Forefoot Pain Is More Complex Than You Think
Pain in the ball of your foot, under your toes, or between your toes can come from several different sources. Morton’s neuroma, plantar plate tears, metatarsalgia, sesamoiditis, and capsulitis can all cause similar symptoms but require very different treatments.
At Next Step Foot & Ankle Clinic, we use careful clinical exams, in-house ultrasound imaging, and diagnostic injections to identify exactly what’s causing your forefoot pain before recommending any treatment. Getting the diagnosis right is everything.
Request an AppointmentFOOT & ANKLE CONDITIONS
Conditions Covered
Comprehensive evaluation and treatment for forefoot pain, nerve conditions, and structural problems affecting the ball of the foot.
Morton’s Neuroma
A thickened nerve in the ball of the foot causing burning, tingling, or feeling like you’re standing on a pebble. Neuroma pain can be mimicked by several other conditions, which is why proper diagnosis matters.
Plantar Plate Tear
A tear in the thick ligament under the ball of your foot. Often missed without ultrasound imaging. Can be confirmed and treated non-surgically in most cases.
Metatarsalgia
General pain and inflammation in the ball of the foot. Often caused by overuse, improper footwear, or biomechanical issues.
Sesamoiditis
Inflammation of the small bones under the big toe joint. Common in dancers and athletes.
Capsulitis
Inflammation of the joint capsule, typically in the second toe. Can progress to crossover toe if untreated.
DIAGNOSTIC APPROACH
Ball of foot pain can be caused by several things, and often by more than one at once. This is probably why some people fail treatment. Only a careful clinical exam and possibly ultrasound exam can adequately rule out other or additional diagnoses. Our diagnostic approach may include diagnostic injections, mechanical testing, and in-house ultrasound imaging. Many clinics don’t even have an ultrasound. We use ours every day for many soft tissue problems.
FOOT & ANKLE CARE
Treatment
Personalized treatment options ranging from conservative care to advanced therapies and surgical procedures.
Conservative
Custom Orthotics
Designed to redistribute pressure away from the painful area and support proper foot mechanics.
Therapeutic and Diagnostic Injections
Steroid injections for inflammation and diagnostic injections to confirm the source of pain.
Padding & Shoe Modifications
Wider, softer shoes and metatarsal pads to reduce pressure on the ball of the foot.
Oral Medication
Anti-inflammatory medication when appropriate.
Advanced / Regenerative
Shockwave Therapy
Effective alternative for neuromas and metatarsalgia that haven’t responded to traditional conservative care.
Class IV Laser Therapy
Reduces inflammation and promotes tissue healing at the cellular level.
Surgical
Minimally Invasive Neuroma Surgery
Performed through very small incisions placed between the toes. No visible scar. Recovery is about 3 days with the foot elevated, then activity as tolerated. Usually about a month to feel entirely normal.
Nerve Decompression
For the right patient, nerve decompression can preserve the nerve rather than removing it.
Open Nerve Surgery
When minimally invasive approaches aren’t sufficient, we offer nerve resection, nerve decompression, and distal nerve denervation procedures. We can pick the right procedure for you.
FAQ
Do most neuromas require surgery?
No. Conservative care usually works for neuromas. Steroid injections, orthotics, wider shoes, and oral medication can often provide significant relief on the first visit.
What’s the recovery from neuroma surgery?
With minimally invasive surgery, recovery is about 3 days with the foot elevated, then activity as tolerated. Most patients feel entirely normal within about a month.
How do you know it’s a neuroma and not something else?
Neuroma pain can be mimicked by several other conditions. We use clinical exams, ultrasound, and diagnostic injections to confirm the diagnosis before recommending treatment.
What if conservative treatment doesn’t work?
We have advanced options like shockwave therapy and laser therapy that have been shown to be effective alternatives. If surgery is needed, we offer both minimally invasive and open surgical techniques.
Can I see the neuroma on an ultrasound?
Yes. Ultrasound imaging can show a typical neuroma. This is one reason why in-house ultrasound is so valuable for diagnosis.