[Musculoskeletal complications of Werner's syndrome]. / Complications musculo-squelettiques du syndrome de Werner.

INTRODUCTION: Werner's syndrome, a rare autosomal recessive genetic disease, is a premature aging disease characterized by early onset of symptoms related to normal aging including short stature, cataracts, graying of the hair, skin ulcerations, diabetes, osteoporosis, atherosclerosis and predisposition to cancer. Musculoskeletal complications can also develop with major impairment of quality of life for these patients. OBSERVATION: We report two typical cases in two males aged 47 and 44 diagnosed on the basis of cutaneous progeroid signs. Diagnosis was confirmed by identification of homozygotous mutations in the WRN gene. The first patient later developed chronic osteomyelitis of the right forearm, which is a rare complication of Werner's syndrome. The second patient presented calcaneum valgus resulting in mechanical overwork and bilateral posterior tibial tendinitis. He also developed osteitis of the 5th toe. CONCLUSION: Dermatologists should be aware of the potential orthopedic complications of this disease in order to diagnose them as quickly as possible and organize multidisciplinary management alongside other specialists such as rheumatologists and orthopedic surgeons.

[Feet insoles and knee osteoarthritis: evaluation of biomechanical and clinical effects from a literature review]. / Orthèses plantaires et gonarthrose: évaluation des effets biomécaniques et cliniques à partir d'une revue de la littérature.

OBJECTIVE: To determine the biomechanical and clinical effectiveness of foot insoles in patients with knee osteoarthritis. MATERIALS AND METHODS: A systematic review of the literature (Medline, Pascal and Embase) using the MESH words knee, and insole and plantar orthosis for the biomechanical part and osteoarthritis, and insole and plantar orthosis for the clinical part. Clinical studies were classified by 2 independent readers using the Jadad scale. RESULTS: Two biomechanical theories were found: the adduction moment theory, which explains the effect of heel wedging, and articular chain theory, which explains the effect of lateral wedged insoles. The clinical effect was explained more by an anti-algesic effect than an anatomic or functional effect: the treated group consumed fewer nonsteroidal anti-inflammatory drugs than the placebo group for up to 2-years of treatment. Evidence is lacking because of methodological weakness and few clinical trials. The information on side effects is limited. DISCUSSION: Laterally wedged foot insoles are proposed for the treatment of knee medial compartment osteoarthritis. The clinical effect is probably limited, but the treatment may reduce the digestive and renal side effects of prolonged use of nonsteroidal anti-inflammatory drugs. Foot insoles could be recommended in clinical practice despite the lack of evidence in comparing the effectiveness of other therapeutics in knee osteoarthritis. CONCLUSION: Use of foot insoles is a nonpharmacologic treatment of osteoarthritis of the knee medial compartment.

[Tendinopathies of the foot]. / Tendinopathies du pied.

Tendinitis of the foot is frequent and is generally due to mechanical overload or inflammatory rheumatic disorders. It most often involves the posterior tibial tendon when obesity and calcaneus valgus combine to contribute to mechanical overwork, or in the early stages of rheumatoid arthritis. More rarely, the anterior tibial tendon or the fibular tendons are involved. The anatomic-clinical stages proceed from oedema to fissuration necrosis and ruptured tendon. The long-term risk is of a sinking internal arch and a fixed calcaneus valgus. A simple but effective treatment is the correction of the calcaneus valgus, but surgical arthrodesis may be necessary.

[Severe and extensive algodystrophies and malignant tumors. Apropos of 4 cases]. / Algodystrophies sévères et extensives et tumeurs malignes. A propos de 4 observations.

The authors report on 4 cases of particularly severe and extensive reflex neurovascular dystrophy, whose clinical course was marked by the onset of a malignant tumor, without any sign of improvement in the reflex neurovascular dystrophy, despite various therapeutic regimens, until the patient's death from malignancy. At this time, the authors compiled a total of 63 case reports (4 of which were reported) and have proposed a classification to differentiate 4 types of disorders in combination according to whether there is a very probable, probable, or possible link or whether the combination is strictly a coincidence. The pathogenic mechanism remains a mystery, when a link is observed; but it never corresponds to criteria to describe a paraneoplastic disorder. Finally, the authors insist on the practical value of detecting this combination, even if due to chance: in order to systematically detect cancer in the presence of any reflex neurovascular dystrophy, and especially to be conscious of a possible reflex neurovascular dystrophy, besides possible metastatic lesions, in the presence of osteoarticular pain present in a patient with cancer. Such a diagnosis, although difficult to realize, has great prognostic and therapeutic interest.