What is the treatment for persistent foot pain after running?

Hi doctor,

I am a 31-year-old male. I weight around 160 pounds and my height s 6 feet 5 inches. I have a problem with my left foot. It came on after several months of aggressive training for road races (running). I took off several weeks entirely from running, and the condition has improved, but now, eight months after the onset of the pain, I have yet to attain complete relief. After a long time standing,walking, and running, I have soreness in the bottom of the foot under the stress fracture and stiffness or soreness (however less pronounced) closer to the toe itself. When running, faster paces where I run more on the forefoot bother the foot more. Whenever I walk barefoot on a hard surface, it feels like the knuckles of the left foot are less cushioned and make more problematic contact with the floor. Additionally, it feels like a nerve or something like a filament slides over that knuckle when I walk barefoot on a hard floor, which may contribute to the pain. I wore the boot for several weeks and did not wear any orthotics. I would like to know what may continue to cause this issue and how I can return to running without pain. I do not believe the sole problem is the bunion, and I would only consider corrective surgery if it were essential. Thanks for your time.

X Ray results:

Periosteal reaction is noted in the third metatarsal greatest in the mid shaft, which may be secondary to age-indeterminate stress fracture. Although no fracture line is seen, clinical correlation advised for the site of tenderness, and radiographic follow-up is recommended. Severe hallux valgus. Mild first MTP osteoarthritis. Small plantar and calcaneal spur.

Doctor correspondence:

X-ray results came back essentially negative. It did show that you, at one point, did have a stress fracture that has healed. This means that you are likely overloading the bones when you run. No new stress fracture was seen. For now, continue wearing the boots. And it would be best if you consider custom orthotics when you run. The osteoarthritis seen is due to your bunion deformity and the fact that the toe is improperly aligned. Once arthritis sets in, it is irreversible since it damages the cartilage. The inserts would not reverse arthritis but will prevent the progression of arthritis. But on a scale of one to ten, how bad your arthritis is, yours is around one or two.