Thanks y'all, I appreciate the consideration and sharing of your experiences.

@Yrocket: Could you post a pic of your insert or share how you figured where to cut the insole? I have tried that approach, cutting a notch out of the insole, but i might have cut too wide or in the wrong place. It seems to me that it would work. When i tried it i took the sole out of the shoe, and stood on it to try and pinpoint the location to cut out.

I also tried to use duct tape and a metatarsal pad to create a slide on attachment to my foot. This actually worked fairly well but put a lot of pressure on the strap in between the toes.

Hey TBCJr,

Just went through an ordeal with one of this things that started late 2017. My journey as follows:

December 2017/Jan 2018 - first symptoms of a *hot* foot and nervy pain going up stairs. Modified running and rested, but apparently the ship had sailed.

Jan 2018- June 2018 - patchy run training building for IM Boulder. Would need a day or two off after every run as the foot pain was intense. Had a met pad, didn't really do much for me at the time. Post IM, foot was a disaster and I thought I would have to amputate. Kidding of course, but it was awful. Not much for running for a couple of months after this as if felt like I had a rock in my foot and I could feel it clicking.

June 2018-June 2019 - pain subsided with rest but never pushed it much with training. Stairs had to be managed specifically, and stability activities or jumping were out of the question. Had a US guided cortisone shot June 2019 - zero help.
June -Oct 2019 - working overseas, ran here and there, maybe it was a little bit less aggravated but still could feel it walking on bumpy surfaces.

June 2020 - cortisone shot number 2. No help. Referral for sclerosing alcohol injection, which actually has some decent research behind it. While some people experience the return of symptoms, the same happens with surgery, except you aren't cut open.

August - Shot 1: freezing, US guided alcohol and cortisone. Not much change.
Mid September - Shot 2: noticeable improvement.
Mid October - Shot 3: definitely improvement. Able to run concurrent days for the first time in 2.5 years. Using a met pad as well and OTC pronation orthotic.

Here is where it gets interesting
Shot 4 was in mid-November. The neuroma had shrunk substantially. In the first and second appointment I could feel the pressure of the needle moving the inflamed tissue in my foot. This was no longer the case, and although I am not an ultrasound tech or radiologist, I could see the neuroma was smaller on screen.

After this shot I had the usual bruising but anticipated zero issues afterwards seeing as the third shot had been a dream. Instead, I had a period of intense discomfort for about 3.5 weeks where running was almost entirely out of the question and I had to walk on my heels down stairs. After inquiring with the radiologist, he said that standardized doses might be too aggressive in the later stage shots (or something to this effect), and that I was probably having a bit of an adverse reaction. He recommended holding off on a 5th shot until things calmed down.

I was able to run daily again in February with a pretty standard level of daily discomfort, but concurrent days didn't make anything worse. Still using a met pad at this point. Finally, one day (I want to say April?) when finishing a run I noticed the met pad was almost irritating me. I took it out on my cooldown. To this day I haven't put it back in because I have essentially zero discomfort. That day I jumped pain free for the first time in just over 3 years. I went into full blown IM training up to 30km over trail and pavement with no repercussions. Felt like my old self! All I had in my shoes was an OTC orthotic for pronation in the problematic shoe, but, I don't even require that anymore and had dropped it by June of last year. All running, jumping, anything, is non-provocative. I do F45 to mix things up and there is ABSOUTELY no way I could have done any of those movements 2 years ago without breaking into tears. I am very happy with my result.

My take:
I would recommend trying the injection if you are able to. I read several studies where there was decent outcomes vs surgery. I am an athletic therapist by trade and I have seen several still symptomatic surgical people in my work. I would try it and see what happens. I am not sure what happened with my 4th shot, but in all honesty it was another 3.5 weeks on a 3 year journey and I am back to normal at this point. Maybe try a cheap insole w/met pad combination like I had while you are doing the treatment and go from there.

If you want more info DM me

Cheers and good luck!

I've had neuromas in both feet for 45 years now..

What's worked well for me is a trick Johnny Halberstadt at the Boulder Running Co. showed me: cut a small circle of orthopedic felt and stick it to the bottom of the inner of the shoe, just behind the metatarsals. It usually takes a few tries with each new pair of shoes to get the pad situated just right, but once it's there, it lifts and separates the metatarsals and relieves the pressure on the neuroma. This helps with the pain and helps prevent further damage.

Placement of the pads is critical - this is why any consumer product except a custom orthotic probably won't work. Doing it yourself allows for cheap trial-and-error until the pads are exactly right.

it's critical to have plenty of room in the toe box of ALL your shoes, running, bike, and work/casual. Compression of the metatarsals is a factor in this injury. Make sure to get running shoes with excellent forefoot cushion, that's the primary characteristic I look for these days; and replace them often. Run on softer surfaces - grass, dirt roads, or synthetic tracks - whenever possible. Concrete is a terrible surface to run on..

Also, be careful of running with the pain. A couple of years ago, I didn't put the pads in a new pair of racing shoes, and consequently tore a calf muscle because I was compensating for the neuroma pain by altering my pushoff. Stupid stupid stupid.