Also a trail distance and Ultra runner for a couple of decades with RA and Osteoarthritis and had good fortune with injections for which I am so thankful for! I followed the path you outlined pretty much. Steroids then gel (Duralane) My first gel lasted a year with lots of running miles and I just received my 2nd and now I'm building my miles again. My insurance won't cover gel injections because they deem it not medically necessary so I had to pay out of pocket. For me and my life tho, I feel it was necessary and less expensive than replacement surgery, so I dont understand insurance All the best for you!