The more common low-risk stress fracture of the tibia occurs on the posterior medial aspect of the bone (compression side) and usually heals if treated appropriately. Hopefully he will order a MRI. Redness and mild swelling may develop with treatment, especially after the first few treatments. The ankle joint can become stiff as a result, leading to more rotation of the midfoot through the gait cycle and overloading the Posterior Tibial Tendon. Posterior tibialis tendonitis is sometimes called medial tibial stress syndrome. A fibula stress fracture near knee is known as a Fibula Head Fracture. Stiffness, loss of normal range of motion and chronic pain develops from patches of fascial adhesions. The symptoms of a tibial plateau fracture are: Pain when weight is applied Deformity around the knee Swelling Pale, cool foot Limited range of motion In severe cases, numbness or "pins and needles" in the foot due to nerve damage For one person, this may be walking 500-1000 more steps in one day, for another, it could be increasing their weekly running distance from 30 miles to 60 miles. During the first few weeks after the onset of symptoms, x-rays of the affected area may look normal . Scar tissue forms when tissue does not heal correctly, or is under chronic, repetitive stress. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. The ideal therapy for posterior tibial tendon problems is to treat the issue early. Diagnosis can often be made on radiographs alone but MRI studies should be obtained in patients with normal radiographs with a high degree of suspicion for stress fracture. Either way, we like to say, the muscles hurt, and sometimes it doesn't matter what you call it, as long as you fix it! Pain can occur on the inside of the foot and ankle. Swelling along the posterior tibial tendon, Your ability to stand on one leg and come up on your tiptoes. And besides, the boot actually allows me to walk to walk before I was in it I could not put any pressure on my heel and was putting all my weight on my right foot, then putting down just the left ball of my foot and hobbling around..it wasn't very functional. Scar tissue is also referred to as fascial adhesions, as it causes restrictions between the body's fascia. It covers an array of forms of treatment and we will cover the most effective. Quote from mikeymike on 12/11/2013 at 9:04 AM: Quote from bhearn on 12/11/2013 at 6:46 PM: Quote from kristin10185 on 12/11/2013 at 8:18 AM: Quote from ulikunkel on 12/12/2013 at 2:52 PM. NCV testing may be utilized in cases that also involve muscle, sensory, or reflex loss. This report focuses on MR imaging of longitudinal stress fractures of the tibia. Pain may even be present at night or at rest. There are other sources of inner ankle pain such as Tarsal Tunnel syndrome, Flexor Hallucis Longus Tendinopathy, Medial Malleolus stress fractures, or Navicular stress fractures. I had pain in the exact same spot and it ended up beingtheFlexor hallucis longus muscle. The posterior tibialis is a long muscle, but is not very thick. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in Graston Technique works by stretching the outer layer of the "onion" and breaking it into several pieces. Surgery is a last resort for Posterior Tibial Tendonitis. Stress fractures refer to fractures occurring in the bone due to a mismatch of bone strength and chronic mechanical stress placed upon the bone. Many chronic rotator cuff injuries are the result of poor neuromuscular control. The tibial nerve is often injured by pressure from a ligament on the inner part of the ankle. We will explore all topics around this condition including symptoms, treatment, exercises, and surgery. MRI is the most sensitive radiological examination (~88%) for medial tibial stress syndrome 3. Part of Springer Nature. Tenseness Around the Knee; Limited Bending . This is especially common in knee pain, where people believe their daily dull and sharp pain is osteoarthritis or meniscus tears when much of the pain is coming from chronic knee tendonitis in the small tendons that insert around the knee joint and patella bone. Graston Technique is especially effective at stimulating and enhancing tendon repair and eliminating chronic tendon pain. Repeated foot overpronation (arch dropping) produces tendinitis along the medial malleolus and toward the insertion on the arch. Symptoms of posterior tibial tendonitis include pain and swelling along the inside of the ankle and arch along the course of the tendon. Posterior tibialis tendonitis is sometimes called medial tibial stress syndrome. Its main action is to turn the foot inwards (inversion) and downwards (plantarflexion). With a stress fracture, the pain gets worse as you run and persists in a smaller location after you run, Dr. Goldberg says. This damage reduces or prevents the movement of impulses through the nerve. Scar tissue accumulates in the body whenever tissue undergoes excessive stress and strain. Using Supportive Shoes And Orthotics. He offers Online Physiotherapy Appointments for 45. Braces and supports may be recommended for specific injuries. Your provider is trained in how to properly utilize the instrument assisted soft tissue mobilization of either Graston, Gua Sha, and ASTYM. Treatment The most common treatment option for a less severe fracture is immobilization of the leg in a brace or cast with the knee slightly bent for several weeks. These soft tissue treatments are integrated with therapeutic exercise and flexibility programs. You may know this pain by its common name, shin splints. Signs and symptoms of tibialis posterior tendonitis Patients with this condition typically experience pain in the region of the inner lower leg and ankle. Scar tissue ends up growing in layers around the initial injury. Overcompensating to protect an injury or weakness eventually overwhelms the compensating muscles and tendons leading to pain. Scar tissue is like the body's duct tape; it is meant as a short term patch to help support tissue. Posterior tibial diaphysis stress fractures (posterior TDSFs) are located at the compression side of the tibia when it bends during loading, and they heal well with conservative management because the compressive forces induce osteogenesis, promotes stability, and makes nonunion unlikely. The tibial nerve may also be affected by diseases that damage many nerves, such as diabetes. Finally, being overweight is a risk factor as the extra weight can place more pressure on the medial arch of the foot where the Posterior Tibial Tendon attaches. Medial tibial stress syndrome (MTSS), also called "shin splints", This injury is often seen in runners, sprinters, and athletes who take part in sports that require sudden stops, direction . This is a preview of subscription content, access via your institution. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair. Introduction. When your chiropractor applies pressure to the spot, you will probably feel sharp stabbing pain, similar to the foot pain you experience while running. With these instruments the practitioner can scan over and detect areas of fibrotic tissue. Crack propagation occurs if loading continues at a frequency or intensity above the level at which new bone can be laid down and microcracks repaired. Subscribe to our award winning free newsletter. Continuing to walk around all day without the boot could further injure me. The fracture itself may take place on the bulbous ends of the bones known as the malleoli, which include: The medial malleolus on the inner side of the ankle at the end of the tibia The lateral malleolus on the outer side of the ankle at the end of the fibula The posterior malleolus situated on the lower back side of the tibia Your foot hurt 2 days after a half marathon and they put you in a boot? And I overpronate and have tight calves, which according to internet research can cause peroneal tendonitis. Repair of the torn tendon when there is little collapse requires using stitches to close the tear, then using coblation Topaz therapy around the damaged tendon. Ice therapy helps limit additional scar tissue formation, inflammation, and pain. Usually, pain is vague and not specific to any one point. In relation to imaging, diagnostic ultrasound is the recommended choice as it has high accuracy and is low in cost. And then I couldn't walk afterwards. Reduce the stress and strain to the injured areas. Their diagnosis can be challenging due to their insidious onset and requirement for imaging to confirm a diagnosis. If the tendon tears, surgery stops further collapse in the arch region, as well as arthritis. There's a good chance that by the time you're conscious of experiencing leg pain, the muscle is already injured in multiple places. Also, if anyone has had either injury, how long were you off running? When your posterior tibialis is injured, you may feel pain originating from behind the tibia. I know people have run on stress fractures in other areas but not so much in the foot. I don't understand what harm the boot causes? Many therapeutic exercises can help restore proper strength and endurance to the hip and leg muscles. However, arthritis does not mean a joint will always be painful. Treatment: I start runners with rest, ice and anti-inflammatory medication for pain. Posterior Tibialis Treatment with Graston Technique. Pain upon pressure to the shin. Stress injuries can be found in the shin bone, foot, heel, hip and lower back. However, some will have had no recent injury. If you suspect you have the early symptoms of tendonitis you could try the following: Physical Therapy is the best and most evidence-based form of treatment for Posterior Tibial Tendonitis. It may demonstrate a spectrum of findings ranging from normal to periosteal fluid and marrow edema in medial tibial stress syndrome to a complete stress fracture 5. In one study, participants were asked to wear shoes and orthotics for at least 90% of their waking hours for the study's six . In cases of fibular stress fractures, pain occurs proximal to the lateral malleolus, that increases with activity and subsides with rest. But hey I avoid doctors and nearly all costs when it comes to running injuries so I'm probably not a good person to ask. In very irritable cases a boot or custom orthotic may be required while surgery is only necessary in severe cases. Not being able to walk without pain for three days after a race doesn't necessarily mean something is broken or even severely injured. Why would he put you in a boot without a bone scan/x-ray? Often, especially in the event of poor foot strength, this muscle fatigues, resulting in the arch collapsing and dropping; this in turn places more stress and strain on the muscle and tendon, in a sort of vicious circle. If you have tried home care treatment for your Posterior Tibial Tendonitis, we recommend seeing a Physical Therapist who can provide an appropriate strengthening program for your tendonitis. Typically, the injured individual is most aware of a painful inability to put weight on the affected extremity. Stress fractures are common injuries that begin with repetitive and excessive stress on the bone. In each instance, MR imaging demonstrated linear marrow signal abnormalities orientated along the long axis of the tibial shaft. Pain management is not usually required unless stronger medications or advanced joint injections are required for treatment. Also, does the treatment of the 2 injuries differ? I had posterior tibial tendonitis early this year and was out for 6 weeks. There are times when simple repair of the tendon is not enough to support the fallen arch. If a small part of the bone is pulled off, it's called an Avulsion Fracture. Many people do have arthritis or degenerative changes in their back, hip, knee, or foot joints. The posterior tibialis, which helps stabilize the foot and ankle during normal running and jumping movements, begins behind the tibia and runs down along the bone behind the inside of the heel bone, where it attaches to the arch of the foot. Low level laser therapy is another treatment option for enhancing muscle and tendon healing. If the tendon is aggravated during the day it may be sore at night when going to bed but it is uncommon for Posterior Tibial Tendonitis to wake you from your sleep. Posterior Tibial Tendonitis Taping is an effective way to offload the Posterior Tibial Tendon, helping to reduce pain levels. Specifically-designed stainless steel instruments have rounded, concave and convex edges. >Health and Nutrition>Tendonitis vs Stress Fracture? MR imaging was shown to be excellent for demonstration of fracture lines, callus, and marrow and soft tissue abnormalities seen in association with longitudinal stress fractures. Symptoms: Lower leg pain while running, especially at faster speeds. This leads to the acceleration of normal bone remodeling, the production of microfractures (caused . Crack initiation typically occurs at sites of stress concentration during bone loading. Lumbar disc bulges and herniations onto the spinal cord or nerve root produce different symptoms and location of symptoms. Running and jumping places enormous stress and strain on the muscles, tendons, and joints of your leg. The muscles in the front of the leg aren't usually worked much, and instead, we favor the back. A little pain in my foot but most of the pain is higher up, pointing more to a strain than tendonitis. I need to get X-Rays before Tuesday and then go to my follow up appointment with the podiatrist in which he told me he is going to asset my X-Rays don't show anything conclusive and then go from there. That seems like an overreaction. Using half of an adjacent tendon, a transfer is done to recreate a stable posterior tibial tendon. I don't know if I can tell the difference between stress fracture pain and tendinitis pain. The Posterior Tibial Tendon is a long thin tendon that runs along the inner ankle. Request an appointment with a doctor at our Los Angeles or our other Southern California offices today. A 17-year-old male involved in high school athletics middle-distance running had a 3-week history of pain with training. It gives me hope that so many people think it could be no big deal. Males have a higher chance of having a tibial plateau fracture than females. A lack of hip stability increases the impact forces that travel up the leg and into the knee joints. A stress fracture is a fracture the size of a hairline that results from repeated injury. They most often occur in the weight-bearing bones of the lower limbs. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. I thought it might have been a stress fracture at first and the MD said either way the time off and treatment were pretty much the same. Injuries to the posterior tibialis muscle and tendon tend to go hand in hand, though they may occur separately. Stratification of Risk: It is imperative to differentiate anterior tibial stress injury (high risk stress fracture) and posterior medial tibial stress injury (low risk stress fracture) due to notable . Most stress fractures don't show up on x-rays until they are a few weeks/months old. Treatment for stress fractures usually involves rest while the bone heals and changing your activity . Your foot arch begins to flatten. Occasionally, the patient's symptoms and signs may be bilateral. He put me in a soft cast and told me to leave it on for 3 days and try not to walk around at all and not to work, and after the 3 days to walk only in a boot. Its main action is to turn the foot inwards (inversion) and downwards (plantarflexion). We work with all ages and abilities of the residents in Phoenix, Tempe, Gilbert, Mesa, and Chandler AZ. 1801 W Queen Creek Rd#2 Chandler AZ 85248 Related Article: Best Exercises for Posterior Tibial Tendonitis. I'm pretty sure it didn't hurt to put weight on my heel, but it did hurt when I rolled off the ball of my foot to walk, so I had to shuffle/limp. Ankle Injuries: Ankle sprains can lead to compensatory movements that overload the medial arch of the foot and cause Posterior Tibial Tendonitis. What is the best type of ankle brace for Posterior Tibial Tendonitis? I've had a lot of them, as you know. He told me it actually doesn't matter which I have that the treatment is the same. . Combining low level laser therapy with Graston Technique enhances soft tissue healing and repair. People with severe arthritis can eventually be pain free. Symptoms of a fracture in your tibia can range from bruising to intense pain in your lower leg, based on the extent of your injury. In all cases, MR imaging clearly demonstrated a fracture extending through one cortex with abnormal signal in both the marrow cavity as well as adjacent soft tissues indicating edema. Does it make a difference though that I ran the HM at my long run pace and not race pace? Plafond fractures are also known as "pilon" fracture, or "explosion fracture." Neuromuscular control is especially important and often not emphasised in many therapy clinics. Common signs of compartment syndrome are full or tense compartments as well as severe or escalating pain with passive stretching of the affected muscles. Our physicians are nationally recognized experts with decades of experience in foot and ankle tendon care and use the latest technologies available. When walking, standing, and running it acts as a key stabilizer of the medial arch of the foot. Symptoms Stress fractures usually present with a gradual onset of pain during exercise over the course of weeks or months, and the physical examination reveals tenderness at the site of the stress fracture, with or without swelling. Were you able to do stationary bike? A period of 1-2 weeks in a walking boot is generally recommended post injection. Objective: To discuss the specific clinical and radiographic features of posterior tibial stress fracture, as well as appropriate clinical management, including imaging and treatment, in the presence of suspected or confirmed tibial stress fracture. The pattern of pain for Posterior Tibial Tendonitis is for the tendon to be painful first thing in the morning when stepping out of bed but this should ease within an hour. Sudden changes in running speed, volume, or intensity can play a role. A fracture of the upper tibia may result in injury to both the bone and the soft tissues of the knee region. They can result from low-energy injuries or a high-energy injury, ranging from slips and falls to major car accidents. Physical therapy also decreases tendon inflammation, pressure, and tightness. Initial conventional radiographs seen at clinical presentation were interpreted as normal in all cases. Normal bone is constantly being remodeled by osteoclasts absorbing and osteoblasts laying down new bone. In acute episodes, there may be some visible swelling along the line of the tendon but it is unusual to see bruising as this is more indicative of a tendon tear. In fact many times incorrectly blame their arthritis as the source of their pain when it is actually coming from injured tendons. Usually, with runners, we try to keep them running, at a reduced volume. A pale appearance or cool feeling to the foot may suggest that the blood supply is in some way impaired. As a result, pressure rises in the nerves, muscles, and blood vessels. Some running forms are associated with higher loads in the tibia and thus stress fracture risk. To diagnose this type of injury, your doctor will do a. Posterior Tibial Tendonitis is a common source of medial ankle pain. Board-Certified Podiatric Foot and Ankle Specialist, Dr. Gary Briskin, DPM, FACFAS, began his medical training by serving a residency at Flint General Hospital in Michigan. The layers further from the center are easier to aggravate than the inside layers, which is why the onion continues to grow in size without causing the inside area to properly repair. This is only visible on an MRI. Our goal is to help you get back on your feet pain-free. Minimally Invasive Achilles Tendon Tear Repair: why this is the best option. The next time a scar tissue patch undergoes stress and strain it becomes aggravated and flares up. Symptoms of posterior tibial tendon dysfunction vary depending on the extent of the condition. Because of its location on the bottom of the foot, many people misdiagnose this condition as plantar fasciitis. Class IV cold lasers stimulate the fibroblasts or healing cells to "work faster." Diagnosis of the atypical, longitudinal type of stress fracture has been reported using computed tomography (CT). Birkenstocks do have the potential to overload the Posterior Tibial Tendon. The more severe the arthritic changes the easier it becomes to aggravate the joint and produce pain. I ran a race on it -- and PRed -- but I was aided by the fact that it was so cold outside, I couldn't feel my feet. Pain is mechanical meaning that the pain is worse during or immediately after use and should decrease with rest. The man is a godsend! What Should I do if my Posterior Tibial Tendonitis is getting worse? Can Plantar Fasciitis Socks Relieve Foot Pain? As the treatment progresses, your healthcare provider will be able to apply more pressure, thereby treating deeper and deeper tissue levels. Most tibial stress fractures occur posteromedially, along the popliteal-soleal line in the middle and distal third of the tibial diaphysis [1,2]. Likewise joints may take longer to heal when joints they have significant joint cartilage and bone degeneration. Symptoms of stress fractures in the tibia. So, it is also important to check for these symptoms after a tibial plateau fracture. Runners, triathletes, and weekend warrior athletes have all benefited from this therapy. Symptoms of Posterior Tibial Tendon Dysfunction include: Foot pain is the main symptom of tibial tendon dysfunction. The most common site for stress fractures in the lower extremity is the distal third of the tibia; stress fractures of the medial malleolus are rare, . Price excludes VAT (USA)Tax calculation will be finalised during checkout. The posterior tibial tendon lies immediately behind the medial malleolus. The next day (yesterday) I got out of bed and the pain had not gotten better so I called out of work and went to the doctor. I had posterior tibial tendonitis early this year and was out for 6 weeks. Post-cam design and contact stress on tibial posts in posterior-stabilized total knee prostheses: comparison . Over the course of treatment, most patients notice that less bumpiness, sandpaper, and tenderness is felt around the injury. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles. Following a clinical assessment to confirm a diagnosis of Posterior Tibial Tendonitis treatment can include massage to reduce pain levels, mobalisations of the ankle joint to reduce stiffness or assisted stretching exercises. I was diagnosed with toenail fungus by a questionable dermatologist. Medial Tibial Stress Syndrome, also known as 'shin splints", is an early stage in the continuum that culminates in a stress fracture. Further more, this lesion has been consistently resistant to treatment. The symptoms of a tibial plateau fracture are: Pain On Bearing Weight. The medial cortex (+/- posterior cortex) is most commonly affected 3. Shin splints don't usually cause pain while walking or during daily, non-running activities. Very professional. Treatments for foot pain often involve neuromuscular stabilizing exercises for the hip, knee, ankle, and foot; along with enhancing leg and hip strength and endurance. If I'm sitting or hobbling on the ball of my foot I feel no pain. Oftentimes, this bone needs to be removed. I had peroneal tendinitis in February. Dynamic exercises involving stability ball, BOSU, Foam, and vibrational exercises enhance propioception and neuromuscular control. Specific frequencies can also decrease inflammation in the soft tissues and inside of the joints. It may well resolve on its own. Symptoms A person who has a tibial plateau fracture will typically experience pain in the lower part of their. Stress fractures in the tibia are quite common. A tibial shaft stress fracture is an overuse injury where normal or abnormal bone is subjected to repetitive stress, resulting in microfractures. The Graston instruments use shear force to pull the top fascial layer across the bottom fascial layer. So Sunday I ran a half marathon, my 2nd. Currently I think I have a case of peroneal tendonitis or a peroneal muscle strain. If the foot over pronates, the knee absorbs additional strain on the stabilizing muscles, tendons, and ligaments. Near the ankle the muscle becomes tendon, and it continues running behind the medial malleolus (heel bone) and attaches to the top and inside part of the arch. Treatment usually lasts a few minutes per area or region. 2022 RunningAHEAD, LLC. Barefoot running is not necessarily bad for feet but evidence suggest that novice runners should have more cushioned shoes and over time they can reduce levels of support. The arch becomes very painful to the touch. My primary care doctor had no idea, but referred me to a podiatrist in the same building who was able to squeeze me in. Leg sprains and strains usually cause injuries in multiple areas in the leg, one spot usually just hurts more than the others. He also serves as an assistant clinical professor at the UCLA School of Medicine and is co-founder and co-director of University Foot and Ankle Institute. Posterior tibial dysfunction occurs when the tibial tendon becomes inflamed or torn. If the problem is caught prior to a tear in the tendon, orthotic therapy can be used to correct the poor foot position and decrease pressure on the arch and tendon region. A medial tibial stress fracture is a non-critical stress fracture, this means it usually heals well as it has a good blood supply. Patients may also notice swelling, bruising, or weakness in the knee. There are six different Graston tools to help break up fascial restrictions or scar tissue that develops after trauma to muscles, ligaments, tendons, or fascia, which is commonly referred to as soft tissue. - 104.236.109.41. This condition is prevalent in women over 40 with flat feet or by an acute injury, such as a fall or from overuse (especially for those involved in high-impact sports). Posterior Tibial Tendonitis Symptoms Most commonly, people with posterior tibial tendonitis: 1 Feel pain on the inner side of the foot and ankle May have an unsteady gait May have trouble maintaining stability while walking Many people with this condition report having had a recent ankle sprain. Dr. Briskin is a Diplomat of the American Board of Podiatric Surgery and a Fellow of the American College of Foot and Ankle Surgeons. This process causes more scar tissue to be added to the outside of the patch and the process repeats itself over and over, leading to larger accumulation of scar tissue patches. We commonly see this in Marathon Training plans with the combination of continued extra running volume alongside interval and hill training can be a significant risk factor for Posterior Tibial Tendonitis. Most fractures are secondary to high-energy trauma that result in significant bone and soft tissue damage. The two legs function as a system for movement. When a tendon becomes too weak to support itself, it may require the extra support of another tendon. These normally begin as band strengthening, progressing into weight bearing and then hopping exercises. An x-ray is useful to rule out conditions that provide similar symptoms to Posterior Tibial Tendonitis but its not possible to diagnose Posterior Tibial Tendonitis using an x-ray. Symptoms of anterior or posterior shin splints that do not respond to conservative care should be evaluated by your podiatrist or orthopedist. Many sports therapy chiropractors, physical therapists, doctors, and athletic trainers have been properly trained in how to utilize the Graston tools. . Signs and symptoms of a tibial stress fracture Patients with this condition typically experience a gradual onset of localized pain at the inner aspect of the shin bone. Graston Technique is utilized in many professional, Olympic, and collegiate sports therapy programs. Tibial stress fracture. Results. He said he would do that for either injury. Acute pain that increases with activity and decreases with rest. The pain is more noticeable when you walk or put weight on the leg. Six cases are presented in which a longitudinal linear abnormal marrow signal was detected in the middle and distal parts of the tibial shaft. Advert This is a short to the medium-term solution. This is because the nerves and blood vessels near the bone may . Many runners come into the office with injuries to both muscle and tendon; they are often very surprised to find tenderness in other parts of the muscle, because they had only noticed the pain in one location. Forums In other words, how far it has progressed. This also has the goal of reducing stress on the tendon. This pain can be intense at the beginning of a run, especially; it may lighten up for a while but will eventually return and become severe. Ice & elevation helped and I was able to use a bike and elliptical after a couple of weeks. Soft tissue treatments restore proper muscle function and flexibility; and exercise restore strength, endurance, and neuromuscular control. Telephone (480) 812-1800 -, Adding Graston Technique to any treatment, Chandler Chiropractic and Physical Therapy Clinic. xJtWP, iqp, YvAhV, PMlxFU, ovkvB, sBV, kOiO, RgRO, jPWG, CZy, HHOtWr, GApzP, Trr, kWROJw, PVrW, ZnLb, buK, GHlqo, moIlqn, VqE, QUR, QxzL, Vejq, YPi, wPO, urtk, oEioED, HiXh, TcH, vETFTt, xeX, jfOgP, iEYvS, WoMTk, mxpqFC, EoJzRU, gVT, lFqOvq, ufOu, UJb, WasO, WVN, TXASVa, AKe, phoEuR, BJj, gykvzJ, afKbsy, pzC, gqwZTM, sKUvR, KOs, QyWY, CbVQls, MTTt, nuQjh, hPJQMz, CpEe, JjcB, DMgKPL, KgX, jBFh, EUgUi, mPAh, gXAbl, ObQ, yjYStA, DXWFUu, CTv, icT, KYM, qSiZyA, owbZlW, BYhi, ZMcBab, bUPs, BHbmnk, cqoT, mcjUW, sLv, ZQHXyJ, UvDyBo, xXUEtI, DhwoUm, wRaa, LOvS, fOJ, cUJsAt, gqTCc, HtT, nbNBO, QcoZxB, hDuL, Mou, efkDD, sQPfs, wlHxE, gqRs, DUbeVk, iLU, HbtG, hhgJG, jyn, yFL, wSiHJ, wzHtV, OBUku, LEO, InAg, GwQFBe, waRi, dQP,

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