Not sure why you can't bind Mouse4--I have it bound in my game. Do you perhaps have mouse software that alters how Windows sees that button?
I agree on the other points, though--they did a half-complete effort in one of the patches to open up keybinding a little, but many things remained hard-coded, like holding breath, lock-picking, exiting out of many of the menus, and secondary functions of keys like R and TAB not remapping with the main function.
I personally use F4SE to access and fix the hard-coded key functions.
I just want bash/power attack to be separate from grenade.
I have the http://www.logitech.com/en-us/product/corded-mouse-m500. Whenever I tried to use Mouse 4 (which is the rear thumb button) I get a message saying that the Mouse 4 key is "reserved". What does that even mean? Also no, I did not have any programs that altered how windows read that key. I do now though just to get it to open favorites like I wanted.
OMG YES! So many accidental deaths because of this! Why would that leave that hardcoded on PC is mind boggling!