What Causes Burning Pain in the Ball of Your Foot?

You're walking and suddenly feel like there's a pebble in your shoe — except there isn't one. Or you notice a burning, aching sensation in the ball of your foot that gets worse in shoes and better when you take them off and rub the area. Maybe the pain radiates into your toes or you feel numbness between them.

Pain in the ball of the foot — the padded area just behind the toes — is extremely common and has two primary causes: Morton's neuroma and metatarsalgia. They can feel similar but involve different structures and respond to different treatments.

Morton's Neuroma

A Morton's neuroma is a thickening of the tissue around a nerve that runs between the metatarsal bones, most commonly between the third and fourth toes. It's not a tumor — the name is misleading. It's a fibrotic thickening caused by chronic irritation or compression of the nerve.

Classic symptoms include sharp or burning pain in the ball of the foot, a feeling that you're standing on a fold in your sock or a pebble, numbness or tingling that radiates into the third and fourth toes, and relief when you take off your shoe and massage the area. The pain is typically worse in narrow or tight-fitting shoes and during activities that put pressure on the forefoot.

Women are affected far more often than men, largely due to footwear — narrow toe boxes and elevated heels compress the metatarsal heads together, squeezing the nerve between them.

Metatarsalgia

Metatarsalgia is a broader term for pain and inflammation in the ball of the foot, usually involving the metatarsal heads themselves rather than the nerve. It feels like a deep ache or bruise under the toes, often across a wider area than Morton's neuroma. The pain worsens with walking, running, or standing for long periods — especially on hard surfaces.

Common causes include high arches (which concentrate weight on the ball of the foot), a long second metatarsal, wearing high heels regularly, high-impact activities like running or jumping, and excess body weight. It can also develop after bunion surgery if the weight distribution across the forefoot shifts.

How to Tell Them Apart

Both cause ball-of-foot pain, but there are distinguishing features. Morton's neuroma tends to produce sharp, shooting, or electric-like pain localized between two specific toes, often with numbness or tingling. Metatarsalgia is more of a diffuse aching or bruised feeling under multiple metatarsal heads without the nerve symptoms. A diagnostic squeeze test in the office — compressing the metatarsals together — often reproduces the neuroma pain with a palpable click.

What Helps

Both conditions respond well to conservative treatment when caught early. The first-line approach for either is modifying footwear — switching to shoes with a wide toe box and low heel reduces compression on the forefoot immediately. Custom orthotics with a metatarsal pad can lift and separate the metatarsal heads, taking pressure off the irritated nerve or inflamed bone.

For Morton's neuroma specifically, padding modifications, injection therapy, and in stubborn cases, shockwave therapy can reduce the fibrotic tissue around the nerve. Surgery to remove the neuroma is effective but reserved for cases that don't respond to conservative care.

For metatarsalgia, addressing the underlying biomechanical cause is key. Orthotics, activity modification, and ice during flare-ups resolve most cases. If a structural issue like a prominent metatarsal head is the driver, that can be addressed surgically with minimally invasive techniques.

The Bottom Line

If you're feeling burning, aching, or a pebble sensation in the ball of your foot, don't just switch shoes and hope for the best. A quick evaluation tells you exactly what's causing it and which approach will fix it fastest. Call (760) 728-4800 to schedule.