Pes Cavus
Redistributes plantar pressure, corrects excessive supination, and relieves metatarsal pain — custom congruent to every patient's foot model.
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Pes cavus pain starts at the arch, not the metatarsals.
Every step concentrates force through a rigid, high-arched foot. The reduced contact area of pes cavus shifts plantar loading to the metatarsal heads and heel — creating sharp focal pressure that the foot cannot redistribute. Without correcting the biomechanical source, metatarsal pain, supination instability, and compensatory chain-reaction problems persist.
Pes cavus is one of the best pathological candidates for custom orthotic treatment. The high arch creates predictable, correctable mechanical dysfunction — and the right device changes the load distribution at every step.
Concentrated plantar loading
The reduced ground contact area of a high arch focuses pressure on the metatarsal heads and heel — driving forefoot pain, callus formation, and stress injury risk.
Excessive supination
A rigid cavus foot cannot pronate adequately to absorb shock — increasing lateral loading, ankle instability risk, and the compressive forces transmitted up the kinetic chain.
Chain-reaction strain
Uncorrected supination and rearfoot varus alter mechanics at the knee, hip, and lumbar spine — contributing to lower back pain and knee pain over time.
The P11 redistributes the load — across the whole foot.
Custom-fabricated to the patient's exact high-arch morphology — with precise arch support that spreads plantar weighting evenly and corrects excessive supination.
Three interventions.
One precise solution.
The P11 doesn't simply cushion the forefoot — it addresses the biomechanical source of pes cavus pain at every phase of gait.
Precise arch support
The UCB shell fills the medial longitudinal arch precisely — distributing plantar pressure evenly across the entire foot rather than concentrating it at the metatarsal heads and heel. Fabricated congruent to the patient's exact arch morphology.
Rearfoot posting for supination
An EVA rearfoot post corrects excessive supination at the source — controlling the uncompensated rearfoot varus and rigid forefoot valgus mechanics that drive lateral instability and chain-reaction strain.
Shock absorption system
A 3mm Spenco top cover combined with heel-to-toe 1.5mm Myolite cushioning provides the shock absorption that a rigid cavus foot cannot achieve on its own — reducing the impact forces transmitted at every step.
It's not just cushioning. It's pressure redistribution.
The rigid high arch of pes cavus creates mechanical dysfunction that cushioning alone cannot solve. The P11's congruent shell changes the geometry of plantar contact — filling the arch to redistribute load, correct supination, and provide the shock absorption the cavus foot cannot generate itself.
- Load redistribution — the congruent UCB shell fills the medial arch precisely, spreading plantar pressure across the full foot and eliminating the concentrated focal loading at the metatarsal heads.
- Supination correction — the rearfoot post controls uncompensated rearfoot varus — the primary driver of lateral instability and kinetic chain strain in pes cavus.
- Shock absorption — 3mm Spenco combined with Myolite extension cushioning absorbs the impact forces a rigid cavus foot cannot dissipate through normal pronation mechanics.
- Neurological feedback — congruent plantar contact provides continuous proprioceptive input, improving muscle activation quality and reducing compensatory loading patterns that drive knee and back pain.
Shape is everything.
What separates Root from generic arch supports is the precise morphological shape captured from the patient's foot — held in the exact clinical position the clinician chose. In pes cavus, this precision is critical: generic devices either underfill the arch or create pressure points that worsen pain.
The P11 is built from a positive model of the patient's foot and can be modified at the practitioner's discretion. Every device fits the specific arch geometry of the patient it was made for.
Modern Root
Width adjusted considering both borders. Default for all Root models.
Traditional Root
Justified to the lateral border. Used for specific clinical indications at practitioner discretion.
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 process.
- 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, posting, and the Myolite extension are then applied.
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 P11 frame is where Root's expertise lives. Every step preserves the shape and position the clinician chose — ensuring the arch fill and rearfoot posting land exactly where the patient's anatomy requires.
- 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. Arch fill, rearfoot post, and Myolite extension are confirmed against the clinical prescription.
- Orthotic frame fabricated — the frame is vacuum formed over the positive model or 3D printed. The 3mm Spenco cover, .6mm suede bottom, and Myolite extension 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 — replicable, consistent, precise
Real-time control over shape, function, and fit.
FitFoot360 gives Root's technicians complete digital control over every dimension of the P11 frame — in real time. Every modification is precise, repeatable, and stored permanently.
Digital positive model — stored indefinitely
Future pairs can be fabricated from the same baseline shape with adjustments. A new impression isn't always required.
Real-time shape modification
Root technicians control arch fill, heel, width, and rearfoot posting directly in the software — every parameter visible and adjustable.
Every parameter per patient
Arch fill depth, frame rigidity, rearfoot post angle, and cover selection are all set per patient — never 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 P11 is set to the individual patient — material rigidity, rearfoot posting, and covers are all chosen for their anatomy and pathology.
Rigidity is selected per patient weight — providing exactly the control required for each patient's degree of supination and arch rigidity.
Extrinsic crepe post balanced forefoot to rearfoot — corrects uncompensated rearfoot varus and provides the supination control the cavus foot cannot achieve on its own.
Captures the patient's calcaneus precisely as cast — providing rearfoot stability and positioning the foot correctly for maximum arch fill effectiveness.
Thick Spenco top cover provides the shock absorption that the rigid cavus foot cannot generate through normal pronation — cushioning every heel strike and push-off.
Selected for shoe compatibility — the suede bottom keeps the device stable in most shoes with removable insoles while the arch fill works above.
Heel-to-toe Myolite extension provides full-length cushioning beneath the metatarsal heads — completing the shock absorption system and smoothing the propulsive phase of gait.
What changes when your foundation is corrected.
Addressing pes cavus biomechanically creates cascading improvements across the entire kinetic chain — from metatarsal pain relief to supination correction to full lower limb alignment.
- Reduced focal pressure — arch fill and rearfoot posting directly reduce concentrated loading at the metatarsal heads, relieving the metatarsalgia that drives forefoot pain in pes cavus.
- Improved supination control — rearfoot posting corrects uncompensated rearfoot varus, reducing lateral instability and the chain-reaction strain it creates at the ankle, knee, and hip.
- Full kinetic chain relief — corrected foot mechanics reduce compensatory strain in the knee, hip, and lumbar spine — addressing the lower back and knee pain that often accompanies untreated pes cavus.
- Long-term prevention — structural correction, not just symptom relief, significantly reduces the risk of lateral ankle sprain, peroneal tendon pathology, and stress fracture over time.
Designed to redistribute load and correct supination.
The P11 relieves metatarsal pain and prevents excessive supination and instability by redistributing plantar pressures and providing precise arch support. Pes cavus is one of the best pathological candidates for custom orthotic treatment — and the P11 is specifically engineered to address it.
The device is posted in the rearfoot to correct excessive supination, with a thick Spenco top cover and heel-to-toe Myolite cushioning providing the shock absorption that the rigid cavus foot cannot achieve through normal gait mechanics. Designed to fit most shoes with removable sock liners or insoles.
The full picture.
Everything you need to prescribe the P11.
- Cavovarus foot type
- Plantarflexed first ray
- Rigid rearfoot
- Supinators
- Uncompensated rearfoot varus with rigid forefoot valgus
Recommended for
- Lower back pain linked to supination
- Knee pain from lateral loading
- Metatarsal pain in high-arch patients
The Pes Cavus device relieves metatarsal pain and prevents excessive supination and instability by redistributing plantar pressures and providing precise arch support. Pes cavus — more commonly known as high arches — is one of the best pathological candidates for custom orthotic treatment.
This device improves gait patterns and relieves metatarsal pain by providing arch support that spreads plantar weighting evenly throughout the foot. The device is posted in the rearfoot to correct excessive supination.
- L3000 (UCB)
- L3010 (longitudinal/metatarsal support)
- L3020 (arch support)
- L5000 (filler)
Based on configuration. Final coding and billing are the provider's responsibility.
Delivery Time
- Standard: 2 weeks
- Expedited: Available on availability
Pes Cavus
Pes cavus — commonly known as high arches — is a structural foot condition characterised by an excessively elevated medial longitudinal arch. Unlike flatfoot, the cavus foot has too much arch, resulting in a reduced plantar contact area that concentrates ground reaction forces at the metatarsal heads and heel.
Fixed Plantar Flexion of the Foot
Pes cavus is often associated with a plantarflexed first ray — where the first metatarsal is positioned in plantar flexion, driving a forefoot valgus that the rearfoot cannot compensate. This creates a rigid, fixed deformity that cannot be corrected passively during gait, making custom orthotic intervention essential.
The resulting mechanical pattern — cavovarus foot type with rigid rearfoot and plantarflexed first ray — leads to metatarsal pain, lateral ankle instability, peroneal tendon pathology, and, over time, lower back and knee pain from unaddressed supination mechanics.
Causes and Contributing Factors
Neurological conditions — pes cavus is frequently associated with underlying neurological conditions including Charcot-Marie-Tooth disease, Friedreich's ataxia, and cerebral palsy. Neurological workup is indicated in progressive presentations.
Idiopathic high arch — in many patients no underlying neurological cause is identified. The condition is structural and managed conservatively with custom orthotics as first-line treatment.
Rearfoot varus and forefoot valgus — the combination of uncompensated rearfoot varus and rigid forefoot valgus drives the supination pattern that loads lateral structures and is the primary target of the P11's rearfoot posting.
Diagnosis
Clinical assessment includes observation of the arch in weight-bearing and non-weight-bearing positions, gait analysis for supination pattern, and assessment of rearfoot and forefoot alignment. The Coleman block test helps identify whether rearfoot varus is driven by a plantarflexed first ray. Neurological examination is indicated in all presentations to exclude underlying systemic causes.
Treatment Pathway
Custom orthotics are the cornerstone of conservative management for pes cavus — specifically devices that fill the arch, redistribute plantar pressure, correct rearfoot supination, and provide shock absorption. The P11 addresses all four mechanical targets in a single device.
The P11 is one of the best pathological candidates for custom orthotic treatment — providing arch support that spreads plantar weighting evenly and corrects the supination mechanics driving pain.
Order on FootID Pro →The right device
for the right diagnosis.
P11 is indicated across the cavus foot spectrum.
Prescribe with confidence across these presentations.
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