pad changes the geometry — actively separating the metatarsal heads rather than compressing them, reducing nerve pressure at every step.
- Metatarsal head separation — the teardrop pad positioned in the third interspace mechanically spreads the adjacent metatarsal heads, reducing the compressive force on the common digital nerve with every toe-off.
- Transverse pressure reduction — the minimal forefoot profile eliminates the extra compression that footwear and forefoot loading add to the interspace, removing the stimulus that drives progressive fibrosis.
- Neurological feedback — congruent shape provides continuous proprioceptive input throughout gait, improving muscle activation quality and reducing the compensatory forefoot loading patterns that arise from neuroma pain.
- Load redistribution — volume congruency distributes plantar pressure evenly across all five metatarsal heads, eliminating the concentrated focal loading at the affected interspace.
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 ensures the teardrop pad is positioned to the correct interspace anatomy — not templated to an average foot.
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 — ensures the device fills the calcaneal contour precisely, providing consistent rearfoot positioning throughout gait.
- 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 Achilles tendon vector?
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 frame is vacuum formed over the positive model or 3D printed, pressing the material precisely to the shape. Covers, postings, and the teardrop neuroma pad are then applied to the correct interspace.
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 — ensuring the P9's teardrop pad is positioned precisely to the patient's affected interspace.
- 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. The neuroma pad position is confirmed against the clinical prescription and affected interspace.
- 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 the teardrop neuroma pad 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 neuroma pad placement are all 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 P9 is set to the individual patient — material, posting, neuroma pad position, and covers are all chosen for their anatomy and pathology, never an average. If the neuroma is not bilateral, specify which side is affected.
Rigidity is selected per patient weight — the slim forefoot profile reduces bulk beneath the metatarsal heads while maintaining the structural control needed to keep the neuroma pad correctly positioned.
Extrinsic crepe post balanced forefoot to rearfoot — built into the positive model of the patient's foot. Provides rearfoot control while the forefoot modification manages nerve decompression above.
Captures the patient's calcaneus precisely as cast — providing rearfoot stability throughout gait while the teardrop pad addresses the forefoot nerve compression.
Full-length Spenco cover provides cushioning comfort directly against the plantar surface — selected for its ability to absorb residual forefoot pressure while the neuroma pad decompresses the nerve.
Selected for shoe compatibility — the slim suede bottom keeps the device stable in low-volume shoes while the neuroma pad works above.
Teardrop-shaped and precisely positioned in the affected interspace — separates the metatarsal heads to decompress the common digital nerve directly. Specify 2nd or 3rd interspace; specify left or right if not bilateral.
What changes when the nerve is genuinely decompressed.
Addressing neuroma biomechanically — rather than simply cushioning the forefoot — creates targeted improvements in pain, nerve recovery, and the ability to return to full footwear.
- Immediate nerve decompression — the teardrop pad separates the metatarsal heads at each step, reducing the compressive force on the common digital nerve from the first wear.
- Halted fibrosis progression — removing the mechanical stimulus for fibrosis allows the nerve to stabilise and, in early-stage cases, partially recover.
- Footwear flexibility restored — the slim forefoot profile allows patients to return to low-volume shoes without the compensation that wider orthotics require.
- Long-term prevention — consistent interspace decompression reduces the risk of recurrence and delays or avoids the need for corticosteroid injection or surgical neurectomy.
Designed to separate the metatarsal heads. Decompress the nerve.
The P9 features minimal forefoot bulk to reduce transverse metatarsal-head compression — fitting in low-volume shoes while providing meaningful decompression. A teardrop-shaped neuroma pad in the affected interspace separates the toes the neuroma lies between, directly reducing pressure on the common digital nerve. Fabricated from a positive model of the patient's foot, the P9 is constructed with a positive model and can be modified at the practitioner's discretion. If the neuroma is not bilateral, the affected side must be specified.
The full picture.
Everything you need to prescribe.
- Positive Mulder's sign
- 3rd interspace neuroma
- Morton's neuroma
Recommended for
- Morton's neuroma
- Positive Mulder's sign
Designed for patients presenting Morton's neuroma — damage and subsequent thickening of a common digital nerve, typically between the 3rd and 4th toes. Reduces transverse metatarsal-head compression while directly decompressing the affected nerve.
Featuring minimal forefoot bulk and a teardrop-shaped neuroma pad positioned in the affected interspace. Fabricated from a positive model of the patient's foot, fully modifiable at the practitioner's discretion. Specify affected side if not bilateral.
- 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
Morton's Neuroma
Morton's neuroma is a perineural fibrosis — a thickening of the fibrous tissue surrounding the common digital nerve, most frequently in the third intermetatarsal space between the 3rd and 4th toes. It is not a true tumour. The nerve thickens in response to chronic mechanical compression, and that thickened nerve becomes progressively more sensitive to the compression that created it.
A Compression Pathology With a Mechanical Solution
Morton's neuroma responds well to decompression — both through footwear modification and targeted orthotic intervention. The P9 addresses the mechanical driver directly, separating the metatarsal heads to reduce the compression that sustains the fibrotic cycle.
Morton's Neuroma (3rd Interspace) — The most common presentation. Sharp, burning pain between the 3rd and 4th toes, often described as walking on a pebble or a bunched-up sock. Positive Mulder's sign on examination. Worsens with tight footwear and improves with shoes removed.
2nd Interspace Neuroma — Less common but clinically significant. Pain between the 2nd and 3rd toes, often associated with hypermobility of the 1st ray and metatarsophalangeal instability. The P9 pad is positioned to the 2nd interspace when indicated — specify at time of order.
Bilateral Neuroma — Neuromas can present bilaterally, though the severity may differ between feet. If the condition is unilateral, specify which side is affected so the teardrop pad is placed correctly. Bilateral orders receive pads in both devices.
Diagnosis
Clinical diagnosis includes palpation of the intermetatarsal space to reproduce pain, Mulder's click test (compression of the forefoot producing an audible or palpable click), and assessment of toe sensation. Ultrasound confirms the presence and size of the neuroma and is the preferred imaging modality. MRI provides additional soft tissue detail when the diagnosis is uncertain or when surgical planning requires clearer anatomy.
Treatment Pathway
First-line treatment includes orthotics, footwear modification (wider toe box, lower heel), NSAIDs, and activity modification. Custom orthotics with neuroma pads are most effective when introduced early — before significant fibrosis has established. If little progress is seen at 2–3 months, corticosteroid injection is indicated. Sclerosing alcohol injection is a minimally invasive option for persistent cases. Surgical neurectomy becomes a consideration after 6 months of conservative treatment without meaningful recovery.
The P9 is designed to be part of the first-line response — decompressing the affected nerve from the first step, reducing the compression that sustains fibrotic progression.
The right device
for the right diagnosis.
P9 is indicated for Morton's neuroma, intermetatarsal nerve compression,
and forefoot pathologies requiring targeted decompression.
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