The human body can be a big mystery–particularly when it comes to pain.

You know your feet and heels hurt.

But why?

Is it plantar fasciitis, heel spurs, or something different? The hope of finding out exactly what’s going on beneath the surface encourages many people to seek out X-rays to determine the exact cause of heel or foot pain. After all, a Superman-style peek into the inner workings of your feet should reveal all, right?

Unfortunately, it’s not quite that simple when it comes to X-rays and plantar fasciitis or heel spurs.

While X-rays may be helpful in many cases, they’re not quite a magic bullet for diagnosing the root cause of heel pain. Here’s everything you need to know about X-rays and plantar fasciitis:

Are X-rays Needed to Diagnose Plantar Fasciitis or Heel Spurs?

While X-rays are a popular first line of defense when it comes to determining the cause of foot pain, they aren’t particularly helpful in diagnosing plantar fasciitis. Why? In large part because X-rays are much better at showing bones rather than soft tissue like muscles and ligaments. And since the main player in plantar fasciitis is a ligament–the fascia or arch of your foot–it’s difficult to determine the presence or extent of damage through an X-ray.

X-rays can detect the presence of heel spurs–sharp, protruding calcium deposits that may dig into the fatty pad of the heel, causing pain. However, the presence of heel spurs does not necessarily mean that someone has plantar fasciitis. While plantar fasciitis can cause the development of heel spurs as the body attempts to compensate for the damaged fascia, at other times heel spurs develop independently of plantar fasciitis and do not cause pain.

What Can X-rays Do?

While X-rays aren’t particularly good for diagnosing plantar fasciitis, they can rule out other causes of foot pain, including stress fractures, cysts, and other problems related to the bones of the foot and ankle.

If your heel and foot pain does not respond to conservative home treatments for plantar fasciitis, your doctor may recommend an X-ray to explore other potential causes of the pain you are experiencing.

Typically, unless you’ve been experiencing heel pain for more than six months, your doctor will base his or her diagnosis on your reported symptoms along with an examination of your foot, heel, and ankles.

Costs for Foot X-rays

For individuals who do not have health insurance, the cost of a foot X-ray can be spendy, ranging between $200-$1000 depending on the provider, location, and how many views of the foot are taken during the X-ray session.

Even for individuals with health insurance, the out-of-pocket cost for a foot X-ray to diagnose plantar fasciitis can be expensive. Many insurance companies cover only a small percentage or nothing at all for X-rays to diagnose plantar fasciitis, especially as a first resort. Before you decide with your doctor that X-ray is the right diagnostic tool for your heel pain, make sure to speak with your insurance provider to avoid surprise expenses.

Alternatives to Plantar Fasciitis X-rays

Overwhelmingly, if you are experiencing heel pain–particularly with those first few steps in the morning–you probably have plantar fasciitis. Diagnosing this condition is typically a straightforward process that involves evaluating your symptoms in light of your habits, lifestyle, and other risk factors for plantar fasciitis (like your footwear). Your doctor can typically make an accurate diagnosis based on your answers to questions about exercise habits, when you experience foot and heel pain, and when your pain gets worse.

In some cases, your doctor may recommend an ultrasound scan–which is far more useful for examining soft tissue. Ultrasound may reveal a thickened plantar fascia (which can indicate plantar fasciitis), tears in the fascia, and may also detect or rule out bursitis, abscesses, rheumatoid arthritis, entrapped nerves, and gout.

If your symptoms persist, get worse, or you and your doctor suspect that another issue may be mimicking plantar fasciitis, next steps include tests that evaluate blood flow, bone scans, an MRI, or neurological testing to rule out nerve entrapment.

The good news is that the overwhelming majority of plantar fasciitis cases can be treated at home with simple, conservative treatments such as icing, stretching, rest, and the use of plantar fasciitis orthotic inserts. With a few months of consistent attention and treatment, most people find significant relief from their symptoms.