The sensation of stepping on a pebble, even when there is nothing on the ground or in your shoe, can be due to several conditions, including Morton's Neuroma or metatarsalgia. If you are experiencing this symptom in the ball of your foot, it is crucial to seek medical attention from a podiatrist as soon as possible for proper diagnosis and treatment. 
Foot Conditions That Cause a Pebble-in-Your-Shoe Sensation
If you have the sensation that you’re walking on a pebble or there’s a stone in your shoe, you may have Morton's Neuroma. This condition affects the nerves between the toes—most commonly the third and fourth toes. It occurs when the tissue surrounding the nerve thickens, causing pain, burning, tingling, and the feeling of a foreign object, like a pebble, under the foot. A neuroma is a common foot problem for women and is often associated with wearing tight, narrow shoes that squeeze the toes together, increasing pressure on the nerves. High-impact activities or repetitive trauma to the feet can also contribute to the development of Morton's Neuroma.
Metatarsalgia is another condition that can cause a sensation similar to stepping on a pebble and cause pain in the ball of your foot. It is characterized by pain and inflammation in the ball of the foot, specifically around the metatarsal heads, which are the bones that connect the toes to the rest of the foot. Metatarsalgia typically occurs gradually, with pain intensifying over time. Resting the foot may provide temporary relief, while standing, walking, or exercising can exacerbate the discomfort.
Possible Causes of Metatarsalgia
- Putting excessive pressure on the forefoot
- Wearing improper footwear that lacks support and cushioning
- Participating in high-impact activities such as running or jumping
- Having a foot deformity such as hammer toe or flat feet
- Having certain medical conditions such as arthritis of the foot or diabetes
- Aging and natural wear and tear on the foot
How a Podiatrist Can Help
While the sensation of stepping on a pebble may seem minor, it can often indicate an underlying condition that may worsen if left untreated. To diagnose the cause of your symptoms, a podiatrist will perform a thorough exam of your feet and review your medical history. They may also order diagnostic imaging tests such as X-rays or MRI scans to get a more detailed view of your foot's structure and to help identify any abnormalities.
Once the cause of the symptoms is determined, your podiatrist can recommend appropriate treatment options based on your specific condition and needs.
Possible Non-Invasive Treatments for Morton's Neuroma
- Changing your footwear to shoes that provide more room for the toes
- Avoiding walking barefoot
- Soaking your foot and removing calluses with a pumice stone—however, anyone with diabetes should discuss this treatment with their doctor first
- Wearing supportive orthotic inserts to reduce pressure on the affected area
- Using padding or cushions on the ball of your foot to relieve discomfort
- Having corticosteroid injections to reduce inflammation and alleviate pain in the ball of your foot
If conservative measures fail to provide relief, surgical intervention may be necessary to remove the affected nerve or release the pressure on it.
Possible Non-Invasive Treatments for Metatarsalgia
- Avoid high-impact activities. Making sure you avoid activities that put excessive pressure on your foot can be helpful. For example, tennis, football, basketball, and soccer can exacerbate your symptoms and pain.
- Footwear changes. Changing your footwear to shoes with a wider toe box and good arch support can help alleviate symptoms.
- Ice. Applying ice to the affected foot and gently massaging the area can help.
- Custom orthotics. Using custom orthotics inside your shoes can help redistribute pressure and provide cushioning.
- Physical therapy. Engaging in physical therapy exercises can stretch and strengthen the foot muscles and improve stability.
In more severe cases, when conservative treatments are ineffective, surgical intervention may be considered to correct any underlying structural issues contributing to metatarsalgia.