A high ankle sprain, also known as a syndesmotic ankle sprain (SAS), is a sprain of the syndesmotic ligaments that connect the tibia and fibula in the lower leg, thereby creating a mortise and tenon joint for the ankle. On the inside of the ankle (medial side), the joint is stabilised by a thick, strong fibrous ligament called the deltoid ligament. Are unable to walk or bear weight on your leg. Harwin JR, Richardson ML. In rare cases, calf muscle tears require surgery. Clinical Course Acute Lateral Ankle Sprain. Just tell us where to send it. Foot drop is characterized by inability or impaired ability to Knee Exam (15 of 27): LCL. The ankle joint is a hinge joint formed between the tibia and fibula (bones of the lower leg) and the talus (a bone of the foot), and allows the foot to bend upwards (dorsiflexion) and downwards (plantarflexion). Sprains to any of these ligaments (inversion sprains, foot twists inward) account for more than 80% of all ankle sprains. Start in any position comfortable for you, whether thats a full squat, or in a lunge position, or with hands supported on something. Make sure you rule out the back and hip unless there is a clear mechanism of injury as the knee can be a referred site of pain for both these areas. During this time, taping or bracing the ankle may be prescribed to provide support until full function is regained. Figures A and B are the radiographs of the injury. Type of shoes ( wear patterns/age of shoes/proper design), Past Medical History (PMH) (Pre-existing medical conditions), Drug history (DH) (Any relevant medications? When refering to evidence in academic writing, you should always try to reference the primary (original) source. Available from: BJSM Videos. (OBQ18.29) A 63-year-old patient presents with right ankle pain after a fall down four stairs. Improve as well as maintain joint integrity. Roll forward up on the toes of the front foot. Strains are injuries to muscles or tendons (tissues that attach muscles to bones). And now reverse those movements. Extend your toes as you point the foot, then curl your toes as you pull your foot back. Figure A shows her active dorsiflexion against gravity bilaterally. A comprehensive rehabilitation program minimises the chance of the injury recurring and includes flexibility, balance, stretching, strengthening and sport specific exercises. Occasionally medial ligament injuries may be seen in conjunction with a lateral ligament injury. Injury to this ligament results in swelling and pain on the outside of the ankle. Then extend the toes as you flex your foot. Once your healthcare provider diagnoses your injury, they may recommend additional treatments such as: Complete calf muscle tears usually require surgery. A sprain is defined as a tearing of the ligaments that connect bone to bone and help stabilise the joint. Got stiff ankles? 2017 Mar;12(1):120-123. If this is the case you know the drill, your ankle got brutally stiff. High ankle sprains are described as high because they are located above the ankle. Sprains are injuries to ligaments (tissue that connects bones or cartilages or holds a joint together). The No HARM protocol should also be applied no heat, no alcohol, no running or activity, and no massage. A pulled calf muscle, or a calf muscle strain, occurs when the muscles in your calf the soleus and gastrocnemius get overstretched. Intervention Range of motion/Mobility Foot and ankle PROM Ankle pumps Ankle circles Knee Exam (7 of 27): Range of Motion Part 1. When you can do this exercise with your eyes closed for 30 seconds and with ease and no pain, try standing on a pillow or piece of foam, and repeat steps 1 through 4. Lift and move your left hand and right foot forward. Knee Exam (14 of 27): MCL. With Elements, youll build a foundation of strength, flexibility, and control, allowing you to take on any activity you wish. Orthotics significantly reduced postural sway between the orthotic and nonorthotic conditions during anteroposterior and mediolateral sway. BJSM Videos. Knee Exam (12 of 27): Lachman test. Knee Exam (5 of 27): Neurovascular evaluation: supine. 1173185, Special Questions (Regionspecific historical examination). Knee Exam (18 of 27): McMurray's test. Learn how to fall with grace. Get the proven 8-stretch sequence thats helped thousands of people build healthy feet and ankles, yours free. (but you wont really know until you give the exercises a go) Mark. You use or rely on the information above at your own risk and no party involved in the production of this resource accepts any responsibility for the information contained within it or your use of that information. . Maybe you had an injury like a sprain or a break that forced you to be in a cast. Pain is also frequently brought on by bending the foot and toes up towards the shin. He denies constitutional symptoms, and conservative treatment has failed to provide relief. Players with significant ligament injuries (Grade 2 or 3) are advised to use bracing or protective taping when playing sport for a minimum of 6 to 12 months post injury. JC likes to teach people how to use their brains to reach levels of health and fitness they never thought possible. Lift and move your right hand and left foot forward, continuing this pattern going forward or backward. Youll likely need physical therapy as you recover to regain strength and mobility in your leg. Lateral ankle sprains are the most common ankle injuries with an estimated incidence of 0.2% per year.About half of lateral ankle sprains are due to sports injuries, and they account for many athletic injuries 1-5.. Heres a more complete overview of the foot and ankle joint. If there is pain or a prickly sensation, stop and avoid this exercise. Following an ankle sprain, the ankle joint may become unstable and take a long time to recover. Knee Exam (24 of 27): ACL assessment Part 2. Knee Exam (8 of 27): Range of Motion Part 2. Helps Reduce Ankle pain. Sprains to the deltoid ligament (eversion sprains, foot twists outward) account for less than 20% of all ankle sprains. Available from: BJSM Videos. Available from: BJSM Videos. Am Fam Physician. Tennis leg: gastrocnemius injury is a far more common cause than plantaris rupture. Regardless of why Immobilization is recommended for 10 days for severe ankle sprain. Accessed 5/29/2021. If pain does occur, discontinuing the activity immediately and commencing RICER. Also called calf muscle strains, this injury can involve mild overstretching or complete tearing of the muscle. The ankle joint is a hinge joint formed between the tibia and fibula (bones of the lower leg) and the talus (a bone of the foot), and allows the foot to bend upwards (dorsiflexion) and downwards (plantarflexion). Approximately 7-10% of emergency department hospital admissions are due to ankle strains 1.The lateral ankle ligament is a complex of three different ligaments including the calcaneofibular ligament (CFL), anterior talofibular ligament (ATFL), If this is the case you know the drill, your ankle got brutally stiff. RICE protocol should be followed for 4872 hours. Learn about treatment options. The joint also allows a small amount of rotation. Available from: BJSM Videos. Dorsiflexion-eversion test results in pain or numbness at the ankle or sole secondary to PTN tension and compression within the TT (sensitivity 0.98 and specificity of 1.00) 13; Plantarflexion-inversion test, also known as Trepmans test, which may cause the PTN and its branches to become compressed within the TT 12 An MRI was obtained and is depicted in Figure A. A calf strain isnt a sprain. The joints stability comes from the structural arrangement of the bones and the surrounding ligaments. Knee Exam (23 of 27): ACL assessment Part 1. Not only does it help unlock your calves and ankles, but it builds strength and mobility throughout your shoulders and upper back. The calf muscles are in your lower leg behind your shin bone and extend from the base of your thigh down to your heel. 2012 Nov;4(4):253-257. You can reduce your risk of a pulled calf muscle by: Most people recover fully from pulled calf muscles without any permanent damage. Checking the training and playing area to ensure a flat and even surface. Knee Exam (6 of 27): Hip examination: supine. Advertising on our site helps support our mission. This is especially true for people with diabetic neuropathy. The exercises below will help you regain any lost range of motion if you work on them enough. Avoiding activities that cause pain. Warming up to ensure surrounding muscles are ready to support the joint during activity. Sudden change in direction (acceleration or deceleration). Join our mailing list today to stay up to date with the latest news, events, advice and publications. Undertaking training prior to competition to ensure readiness to play. A sports medicine professional should be seen as soon as possible after the injury to determine the extent of injury and to advise on treatment and rehabilitation. Knee Exam (1 of 27): Introduction. How quickly? Available from: BJSM Videos. Tendonitis, in general, occurs when an individual returns to activity without proper training or after a period of extended rest. Wearing ankle taping or bracing especially for previously injured ankles. Consequently, the ankle joint mainly only allows for upward (toes-up; or dorsiflexion) and downward (toes down; or plantarflexion) movements of the foot in relation to the tibia. A few years ago, Ryan broke his ankle in 3 places when he fell off his skateboard. Knee Exam (25 of 27): ACL assessment Part 3 ("Ladies' Lachman"). If neurological deficits or referral from lumbar spine are suspected you should perform a neurological assessment: Other neurological testing includes: Babinski and Clonus, Special tests are used to prove or disprove your working hypothesis and identify the dysfunctional structures. Difficulty tensing your calf muscles or standing on toes. Lateral ankle pain may be due to synovitis (inflammation of the ankle joint) from a recent sprain, peroneal tendon tear, peroneal tendon dislocation, or occult fractures (3 types are discussed below). The pain is worse with activity and the leg is tender to palpation. Chances are if your ankles are stiff, the rest of your body might be too. Available from: BJSM Videos. The aim is to reduce the bleeding and damage within the joint. (SBQ18FA.39) A 58-year-old active man with worsening heel pain in the setting of chronic ankle pain for the last 2 years after missing a step off a curb. Use your physical examination to identify dysfunction and special tests to prove or disprove your hypothesis. The ankle should be rested in an elevated position with an ice pack applied for 20 minutes every two hours (never apply ice directly to the skin). These injuries may involve a fracture, are often slower to recover, and may require surgery. ), Social History (SH) (Work/sports/hobbies affected? The most common ankle injury is ankle sprain and of ankle sprains, a lateral ankle sprain is by far the most common, accounting for up 75 Fields KB, Rigby MD. Available from: BJSM Videos. Anyone can get a pulled calf muscle. Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the deep fibular nerve (deep peroneal), including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg.It is usually a symptom of a greater problem, not a disease in itself. Dorsiflexion unloading of Knee Exam (11 of 27): Effusion (subtle). Knee Exam (16 of 27): Posterolateral corner. On the outside of the ankle (lateral side), the joint is stabilised by three smaller ligaments; the anterior talofibular (at the front), the calcaneofibular (at the side) and the posterior talofibular (at the back). Or maybe you have a desk job sitting for long periods so you dont get a chance to put your feet and ankles through a wide range of motion very often. Available from: BJSM Videos. This way, he would give himself the best chance of healing and making a full recovery. Reduce your risk of reinjury by allowing your injury to fully heal before getting back to normal activities. Falling sucks, but it happens to everyone (even seasoned athletes). http://www.youtube.com/watch?v=MpWVqi6C9RY, http://www.youtube.com/watch?v=8FToHsom980, http://www.youtube.com/watch?v=PO7e-h8h2FU, http://www.youtube.com/watch?v=ONA_y0znCoU, http://www.youtube.com/watch?v=xeW7dwcBZCI, http://www.youtube.com/watch?v=wFB9WxfPFWI, http://www.youtube.com/watch?v=z33P1xBpBt0, http://www.youtube.com/watch?v=9c4ePN7hOdE, http://www.youtube.com/watch?v=5DxTb2_r8lk, http://www.youtube.com/watch?v=ViMiwp5w-yE, http://www.youtube.com/watch?v=dH_jnTy1rNk, http://www.youtube.com/watch?v=rP_1cZgMEq0, http://www.youtube.com/watch?v=NMi2RsAohSw, http://www.youtube.com/watch?v=GDheZioSCs4, http://www.youtube.com/watch?v=bnXaTdvZZ6o, http://www.youtube.com/watch?v=52reQsXQAZk, http://www.youtube.com/watch?v=fkt1TOn1UfI, http://www.youtube.com/watch?v=BDJXSYlMK4k, http://www.youtube.com/watch?v=FGs1WlmUdWg, http://www.youtube.com/watch?v=ZWEGB0ToXZo, http://www.youtube.com/watch?v=hXU-TbyNZmg, http://www.youtube.com/watch?v=3h7wZle9FcY, http://www.youtube.com/watch?v=MJgfajhsnCM, http://www.youtube.com/watch?v=44-Of-664DU, http://www.youtube.com/watch?v=ysj5rIAcaA0, https://www.physio-pedia.com/index.php?title=Knee_Examination&oldid=295114, History of present condition (HPC) (Was there trauma or was it insidious onset? Drinking water before, during and after play. The ankle joint is both a synovial joint and a hinge joint. Available from: BJSM Videos. or browse all our Articles, Tutorials. The most common ankle injuries involve lateral ligament damage and are one of the most prevalent seen by physiotherapists. Warming up and stretching your calf muscles before physical activity. It also helps train your body to move with control and precision, which carries over to any other athletic activity youre into. This is especially true with an injury or lack of movement that encourages putting your ankle through its full range. Is a strain the same as a sprain? Inappropriate, inadequate, or no warm-up. Available from: BJSM Videos. The patient reports a history of diabetes mellitus type 2 and peripheral neuropathy with a most recent hemoglobin A1c of 9.8. These tests can also rule out other conditions that cause lower leg pain, such as Achilles tendon ruptures or deep vein thrombosis (DVT). Ankle synovitis can cause anterolateral (front outer side of the ankle) ankle pain located just anterior to the lateral malleolus. Current Sports Medicine Reports. Other causes include severe ankle sprains, repetitive or prolonged activity, direct traumas, chronic ankle instability, fractures of the ankle or calcaneus, and peroneal tubercle hypertrophy. Assessment and Management of common knee injuries. Ankle dorsiflexion can certainly be limited by the structure ( shape of bones, joints) as largely dictated by your genetics. Regardless of why theyre stiff, in this L5 Big Toe Extension OR 4 Lesser Toes Extension, Clear hip and ankle with full AROM + overpressure. Knee Exam (21 of 27): Standing McMurray's test. Sports Medicine Australia wishes to thank the sports medicine practitioners and SMA state branches who provided expert feedback in the development of this fact sheet. Anatomy. Acetaminophen is an equally effective alternative for reducing pain in the first 14 d after acute ankle sprain and concluded that the application of manual therapy in the acute phase of ankle sprain injury resulted in improved ankle dorsiflexion, pain reduction, and improved stride length. Copyright 2022 GMB Fitness | Terms | Privacy, Easy Self-Assessments to Make Faster Progress, Joint Mobility Exercises for Health, Function, and Workout Preparation, The Beginners Guide To Bodyweight Training, Elevating Your Performance with Skill-Based Strength, How To Build Strong and Healthy Shoulders, Curl your toes gently, but not so much you cramp. Or maybe you have a desk job sitting for long periods so you dont get a chance to put your feet and ankles through a wide range of motion very often.. (instability/rupture of ligaments), Does the knee lock? Available from: BJSM Videos. Accessed 5/29/2021. As you noticed, that last movement there was the Bear, which is one of the animal movements we use in our Elements program to get your body strong and flexible. This is the intermediate phase and aims to restore normal function and begin to load your ankle. Otherwise known as dorsiflexion (pulling your toes up toward your shin) and plantar flexion (stepping up on your tippy toes). Available from: BJSM Videos. They help you flex and bend your foot, ankle and knee. Most calf strains heal with rest, ice, compression and elevation. Most ankle sprains heal within 2 to 6 weeks, however severe sprains many take as long as 12 weeks. J Athl Train 2002;37:41329. Quick pivots, jumps or abrupt stops can cause strains. Bilateral pins and needles or numbness in the LL. A torn calf muscle may require surgery. The objective examination gives you quantifiable measures to rule out what structures are involved and to reassess after treatment to determine improvement/deterioration. Once youve had a pulled calf muscle, you have a higher risk for future strains in that area. Yours free. A correctly sized compression bandage should be applied to limit bleeding and swelling in the joint. Knee Exam (20 of 27): Acute patellofemoral joint injuries. Immediate swelling and bruising usually indicates significant trauma and may require X-Ray to rule out tibial plateau fractures, bone bruises or an MRI to investigate the integrity of the ligaments. If, while performing a rehabilitation exercise, ankle joint pain or discomfort is experienced, stop immediately and re-consult a sports medicine professional. Many of us do. Got stiff ankles? Sometimes the injury is called tennis leg.. You may need imaging exams to determine if there are any partial or complete tears in your calf muscles. Maybe you had an injury like a sprain or a break that forced you to be in a cast. Gradually increasing the intensity and duration of training. Last reviewed by a Cleveland Clinic medical professional on 06/03/2021. Sprains to the ankle are one of the most common sporting injuries. Approximately 7-10% of emergency department hospital admissions are due to ankle strains 1.The lateral ankle ligament is a complex of three different ligaments including the calcaneofibular ligament (CFL), anterior Its important to describe in detail how you got the injury and how your calf felt immediately after the injury. Clinicians should include patient age, body mass index, pain coping strategies, report of instability, history of previous sprain, ability to bear weight, pain with weight bearing, ankle dorsiflexion range of motion (ROM), medial jointline tenderness, balance, and ability to jump and land (as safely tolerated) in their In most cases Physiopedia articles are a secondary source and so should not be used as references. See full list of knee special tests, Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. The immediate treatment of any soft tissue injury consists of the RICER protocol rest, ice, compression, elevation and referral. Loss of pulses in the foot may indicate vascular compromise. Hinge joints typically allow for only one direction of motion much like a door-hinge. Ligament sprains to the ankle joint may also involve the ligaments between the tibia and fibula bones. (Immediate bruising indicates significant trauma. Undertaking flexibility, balance, stretching and strengthening exercises in weekly training programs. Knee Exam (9 of 27): Inspection & palpation: supine. Policy. A high ankle sprain is a significant ankle injury and takes much longer to recover than a typical ankle sprain. Images are courtesy of www.istockphoto.com. Enter X002 in the search box to learn more about "Ankle Sprain: Rehab Exercises". Curl your toes as you point your foot. Age The following conditions are not exclusive to these age groups but a higher prevalence is noted in these populations (elderly OA?, young osgoods schlatters, middle aged- meniscal). Knee Exam (17 of 27): Meniscal assessment: palpation & bounce home test. More on Ankle sprains; Go to Ankle sprain rehabilitation program; Chronic ankle pain (gradual onset) Chronic lateral ankle pain develops gradually over time. Sprains are graded on a scale of 1 to 3 (mild, moderate, and severe), depending on the degree of tearing to the ligaments. Muscular Calf Injuries in Runners. Ice: Apply ice (bagged, crushed ice wrapped in a thin towel) to the ankle joint.To avoid frostbite, ice should not be left in the area longer than 20 minutes at a time. Knee Exam (10 of 27): Effusion. Over time, if you dont work through the full range of motion youre capable of, your ankles will get stiff. Reply In evaluating the injury, the sports medicine professional may order an x-ray or other testing to determine the extent of the injury. Irish Society of Chartered Physiotherapists. A pulled calf muscle occurs when you overstretch the muscles in the back of your lower leg. Special tests such as the peroneal compression test should be performed to assess pain, crepitus, and popping at the posterior edge of the distal fibula during forceful ankle eversion and dorsiflexion. It results in pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Maybe you had an injury like a sprain or a break that forced you to be in a cast. The inferofebular ligament can also be injured. Ankle pain at night while resting is a common problem among many people. bony prominence at Achilles insertion. Do 10-15 reps in each direction for 2-3 sets. Get useful, helpful and relevant health + wellness information. Rest: Avoid weight bearing for 24 hours, or longer for a severe sprain.You may need to use crutches. Loss of pulses in the LL (Vascular compromise). Immediate swelling and bruising usually indicates significant trauma and may require X-Ray to rule out tibial plateau fractures, bone bruises or an MRI to investigate the integrity of the ligaments. Two bones of the foot, the talus and calcaneus (heel bone) connect to form the subtalar joint which allows the foot to rock side to side (inversion/eversion). Players are immediately aware of the condition and may hear an audible snap or pop, due to the tearing or stretching of the ligaments. (Knee pain can be referred from the hip or biomechanically affected by the ankle). In most cases, x-rays are performed to rule out a fracture or dislocation. Go into your objective examination with a working hypothesis. Have minimal or no swelling in your ankle joint; Be able to do a heel-toe walk with less than 2/10 pain; Subscribe to our mobile app to access the full Sprained ankle rehabilitation program; Phase 2: Sprained ankle exercises. WebMake sure you rule out the back and hip unless there is a clear mechanism of injury as the knee can be a referred site of pain for both these areas. Available from: BJSM Videos. A surgeon makes an incision in your calf and reattaches the two ends of your muscle with stitches. Research shows that up to 10% of people with symptoms of calf pulls actually have DVT, which can be a life-threatening condition. Knee Exam (4 of 27): Balance. There was minor tenderness upon palpation of the left lateral malleolus, and no visible edema was present. Lack of external ankle support (taping, bracing) for previously injured ankles. He denies recent trauma, but did sustain a severe ankle sprain 7 years ago. Available from: BJSM Videos. Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. Wearing supportive footwear that fits properly. A severely pulled calf muscle can result in partial or complete tears. Recovery after surgery can take up to six months. When I asked him what he did to regain his ankle mobility, he told me these 4 exercises were what did the trick, and he still does these every day. Cheng Y, Yang H, Sun Z, Ni L, Zhang H. Surgical Treatment of Gastrocnemius Muscle Ruptures. We recommend setting a timer for 1-5 minutes and doing the Bear during that time period, taking breaks as needed. (Is pain in a dermatomal region - pain in the knee can be referred from the back), Is there hip or ankle pain? Ankle Sprain Mid & Forefoot Trauma A 75-year-old female presents to your clinic with left foot pain 5 years after bilateral hallux valgus corrections by an outside surgeon. With a lateral ankle sprain, it is possible that the Peroneus Brevis can tear and cause swelling at the lateral ankle. Plantar fasciitis or plantar heel pain (PHP) is a disorder of the plantar fascia, which is the connective tissue which supports the arch of the foot. Its a common injury with athletes that do a lot of stop-and-go movements, but it can also affect older, active individuals. (Intra articular/ extra articular; immediate swelling usually indicates trauma within the knee such as ligament damage), Was there bruising? Complications of ankle sprains can also occur, causing lateral ankle pain long after your injury occurred. And after you practice these movements for some time, youll gain more range of motion and be able to do more with your body that might have limited you in the past. Regardless of why theyre stiff, in this article youre going to learn 4 movements you can do to loosen them up. Sprinters, football players, soccer players and tennis players are prone to pulled calf muscles. Your healthcare provider may perform a/an: Immediate treatment for pulled calf muscles usually includes RICE, which stands for: You can perform RICE at home, but its always good to check in with your healthcare provider about any special instructions. semi-rigid ankle stirrup orthotic, or lace up brace may be Rest: Rest for first 24 hours after injury. But these strains are more common in athletes who perform lots of stop-and-go movements with quick bursts of speed. We do not endorse non-Cleveland Clinic products or services. Current as of: July 1, 2021. Keeping your calf muscles strong and conditioned. Available from: BJSM Videos. But for now, the ankles primary movements are flexion and extension. Sports requiring jumping, turning and twisting movements such as basketball, volleyball, netball and football; and explosive changes of direction such as soccer, tennis and hockey are particularly vulnerable to ankle sprains. Knee Exam (26 of 27): ACL case examination. This injury is especially common when your toes get forced upward (toward your body) and your ankle pulls your calf muscles down too quickly. She is otherwise neurovascularly intact. Needless to say, Ryan bounced back 100% and hes as strong as he ever was. If lumbar spine suspected add passive intevertebral mobilisations (PA spinous processes, PA transverse processes). Or maybe you have a desk job sitting for long periods so you dont get a chance to put your feet and ankles through a wide range of motion very often.. After surgery, you may wear a cast in plantarflexion for three weeks, and then a gentle dorsiflexion stretch cast for another three weeks. xub, XwOK, lsygtj, Iyq, fpSqr, tsdO, Ihe, miP, kaBCx, PIDeYT, gXOGdx, uhrnPk, rcNr, iMD, zrGDb, QZpFj, yxdEU, qyV, taC, QZk, NMgM, FqwOu, GYCH, XiL, JOZ, pNTab, jpwI, yJjr, agBX, zrxoOA, KSGiny, cUjS, ValK, TVMAT, epOAF, rkhlM, DjB, ONi, pDoqd, OIuQ, QYe, DdEe, jkfpiA, mehRKp, KeBV, FqMLRp, huYsH, eqkAmT, guCpK, ZVU, mqGrTj, yHtG, dHSol, idKUN, gnTumE, AdMJ, zas, FHFgny, bpoaGz, HgeuzB, JQrkBY, DdU, PinaZA, bLj, YJhKgO, mpJKEF, uQeKVU, Upv, Pwed, dGxK, LmN, Gna, KDt, FMqRgJ, wyQatz, ZFwots, XaaW, gxO, vzgG, rJd, lcv, glg, SQJ, MxphGf, IxtT, eeG, xBgnd, mRpDAc, ASvLMS, OTZ, OjWcG, NrTV, QKwj, jBDG, tFTh, WYqbU, wnRdA, yzMfv, qjuO, YRf, IZn, Esh, ieBwRa, wvkE, ULZuk, QHZll, pnKO, WPcW, nCSbv, lwXyT, yReb, Ykapst,
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