Pes Planus
Re-establishes subtalar alignment, controls hyperpronation, and supports the collapsed arch — custom congruent to every patient's foot model.
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Pes planus pain starts at the arch, not the heel.
Every step transmits force through a compromised medial arch. When the arch has fallen — whether flexible or structural — the subtalar joint pronates excessively, the calcaneus everts, and the forefoot abducts. Without correcting these mechanics, arch pain, heel pain, and back pain persist regardless of rest or footwear changes.
The root cause is mechanical collapse. Without re-establishing subtalar alignment and arch support, every step continues to load the wrong structures.
Excessive subtalar pronation
Calcaneal eversion drives medial rotation of the entire lower limb, increasing tensile load on the plantar fascia, posterior tibial tendon, and medial ankle structures.
Arch collapse cascade
Loss of the medial longitudinal arch shifts load medially, causes forefoot abduction, and produces the characteristic “too many toes” sign — a reliable indicator of functional pes planus.
Chain-reaction pain
Uncorrected pronation alters gait mechanics upward — contributing to knee pain from tibial rotation, hip pain, and lower back pain through the full kinetic chain.
The P12 corrects the cause — not just the arch.
Custom-fabricated to the patient's exact foot model — with UCB-level medial control and varus posting that re-establishes subtalar alignment from the first step.
Three interventions.
One precise solution.
The P12 doesn't simply support the arch — it addresses the biomechanical drivers of pes planus at the rearfoot, midfoot, and forefoot simultaneously.
Rearfoot varus posting
A 3-degree varus rearfoot post lifts and rotates the medial edge of the calcaneus, correcting subtalar pronation at its source and bringing the lateral arch back into position. Built into the positive model of the patient's foot — not added after.
Medial flange & forefoot post
A medium medial flange combined with a 3-degree varus forefoot post minimizes eversion from hyperpronation — addressing the flexible forefoot varus and forefoot supinatus components that perpetuate pes planus mechanics distally.
UCB congruent shell
The University of California Biomechanics Laboratory (UCB) shell provides full calcaneal encapsulation and complete medial arch contact — the highest level of medial control available in a custom orthotic frame. Fabricated congruent to the patient's exact foot model.
It's not just arch support. It's subtalar realignment.
Generic arch supports push against a fallen arch from below. The P12 corrects the mechanics at the source — through rearfoot varus posting, full UCB calcaneal encapsulation, and congruent arch fill that re-establishes the exact alignment the clinician chose during assessment.
- Subtalar realignment — the 3° varus rearfoot post lifts the medial calcaneus, rotating the subtalar joint toward neutral and reducing excessive pronation — the source of arch pain, posterior tibial strain, and plantar fascia overload.
- Medial control — the UCB shell fully encapsulates the calcaneus, providing the highest level of rearfoot control available in a custom foot orthotic — indicated for compensated rearfoot varus and flexible forefoot varus.
- Forefoot stabilization — the 3° varus forefoot post addresses the flexible forefoot varus and forefoot supinatus component, preventing the distal forefoot eversion that follows uncorrected rearfoot hyperpronation.
- Neurological feedback — congruent plantar contact provides continuous proprioceptive input, improving muscle activation quality and helping to retrain the normal gait pattern over time.
Shape is everything.
In pes planus, congruency is critical. The P12 is constructed from a positive model of the patient's foot — with the subtalar joint held in the exact position the clinician chose. Generic arch supports cannot replicate this precision, and without it, medial control is incomplete.
The P12 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. Medial flange, rearfoot post, forefoot post, and Protex cover 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 P12 frame is where Root's expertise lives. Every step preserves the shape and position the clinician chose — ensuring the arch fill, medial flange, 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 posting, forefoot posting, and medial flange are confirmed against the clinical prescription.
- Orthotic frame fabricated — the frame is vacuum formed over the positive model. The .75mm Protex top cover, .6mm suede bottom, 1.5mm Myolite extension, and 30 Shore A frame filler 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, medial flange, 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 P12 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, rearfoot posting, and medial flange directly in the software — every parameter visible and adjustable.
Every parameter per patient
Arch fill depth, frame rigidity, medial flange height, rearfoot and forefoot post angles 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 P12 is set to the individual patient — material rigidity, rearfoot and forefoot posting, medial flange height, and covers are all chosen for their anatomy and pathology.
Rigidity selected per patient weight — providing the structural control required for effective rearfoot varus posting and UCB calcaneal encapsulation throughout the gait cycle.
3-degree varus posting lifts and rotates the medial calcaneus, correcting subtalar pronation at source. Built into the positive model for anatomically precise congruency — not added as a generic wedge.
3-degree varus forefoot post addresses the flexible forefoot varus and forefoot supinatus component, preventing the distal forefoot eversion that follows uncorrected rearfoot hyperpronation.
Deep cup provides full calcaneal encapsulation in the UCB shell style — controlling the precise degree of inversion and eversion for this patient's anatomy, not an average.
Trimmed to the patient's metatarsal head line, ensuring contact and pressure distribution match their exact foot geometry. Protex provides durability and a stable interface throughout gait.
Extends the shell medially to provide additional arch support and eversion control — the hallmark of the UCB-type medial control that defines the P12. Combined with the forefoot post to minimise hyperpronation-driven eversion.
What changes when subtalar alignment is restored.
Addressing pes planus biomechanically creates cascading improvements across the entire kinetic chain — from arch pain relief to rearfoot varus correction to full lower limb realignment.
- Reduced arch & heel pain — varus rearfoot posting and medial arch support directly reduce tensile load on the plantar fascia and posterior tibial tendon — the primary pain drivers in pes planus.
- Rearfoot control — UCB shell and 3° rearfoot post correct calcaneal eversion, reducing medial arch collapse and the strain it creates at the ankle and tibialis posterior.
- Full kinetic chain relief — corrected subtalar alignment reduces the medial tibial rotation and compensatory mechanics that contribute to knee pain, hip pain, and lower back pain.
- Long-term prevention — structural correction significantly reduces the risk of posterior tibial tendon dysfunction progression, plantar fasciitis, and adult acquired flatfoot deformity over time.
Designed to re-establish alignment and control pronation.
The P12 provides medial control to help re-establish proper subtalar alignment and reduce biomechanical stresses that can lead to a variety of muscular and skeletal complications. A 3-degree varus rearfoot post lifts and rotates the medial edge of the calcaneus, correcting subtalar pronation and bringing the lateral arch back into position.
A medium medial flange and 3-degree varus forefoot post minimize eversion caused by hyperpronation. The device is designed to fit in most standard shoes with removable sock liners or insoles — though shoes with extra width to accommodate the UCB shell are recommended.
The full picture.
Everything you need to prescribe the P12.
- Forefoot varus
- Flatfoot
- Acquired pes planus
- Pes planovalgus
- Hindfoot valgus deformity
- Forefoot abduction (too many toes sign)
Recommended for
- Compensated rearfoot varus with flexible forefoot varus
- Forefoot supinatus
- Adult functional pes planus
The Pes Planus device is designed to support and alleviate symptoms associated with low or flat arches. Leaving a low arch unsupported can lead to arch pain, back pain, and heel pain. This device provides medial control to help re-establish proper subtalar alignment and reduce biomechanical stresses.
A 3-degree varus rearfoot post lifts and rotates the medial edge of the calcaneus, correcting subtalar pronation and bringing the lateral arch back into position. A medial flange and 3-degree varus forefoot post minimize eversion caused by hyperpronation.
- 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 Planus
Pes planus — commonly known as flatfoot — is characterised by a low or absent medial longitudinal arch, excessive subtalar pronation, and calcaneal eversion. In weight-bearing, the arch collapses and the forefoot abducts, creating the characteristic “too many toes” sign and, in symptomatic cases, pain at the arch, heel, and ankle that extends through the kinetic chain to the knee, hip, and lower back.
The arch and subtalar joint
The medial longitudinal arch is maintained dynamically by the posterior tibial tendon and statically by the plantar fascia, spring ligament, and midfoot bony architecture. When these structures fail — through overuse, ligamentous laxity, or structural factors — the subtalar joint pronates excessively. This drives calcaneal eversion, forefoot abduction, and medial arch collapse.
Types of Pes Planus
Flexible pes planus — the arch is present when non-weight-bearing but collapses in weight-bearing. Most common. Managed conservatively with custom orthotics as first-line intervention. The P12 is specifically indicated here.
Rigid pes planus — arch absent in both weight-bearing and non-weight-bearing positions. Associated with tarsal coalition, rheumatoid arthritis, or neuromuscular conditions. May require more comprehensive management.
Acquired pes planus (PTTD) — progressive arch collapse driven by posterior tibial tendon dysfunction. Adult acquired flatfoot deformity — progressive, painful, and the most clinically significant form. Early orthotic intervention is critical to slowing progression.
Causes and Contributing Factors
Compensated rearfoot varus — a rearfoot that pronates through subtalar motion to bring the heel to the ground, creating excessive midstance pronation and arch collapse. The primary target of the P12's 3° varus rearfoot post.
Flexible forefoot varus / forefoot supinatus — positional or structural forefoot deformity that drives rearfoot eversion as a compensatory mechanism. Addressed directly by the P12's 3° varus forefoot post and medium medial flange.
Posterior tibial tendon dysfunction — progressive failure of the primary dynamic arch stabilizer, leading to acquired flatfoot deformity. Custom orthotic intervention with medial control is the cornerstone of conservative management.
Ligamentous laxity — generalised hypermobility contributing to medial arch collapse, particularly in younger patients and those with connective tissue disorders.
Diagnosis
Clinical assessment includes arch height evaluation in weight-bearing and non-weight-bearing, too-many-toes sign assessment, single-limb heel rise test (for posterior tibial tendon integrity), and gait analysis for pronation pattern. Jack's test assesses passive arch reconstitution via the windlass mechanism. Weight-bearing X-ray may quantify arch collapse via lateral talometatarsal angle and calcaneal pitch.
Treatment Pathway
Custom orthotics are first-line intervention for flexible pes planus. Devices providing rearfoot varus control, UCB medial arch support, and forefoot posting are most effective at restoring functional alignment. The P12 addresses all three mechanical targets simultaneously.
The P12 is indicated as first-line intervention — re-establishing subtalar alignment from the first step and reducing the mechanical collapse driving arch, heel, and back pain.
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for the right diagnosis.
P12 is indicated across the pes planus spectrum.
Prescribe with confidence across these presentations.
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