Richmond & Kensington, London
Intermetatarsal Bursitis
Treatment in Richmond & Kensington
Ball of foot pain from intermetatarsal bursitis accurately diagnosed and treated by HCPC-registered podiatrists. Conservative care first — no referral needed.
HCPC Registered
Accurate Diagnosis
Orthotics & Offloading
Injection Therapy Available
Intermetatarsal bursitis is a condition in which the small fluid-filled sacs (bursae) located between the metatarsal bones in the forefoot become inflamed. The bursae normally act as cushions between the bones, tendons and soft tissues, reducing friction during movement. When they become irritated or inflamed, they can cause significant pain and swelling in the ball of the foot.
The condition is most commonly found between the 2nd and 3rd or 3rd and 4th metatarsal heads — the same area affected by Morton's neuroma, with which it is frequently confused or co-exists. Accurate diagnosis is important because the treatment approach differs depending on whether the problem is bursitis, a neuroma, metatarsalgia, or a combination of these.
Common Causes & Risk Factors
Repetitive high-impact activity — running, walking
Tight, narrow or high-heeled footwear
Abnormal foot biomechanics or over-pronation
Excessive pressure on the ball of the foot
Forefoot instability
Injury or direct trauma to the forefoot
Inflammatory arthritis (e.g. rheumatoid)
Occupations requiring prolonged standing
Signs & Symptoms
Pain in the ball of the foot — often 2nd/3rd or 3rd/4th toe space
Swelling or a feeling of fullness in the forefoot
Pain when walking barefoot on hard floors
Worsened by tight shoes or prolonged standing
Tenderness when the metatarsal heads are squeezed together
Occasional tingling or numbness into the toes
Feeling of walking on a lump or pebble
Ball of foot pain has several possible causes and accurate diagnosis is essential before starting treatment. The following conditions can present similarly to intermetatarsal bursitis and are important to distinguish between:
Morton's Neuroma
Thickening of the nerve tissue between the metatarsals. Often co-exists with bursitis. Typically causes burning, shooting pain or numbness into the toes. Distinction often requires careful clinical examination.
Metatarsalgia
General forefoot pain from overload of the metatarsal heads. Broader in distribution than bursitis, without the localised inter-space tenderness. Usually biomechanical in origin.
Stress Fracture
A hairline fracture of a metatarsal bone — most common in runners. Pain is more localised to the bone itself rather than the inter-space and worsens progressively with activity.
Plantar Plate Injury
Damage to the ligament on the underside of the toe joint. Often causes the toe to drift upward or sideways, with pain directly under the metatarsal head rather than between the bones.
Freiberg's Disease
Avascular necrosis of a metatarsal head — most commonly the 2nd. Causes pain, stiffness and joint changes visible on X-ray. More common in adolescents and young adults.
Inflammatory Arthritis
Conditions such as rheumatoid arthritis can cause forefoot pain and swelling. Typically affects multiple joints, is associated with morning stiffness and may require blood tests for diagnosis.
Treatment focuses on reducing inflammation, offloading the affected area, correcting the biomechanical factors driving the problem and gradually returning you to full activity. The right approach depends on how long you have had the condition and how severe your symptoms are — we will discuss all options with you at your first appointment.
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Assessment & Diagnosis
A thorough clinical examination including palpation of the forefoot, squeeze test and assessment of the inter-metatarsal spaces allows us to accurately localise the problem and distinguish bursitis from a neuroma, metatarsalgia or other forefoot condition. We take a full history of your symptoms, activities and footwear.
02
Load Management & Activity Modification
Reducing the load through the inflamed area is an important early step. We advise on temporary activity modification, avoiding aggravating activities and footwear changes to allow the acute inflammation to settle while you continue your treatment programme.
03
Padding & Metatarsal Offloading
Metatarsal domes or deflective padding placed just behind the affected metatarsal heads can significantly reduce pressure on the inflamed bursa and provide immediate symptomatic relief. This is a simple, effective and immediate intervention that can be applied at your first appointment.
04
Gait Analysis & Biomechanical Assessment
Using our treadmill with Onform joint tracking software, we assess your walking and running mechanics to identify the biomechanical factors contributing to forefoot overload. We use visual overlays and line drawing to show you exactly what is happening — so treatment decisions are clearly explained and understood.
05
Custom Orthotics
Custom foot orthotics incorporating a metatarsal dome or raise redistribute load away from the painful inter-metatarsal space and address any underlying biomechanical drivers of the condition. This is particularly effective for people with abnormal foot mechanics, flat feet or forefoot instability contributing to the bursitis.
06
Injection Therapy
For persistent or more severe cases, a corticosteroid injection into the inter-metatarsal space can significantly reduce inflammation and pain. This is often used alongside orthotics and activity modification rather than as a standalone treatment. We will discuss whether an injection is appropriate for your specific presentation at your appointment.
07
Footwear Advice
Shoes with a wide toe box, low heel and adequate forefoot cushioning reduce compression of the metatarsal heads and pressure on the bursae. We provide specific footwear recommendations based on your lifestyle, whether you are managing work, everyday activity or returning to sport.
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Accurate forefoot diagnosisWe carefully distinguish between bursitis, neuromas, metatarsalgia and other conditions before treating.
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Treadmill gait analysis with OnformVisual joint tracking to identify the biomechanical drivers of your forefoot pain.
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Same-appointment offloadingMetatarsal padding applied at your first visit for immediate pain relief.
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Injection therapy in-clinicCorticosteroid injections available without needing a separate referral.
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HCPC-registered podiatristsQualified and regulated — with a whole-body approach to foot and lower limb health.
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Two convenient London clinicsRichmond (TW9) Monday to Friday and Kensington (W8) on Fridays.
How is intermetatarsal bursitis different from Morton's neuroma?
Both conditions cause pain in the same area of the forefoot and can be difficult to distinguish clinically. Morton's neuroma involves thickening of the nerve itself and typically causes more burning, shooting or electric-shock type pain, often with tingling or numbness into the toes. Intermetatarsal bursitis is inflammation of the bursa and tends to present with a more generalised aching and swelling. The two conditions frequently co-exist — careful examination by a podiatrist is essential to identify what you are dealing with.
How long does intermetatarsal bursitis take to settle?
With appropriate treatment — activity modification, offloading, orthotics and footwear changes — most cases of intermetatarsal bursitis show significant improvement within 6–12 weeks. More persistent cases may require an injection. Recovery time varies depending on how long the condition has been present and whether the underlying biomechanical factors are addressed.
Can I keep running with intermetatarsal bursitis?
This depends on the severity of your symptoms. In mild cases, continued running with appropriate footwear, metatarsal padding and load management may be possible. In more acute cases, a short period of reduced activity allows the inflammation to settle before a gradual return to running. We will give you specific guidance based on your assessment findings and training goals.
Will I need surgery?
Surgery for intermetatarsal bursitis is rarely necessary. The vast majority of cases resolve with conservative treatment — offloading, orthotics, activity modification and injections where needed. Surgical removal of the bursa is only considered in very persistent cases that have failed all conservative measures, and we would provide a referral to a trusted foot and ankle surgeon if this became appropriate.
Is this covered by private health insurance?
Podiatry consultations and injection treatments are typically covered by most major insurers. We work with Bupa, Aviva, WPA and others. Orthotics are generally not covered by UK insurers. Please check your policy before booking. See our
Insurance page for full details.
Book your forefoot assessment today
Richmond and Kensington clinics available. Ball of foot pain accurately diagnosed and treated.
