Tendinopathie du tibial postérieur et syndrome de Werner

Posterior tibial tendinopathy is seen most frequently in women over age 50 and is associated with overweight and valgus deformity of the hindfoot. We report the unique observation of bilateral posterior tibial tendinopathy associated with significant flatfoot in a 41-year-old man, symptomatic since age 39 and presenting with signs of premature ageing, particularly affecting the skin. His severe tendinopathy indicated surgical intervention on the left side, consisting of partial arthrodesis for stabilisation and exploration of the tendon. The skin manifestations of ageing led to dermatological and genetic explorations, which confirmed the diagnosis of Werner syndrome with clinical signs of premature aging. This syndrome is an autosomal recessive genetic disease, caused by chromosomal instability and mutation of the WRN gene. It is characterised by the signs of ageing: cataracts, hair loss, greying, skin alterations, osteoporosis, and atherosclerosis. There is an increased incidence of skin ulcerations, diabetes mellitus and predisposition to cancer. Flatfoot is known to be a musculoskeletal complication, but the presence of tibial posterior tendinopathy appears to be a new aspect of ageing tendons, as described in this case report.