A 73-year-old woman with a medical history of myocardial infarction, type 2 diabetes, hypertension, and obesity (BMI 39) presented with an eight-year history of bilateral heel pain. The symptoms initially began in the right heel and gradually developed in the left. Standard X-rays demonstrated typical bony growth on the underside of the calcaneus, plantar fascia thickening and cortical irregularities ( Fig. 1 ).

X-ray of the right foot demonstrating typical calcaneal bony growth, plantar fascia thickening and cortical irregularities.

Over the years, she had attempted several conservative treatments, including regular paracetamol (1,000 mg four times daily), topical and oral NSAIDs, and physiotherapy, none of which resulted in notable pain improvement. She declined local corticosteroid injections, and systemic steroids were avoided because of her poorly controlled diabetes.

Her walking capacity steadily deteriorated. Whereas she had previously been able to take long daily walks to support blood glucose management, the pain eventually restricted her to only a few meters of mobility ( Table 1 ). In early 2023, she began noticing spontaneous bruising and experienced a reduced appetite. Laboratory testing revealed leukopenia and thrombocytopenia. A subsequent abdominal CT scan and bone marrow biopsy confirmed a diagnosis of marginal zone lymphoma.

She initiated treatment with intravenous rituximab, 700 mg, administered at weeks 0, 1, and 2 (June 12, 19, and 26, 2024). Throughout treatment, her pain intensity and walking ability were monitored using the Visual Analogue Scale (VAS) and pedometry data collected via an Apple Watch Series 6 ( Table 1 ).

Before the first rituximab infusion, her pain intensity was rated as VAS 7 at rest, increasing to VAS 10 after walking approximately 100 meters. Notably, the day after the initial dose, she reported a VAS score of 1 and was able to walk between 1 and 1.5 kilometers. However, by Days 4 to 6 her symptoms began to worsen again, with pain rising to VAS 6-7 and her walking distance decreasing to about 1 km.

Following the second infusion, pain relief occurred more rapidly and was sustained for a longer period. On Day 1, she managed to walk 2 km, and over the subsequent days she consistently maintained distances of 0.5 to 1 km. The third infusion resulted in even more pronounced improvement: she regularly walked 2-3 km with minimal discomfort. Her pain levels remained low, VAS 1 at rest and VAS 2 during longer walks. Table 1 summarizes the changes in both pain severity and walking distance throughout the treatment period. Table 2

At one-year follow-up, she continued to report stable improvement, with VAS 1-2 at rest and VAS 3-4 after walking 2.0 km. Apple Watch data showed a mean daily walking distance of 2.8 km.

We conducted a scoping review in accordance with PRISMA-ScR guidelines to identify published cases of patients with plantar fasciitis who received monoclonal antibody therapy for symptom relief. The objective was to determine whether similar cases to our own had been reported and to evaluate the potential risks and benefits associated with monoclonal antibody use in the context of plantar fasciitis treatment.

A specialized health sciences librarian at Örebro University, with expertise in systematic review methodology, developed the search strategy. A comprehensive literature search was performed in Ovid MEDLINE (1946 to December 01,2025) and Embase (Elsevier) without restrictions on publication year. Both subject headings (MeSH and Emtree) and free-text terms were included in the search. The librarian provided a board compilation of terminology related to plantar fasciitis as well as an extensive list of monoclonal antibodies to maximize the sensitivity of the search. Relevant Embase records were identified through citation alerts and manual screening, as complete search strings were not available for documentation. Conference abstracts, lectures, and articles published in languages other than English were excluded.