I am in pretty much your same boat...have orthotics and use Hokas for wide width shoes. Sometime pain goes to the toes, sometimes it doesn't. It's quite annoying, to say the least.

Possible metatarsalgia? I have it and my bones in my toes have actually thickened. Supposedly it’s something I’ll always have to deal with because of the bone thickening. I have noticed that if I strengthen core areas, keep my quads, and hamstrings loose it seems to help a bit. A high cushioned shoe has also been helpful.

Thanks a lot. I am really uncertain what this can be. Now its even coming back in the right foot :(
I am running in Hokas and Altras - not really doing much for me.

Update: Eventually gave up on trying to solve the cause of this, via the inlays and chiropodist. Went to my old physiotherapist (who used to try to help me solve the effect of this injury) and he straight up suggested Shockwave therapy.
I was a bit skeptical, but after 3 (painful) sessions, I can run with no pain and very little discomfort walk in normal shoes.

We will see if this is a permanent solution, but just wanted you all to have this update!

T

If you bike, make sure that those shoes aren't too tight. My biggest relief came from switching to a midcleat postition, offloading the metatarsals entirely. It also has the side benefit of apparently giving me a few more watts ;-)

The down side is massive toe overlap, which is only helped somewhat by shorter cranks :-(

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DFL > DNF > DNS