In reply to krumpthuglas:
I wore Mythos for 20 years. I have the same street shoe size as you 44.5-45 depending.
You are in the ballpark but sounds like you could be a bit aggressive and could go up 0.5 for a bit more comfort.
I started with 42.5 and wore that pair for years till it wore out. When I chose it I tried on sizes in stores. Found a pair that was snug and relatively comfortable in the store - 43. Then dropped 0.5 from that.
But I bought those in the Dolomiti in Italy, in desperation, because the previous shoes (other brand) I had with me on the trip were so painful I couldn't climb. The 42.5 stretched out quickly enough for me to climb all day everyday in them for the next few weeks of the trip.
I loved them, and bought a spare in the same size, but when it came to use the new shoe, I found it was way too tight and never became pain free. I thought perhaps the last had been modified. But it was probably just manufacturing differences - or my changing feet. So I ended up going up to a 43, and then for much later pairs I had to go for 43.5 because my aging foot, and Haglunds-like heel problems meant my feet were/are pretty intolerant.
With your pain I think you might need to upsize. Or maybe it isn't the right shaped shoe for you?
I have now moved to TC Pros (thanks to help from here). Because my big toe can no longer stand (literally) the flexibility of the Mythos. But actually, I think the asymmetrical shape of the TC far better suits my foot than my beloved old Mythos.
Good luck!