I went out and took the boot off the inner tie rod end to make 100% sure that was the problem......and it wasn't. It looks like the bushings inside the steering rack are worn causing it to move up and down when the driver's side wheel is moved. So now I'm on the hunt for a reasonably priced remanned rack or maybe even a used rack with low miles. I won't have the truck forever so I'm not spending $1500+ on a new rack from the dealer.
I did verify with those that need to do an inner tie rod that the correct wrench you need is a 42mm crows foot or crescent wrench. Now that size is quite hard to find so most people seem to opt for a 1 5/8" wrench which is just a hair small but in practice probably works fine.
I also checked part numbers with Toyota of Dallas and here's what you'd need for a 4WD, 3.4L, 4runner:
- 45503-39075 - Inner Tie Rod
- 90460-62006 - Inner Boot Clamp