Pain in the ball of your foot: neuroma, bursitis or plantar plate injury?

Pain in the ball of your foot can feel like a pebble under the toes, a sharp pain during push-off or burning into the toes. “Metatarsalgia” describes the area of pain, but does not identify which structure is responsible.

At Steps Podiatry & Gait in Inverness, we assess whether symptoms relate to a nerve, a bursa, the plantar plate or another structure. That distinction helps us choose the right way to reduce pressure, protect the tissues and restore comfortable activity.

Three conditions that can feel similar

Morton's neuroma: the nerve

Morton's neuroma involves thickening and fibrous change around an interdigital nerve between the metatarsal heads. It may cause burning, tingling or pain extending into adjacent toes, often aggravated by footwear that compresses the forefoot. The symptoms and scan findings need to be considered together. [1]

Intermetatarsal bursitis: the cushioning tissue

A bursa is a small cushioning sac. Irritation of a bursa between the metatarsal heads can cause pain in a similar area to a neuroma. The two may coexist, so finding one abnormality does not necessarily explain the whole presentation. [1,2]

Plantar plate injury: the joint support

The plantar plate is a strong supporting structure underneath the joint at the base of a toe. Injury commonly affects the second toe joint. Pain may be centred underneath the joint, with swelling or, in more advanced cases, a toe that lifts or drifts. Examination includes checking joint stability and how the toe contacts the ground. [3]

Why symptoms alone are not enough

The location, behaviour and timing of pain help narrow the possibilities, but symptoms overlap. Joint inflammation, bone stress injury and other forefoot problems also need consideration. [1]

During your specialist foot and ankle assessment, we discuss your footwear, activity demands and previous treatment. We examine the painful area, toe position, joint stability and relevant movement or loading tasks. You should leave with an explanation of the likely source and the priorities for care.

What does ultrasound add?

Where indicated, ultrasound allows us to assess the interdigital nerve, bursae, plantar plate and nearby joints. We can examine selected structures during movement and relate the findings to the area that reproduces your symptoms. [1]

A 2025 prospective diagnostic study highlighted the importance of considering bursitis in patients with pain between the metatarsal heads. It also showed that distinguishing bursitis from neuroma on ultrasound requires careful interpretation. A visible bursa or an enlarged nerve is not, by itself, proof of the pain source. [2]

At Steps, diagnostic ultrasound supports the clinical assessment and the decisions that follow.

How the findings change treatment

• Neuroma: treatment may begin with reducing footwear compression and redistributing forefoot pressure. A randomised trial supports appropriately designed insoles with metatarsal and arch support for improving walking pain and function. [4]
• Bursitis: we review pressure and activity demands and consider whether nearby joint inflammation or a coexisting nerve problem needs attention. Footwear and offloading advice are tailored to the assessment.
• Plantar plate injury: protecting and stabilising the affected joint may take priority. Depending on severity, options include clinician-directed taping, suitable footwear, offloading and a period of immobilisation before a gradual return to activity. [3]

Offloading and joint stabilisation have different purposes. For a plantar plate problem, reducing pressure underneath the foot may help pain without adequately controlling an unstable joint. [3]

Your pathway at Steps

We agree what to change first, explain any recommended support and set goals around comfortable walking, work or sport. At review, we assess symptom response, footwear tolerance and relevant function; joint stability is especially important when the plantar plate is involved.

If symptoms persist, or there is significant instability, we reassess the findings and discuss further investigation or specialist referral where appropriate. Treatment progresses according to the structure involved and your response.

Book a specialist foot and ankle assessment at Steps in Inverness. Bring your usual footwear and any existing insoles so we can assess how they fit into your plan.

Evidence behind this article

1. Son HM et al. A problem-based approach in musculoskeletal ultrasonography: central metatarsalgia. Ultrasonography, 2022.
2. Larsen SB et al. Morton's Neuroma or Intermetatarsal Bursitis—A Prospective Diagnostic Study of Intermetatarsal Pain. Diagnostics, 2025.
3. Kinter CW, Hodgkins CW. Lesser Metatarsophalangeal Instability: Diagnosis and Conservative Management of a Common Cause of Metatarsalgia. Sports Health, 2020. See also Lesser Metatarsophalangeal Joint Instability: Nonsurgical Treatment Alternatives.
4. de Oliveira HAV et al. Effectiveness of customized insoles in patients with Morton's neuroma: a randomized, controlled, double-blind clinical trial. Clinical Rehabilitation, 2019.

Evidence checked September 2026. The treatment pathway above applies clinical evidence and published management principles to individual assessment at Steps.