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TTS or PF??

Posted by HilaryG on 4/04/03 at 16:27 (115425)

I was wondering if anyone can tell me the difference in symptoms of PF and TTS. My pod tapped on me for Tinel- no response. He told me that doesn't necessarily mean no TTS. He said that what I have is most likely PF and adjusted my orthotics, which I already wore for painful flat feet. Since I don't have the typical pain on first steps in the morning I am concerned that maybe what I have is TTS and not PF. I do have primarily heel and arch pain, but after standing and by the end of the day I have generalized pain all over the bottom of the feet. (I have this on both feet!) Sometimes after standing for a long time I also have some pain in the insides of my ankles. There is no numbness or tingling, just pain. Any ideas or advice?

Re: TTS or PF??

SteveG on 4/04/03 at 16:45 (115427)

Many people on this board have PF and don't have pain with the first steps in the morning. Your pod should, however, be able to elicit pain by pressing on the insertion point. They know exactly where to press and the resulting pain tends to confirm the diagnosis of PF. Many people with PF (including me) also have general discomfort all over the bottom of the foot (and some ankle pain), since the whole fascia can be sore and inflamed. I am not a doctor, but the fact that you don't have any numbness or tingling does tend to rule out nerve entrapment (TTS). When I discussed possible TTS with my pod he asked about tingling, numbness, etc. Since I, too, did not have these symptoms, he thought there was no need to change the diagnosis from PF to TTS.

Re: TTS or PF??

Lara t on 4/05/03 at 12:07 (115472)

What STeve says is accuarate as best as know, but there can be problems in describing pain. For years I described my discomfort as 'burning', not as 'tingling'. When I got to a doctor that knew TS, he recognized the pattern of various other symptoms (where, when, treatment responses), and intepreted my 'burning' as nerve pain, even though it wasn't the common description. Now that I've been diagnosed and know how the textbooks describe things, I could label my discomfort as 'tingling'.

Describing pain/discomfort can be sort of like describing color. We don't really KNOW what someone else is thinking/seeing/feeling, we just assume we do (and probably are right, or close enough, most of the time).

Re: TTS or PF??

HilaryG on 4/05/03 at 13:32 (115476)

I appreciate the responses, but I do wish I would hear from one of the doctors. I know you can't diagnose me without seeing me, but could you just help me learn the diferences between PF and TTS symptoms? Thanks

Re: TTS or PF??

Dr. Z on 4/05/03 at 13:36 (115477)


Steve has a very good handle on TTS vs PF. The history such as do you have it in both feet or one is important. Are there other problem such as lower back injury/disease associated with your foot pain. First step pain in the morning isn't TTS . Pain where the pf inserts into the bottom of the heel is another great indicator of pf and not TTS. You can also have a combination of both. Injury to the foot such as ankle sprain and then pf type pain is another check mark on the side of TTS

Re: TTS or PF??

HilaryG on 4/05/03 at 13:56 (115479)

I have it in both feet, no ankle sprain or lower back injury. Does that make it more likely to be PF or TTS?

Re: TTS or PF??

SteveG on 4/05/03 at 14:42 (115484)

Given Dr. Z's reply and the other responses, I would say the answer is yes

Re: To SteveG

HilaryG on 4/05/03 at 14:59 (115486)

Steve, I'm sorry I don't undeerstand. Yes it would be more likely to be PF or yes it would be more likely to be TTS?

Re: To SteveG

SteveG on 4/05/03 at 15:05 (115487)

Oops, that is a bit ambiguous. I meant to say that PF is much more likely.

Re: To SteveG

Lara t on 4/05/03 at 17:24 (115496)

And I would have guessed the opposite since I have bilateral TTS, no foot injury, no back injury etc. I think at this point while Steve is probably right PF is more likely, there is a lot of seeming overlap in the symptoms - particularly if you don't have one of the primary differentiating symptoms (which many people don't) like pain in morning or Tinel's sign. In general, PF is more likely - it's a much more common ailment.

Re: lara

Pam S. on 4/07/03 at 00:08 (115561)

Dear Lara:
How was your TTS diagnosed? Did you have needle EMG? Is tts usually bilateral? Do you wear orthodics with your famous compressions socks. I owe you my life to these compression socks. I am not perfect but I can get thru the dinner hour without the intense burning. Note my questions earlier. I forget where I post things. Thx, Pam S

Re: lara

Lara t on 4/07/03 at 23:09 (115626)

I'd go to a doctor, get some relief, it would come back. I'd go back, they'd do something else, I'd get some relief, it would come back. Sometimes the relief was simply coincidence (like the several fungal infection that had me sitting on the couch ALL week-end soaking my foot - unbeknownst to me the rest did me a great deal of good - or the taping of my foot - which did a great deal of good, and convinced the doctor that orthotics were the answer - it wasn't, and when it came back he told me it was now in my head, or when I started taking Ibuprofen in larger-than-normal doses (with dr. recommendation) and turned the clock back several months before it caught up to me again. During this process I was referred for PT, and I saw an brochure for a podiatrist that focused on sports injuries. I decided next time it flared up (badly enough) I would go there. I'm not particularly an athlete, but I thought it was a result of my active life (karate, tennis, jogging/walking) and a sports podiatrist was more likely to have ideas than other podiatrists.

It flared up, I went to the sports podiatrist guy, and before I finished my history he thought he knew what the problem was (TTS) and sent me to a neurologist for confirmation - NCV test. He said even if it came back negative it didn't mean I didn't have TTS - it came back positive for TTS so we never dealt with any ambiguity from a negative test.

The interesting thing to me is 2 podiatrists and one Family Practitioner diagnosed it as PF, before I got to this podiatrist. When I got to this guy, who knew TTS, he was able to recognize it immediately. Apparently my symptoms weren't textbook (or I didn't describe them according to the textbook's words), but when I got to someone who 'knew' TTS, he recognized it immediately and my symptoms really weren't all that confusing. To be fair, the other doctors are well-respected, competent doctors. A lot of doctors don't know TTS - it's relatively new in the history of medicine.

My TTS is absolutely, evenly bilateral. Too bilateral in my opinion. I know our body is symmetrical, but it's not perfectly symmetrical. Yet I feel it the same in both feet at all times. Even more curious - if I treat the right foot, both feet get better - if I treat the left foot, both feet get worse! (I didn't know that until I tried the compression socks - he only had one in his office when he first gave it to me - that was after the first three doctors)

I gave up the orthotics. They didn't really help or hurt much after the compression socks, and they were a nuisance if they weren't doing anything so I quit switching them.

I'm not sure if I missed some questions earlier? Let me know if I did.

I know how you feel about hte compression socks. They look so innoucuous, and unimpressive. I call them my 'magic socks'. It's the difference between being unfit for human companionship and dreaming of an amputation, and having a reasonable, if less active, life.

Re: lara

HilaryG on 4/08/03 at 06:29 (115637)

Lara, COuld you tell me what your symptoms were. I don't have any tingling or pins & needles, just pain.