The patient may also have pain along the proximal plantar fascia. Scott Wearing is widely published in plantar fasciitis research. Indeed, many runners continue to run with their symptoms. Dr. Verville is most concerned with providing effective solutions to help each of her patients heal quickly and correctly. For runners, that means getting a new pair after six months or 300 miles of running, Dr. Pandya said. Continue reading to learn the rationale as to why. Tom started RunningPhysio in March 2012 to help those training for marathons that spring, since then its developed into a resource used by runners all over the world. Over two million people in the US experience plantar fasciitis every year. ). However, without a sound evidence base this can only really be theory and opinion in relation to plantar fasciopathy. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. Its based on general theories on how tissues respond to load and how treatment often involves optimal loading of the tissue to stimulate recovery. Tom returned to the UK in 2006 and started working in Brighton as a senior physiotherapist. I am currently paying private for Shockwave therapy and have just had my second session, my foot is sore for 24/48hrs after treatment but the pain does seem slightly reduced, I am worried that this isnt going to work and its costing me a small fortune. And if youve had plantar fasciitis before, youre more likely to develop the condition again in the future, he said. But the condition is common among athletes and also in people who suddenly change their levels of physical activity, like those who get back into working out after an injury, or people leveling up miles as they train for a marathon. In tendinopathy load management is key in the reactive stage and the same is true of plantar fasciitis. WebPlantar fasciitis is the inflammation of the plantar fascia, tissue in the foot used during walking and foot movement. The resulting gait change causes the body to compensate to avoid the pain. That was about $2000, yes its going to cost money. WebPlantar fasciitis can be caused by: a sudden increase in the amount of activity you do. Stress fractures usually are shallow along the surface of the bone but might be deep. I bought Vionic flip flops and was NEVER without supportive footwear, even in the shower. She is known for high-quality podiatry care and for the amazing doctor-patient relationships she develops. Even stretching your calf over a stair at work or home can help add flexibility, Dr. Pandya said. You could certainly apply this concept to plantar fasciitis. Self Massage For Tight Calf Muscles After Running, 5 Triathlon Specific Exercises to Stay Injury Free, Shin Strengthening Heel Walk Drill for Runners. You also have the option to opt-out of these cookies. Plantar fasciitis is a painful foot condition caused by inflammation of the tissue band or fascia that runs from the base of the heel to the toes. In the reactive stage the tendon responds to excessive load by thickening and stiffening which helps act as a stress shield to decrease load. Modifying sporting activities to find a level that doesnt aggravate symptoms is key to management. After being under stress for so much time, the plantar fascia (the tissue that supports the arch on the bottom of your foot) weakens and can become swollen and irritated. Individuals with pes planus (low arches or flat feet) or pes cavus (high arches) are at increased risk for developing plantar fasciitis. The exact incidence and prevalence of plantar fasciitis by age are unknown. Currently 2 weeks into treatment and possibly going to try a XC Parkrun to see how it is. Other anatomic risks include overpronation, discrepancy in leg length, excessive lateral tibial torsion and excessive femoral anteversion. With more chronic degenerate plantar fasciitis load management is still key but can involve a gradual increase in load on the plantar fascia. WebPlantar fasciitis is the most common cause of heel pain presenting in the outpatient setting. If you avoid treatment, plantar fasciitis could lead to bigger problems down the road. I suffered from PF for about two years. I have an FC, well not sure since doctors dont know. Other modalities in Stage 2 include orthotics, taping, physical therapy, and night splinting. All that jargon aside where does it leave us with managing plantar fasciitis? Plantar fasciitis is a condition so common in athletes its even been called runners heel. Over-the-counter arch supports are especially useful in the treatment of adolescents whose rapid foot growth may require a new pair of arch supports once or more per season. Understand that if you email us, you are agreeing to the use of an unsecured method and understand that all replies will be sent in the same fashion, which you are hereby authorizing. Great info, thank you for posting this. Breaking News. However, the relationships between the biomechanical variables have yet to be determined. not April. Even though treatment can ease the pain to some extent, it takes some time before the foot is completely okay. Dr. The function of the plantar fascia is to provide static support of the longitudinal arch and dynamic shock absorption. Treatment of plantar fasciitis consists of three stages: Stage 1 involves prescribing the patient a heel cushion to decrease shock absorption of the plantar fascia, as well as a short course of medication to decrease inflammation in the heel. Diagnostic testing is rarely indicated for the initial evaluation and treatment of plantar fasciitis. A number of factors will play a part in loading your training type, volume and intensity will have a role as will footwear and training surface. Stretching the Achilles is widely recommended for plantar fasciitis but it might be best avoided in the reactive stage as it places greater stress on the fascia. Cook and Purdam (2009) highlighted the importance of determining the stage of a tendinopathy in determining management. Plantar Fasciitis mostly happens because of the injuries that have happened over time. The program consists of 4 phases and a 5th injury prevention/mitigation phase: Before you start it is important to determine your risk of exacerbating your symptoms and how much you should rest or offload your foot in the early stages. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Western Washington Medical Groups podiatrists have helped many patients recover from this painful condition through expert diagnosis and treatment. Digital Marketing and Website Design by Firm Media. Youll want to dedicate your workout shoes to only exercise, and replace them before they get run down. This category only includes cookies that ensures basic functionalities and security features of the website. The main disadvantage of orthotics is the cost, which may range from $75 to $300 or more and which is frequently not covered by health insurance. 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Jaivin, MD, FACS, The Difference Between Total and Reverse Shoulder Replacement, What Shoulder Replacement Surgery Involves. You might notice that its worse in the morning when you first wake up (first-step pain). Repeated stress on the plantar fascia causes small tears which can lead to inflammation and pain. That pain becomes especially pronounced after lengthy periods of inactivity people with the condition feel their feet throb when they step out of bed after a nights sleep, or when they get out of the car after a long drive, Dr. Tan said. CRAIG C. YOUNG, M.D., DARIN S. RUTHERFORD, M.D., AND MARK W. NIEDFELDT, M.D. In general, plantar fasciitis is a self-limited condition. The classic sign of plantar fasciitis is that the worst pain occurs with the first few steps in the morning, but not every patient will have this symptom. Please upgrade or install a more compliant browser like Chrome, Firefox, Safari, etc. We also use third-party cookies that help us analyze and understand how you use this website. This could mean that plantar fasciitis also goes through stages along a similar continuum. There are four specific stages of plantar fasciitis healing, which are: 1. Throughout the program, Phil explains the aims of each phase and where you need to be before you can progress onto the next level. This covers how and when to apply treatment such as cold therapy & compression, heat, massage, and taping. Next, the process is reversed, and the outside four toes are repetitively tapped to the floor while keeping the big toe in the air. A step-by-step rehabilitation program for acute and chronic Plantar Fasciitis heel pain. The disorder classically presents with pain that is particularly severe with the first few steps taken in the morning. https://www.kinetic-revolution.com/can-you-run-with-plantar-fasciitis Its probably more common than most people think, she said, noting that shes seen a resurgence of patients with the condition as more people have been returning to post-lockdown life. Stage 2 may involve cortisone injections into the heel region, if Stage 1 has failed to bring significant relief. It's not always clear why Having done the exercises for 2 weeks every morning I am managing the symptoms and pain is down at 1-2. Avoiding walking barefoot around on hard surfaces can also help opt for a slipper or house shoe instead. Necessary cookies are absolutely essential for the website to function properly. We dont just aim to heal your injury with this program but enable you to come back even stronger than before. WebWhat is plantar fasciitis? I made the ortho CAST me. Key features in tendinopathy aredetermining the stageof the tendinopathy,modifying both tensile and compressive loadand promoting tendon adaptation throughappropriate loading exercises. If you strain your plantar fascia, it gets weak, an injury or weakness in the ankle. The major disadvantages of iontophoresis are cost and time because, to be effective, it must be administered by an athletic trainer or physical therapist at least two to three times per week. Bilateral symptoms can occur in 20-30% of those diagnosed with plantar fasciitis. However, this tends to be moderate and is frequently little more than a tingling sensation. It is common in several sub-groups of people, including runners In general, we start by correcting training errors. Indeed while there are similarities to tendinopathy (which has been used as a framework to guide some of these ideas) there are differences too. If youve had grumbly heel pain for a while which has gradually worsened and youre an older athlete it is more likely a more degenerate picture. In recent years the work of Cook, Purdam, Magnusson and co. has advanced our understanding of tendon pathology. overstretching the sole of your foot. In one study,3 83 percent of patients involved in stretching programs were successfully treated, and 29 percent of patients in the study cited stretching as the treatment that had helped the most compared with use of orthotics, nonsteroidal anti-inflammatory drugs (NSAIDs), ice, steroid injection, heat, heel cups, night splints, walking, plantar strapping and shoe changes.3. It is the most common form of heel pain in Frisco men and women who are middle-aged, and it can happen in either foot or both feet at the same time. opps I meant Emily. Essentially, what you want is for your foot to regain natural movement around a surface with the necessary give and take to support, massage and ultimately strengthen against. Plantar fasciitis is caused by straining the part of your foot that connects your heel bone to your toes (plantar fascia). Early intervention and treatment can help correct the cause and prevent this condition from escalating into further joint, ligament, or muscle damage. You can opt-out if you wish. 2006)revealed marked long term improvement with specific plantar fascia stretching. You shouldnt wake up in the morning thinking, My feet are killing me, Dr. Tan said. instructions how to enable JavaScript in your web browser. Heres the rundown: plantar fasciitis is an inflammation of the plantar fasciaa ligament that runs along the arch of the foot and attaches to the heel bone. By now your early morning soreness will be diminished. PLANTAR FASCIITIS CHRONIC. However according to Wearing (2006) compressive load has not been fully examined in plantar fasciitis. Anyone can read what you share. Then I did stretches while they were warm. Some individuals wear shoes that are too small, which can exacerbate many types of foot pain.7 Patients often find that wearing shoes with thicker, well-cushioned midsoles, usually made of a material like high-density ethylene vinyl acetate (such as is found in many running shoes), decreases the pain associated with long periods of walking or standing. There are certainly many overlaps between tendinopathy and fasciopathy, this begs the question: should we approach plantar fasciitis in a similar way to tendinopathy? These changes share a lot in common with another group of conditions tendinopathy. But there are ways to reduce your risk. Perhaps future research will shed light on this. Plantar fasciitis, an inflammation of the tight band of tissue on the bottom of your foot, can happen to anyone, said Dr. Eveline Tan, a podiatrist at Northwestern Medicine, but it occurs more frequently in people who are on their feet for long periods of time. Less pain in the morning. For full functionality of this site, it is necessary to enable JavaScript. However, overuse rather than anatomy is the most common cause of plantar fasciitis in athletes. Orthotics (helped a little) Strassburg sock, (helps a little) Golf ball Ice filled water bottle. These changes involve thickening of the tissue and disruption of the fibres which make up the fascia (collagen). Plantar fasciitis is a condition that develops over time as a result of small rips and tears in the foot ligament that extends from the heel to the toes in the bottom of the foot. At present I think there can be a one size fits all approach to plantar fasciitis. From (generally) less invasive to more invasive, treatment options may include: The treatment approach recommended depends on the severity of your plantar fasciitis as well as the extent to which it has affected other parts of your body. How Do I Know If I Have Acute Or Chronic Plantar Fasciitis? It involves a surgical release of part of the insertion of the plantar fascia. Its ideal to see a podiatrist as soon as you notice signs of plantar fasciitis, in order to reduce the pain and avoid further complications. These cookies do not store any personal information. This can help you identify a cause to your plantar fasciitis and potential solutions. Over-the-counter arch supports may be useful in patients with acute plantar fasciitis and mild pes planus. Tom is a physiotherapist with over 10 years of experience and a very keen runner! Great article. In degeneration the tendon structure changes and there is change in the collagen which makes up the tendon. During the exam, your health care provider will check for areas of Does this sound like PF, or something I should see Podiatrist for , again ? The aim of phase 2 is to eliminate pain and allow a normal gait or walking pattern with minimal discomfort. Tiger Woods announced he has the common foot condition. He graduated with a BSc (Hons) degree in 2002 and since then has worked in clinics in the UK and overseas. Well, I would suggest it may be helpful to stage plantar fasciitis in a similar way determine if it is in an acute reactive stage or a more chronic degenerative stage and vary your management accordingly. One study19 found that the use of iontophoresis resulted in significant improvement after two weeks but no long-term differences at six weeks. Unless you study histology I doubt that clarifies much! Many sports medicine physicians have found that outlining a plan of relative rest that substitutes alternative forms of activity for activities that aggravate the symptoms will increase the chance of compliance with the treatment plan.4, It is equally important to correct the problems that place individuals at risk for plantar fasciitis, such as increased amount of weight-bearing activity, increased intensity of activity, hard walking/running surfaces and worn shoes. Theyupdated the review in 2010but it was later withdrawn as it was substantially out of date! Physio Stretching and strength building using many of your videos. It can be helpful to think of plantar fasciopathy as a response to excess load. This is the acute phase where the aim is to protect your foot, reduce pain and inflammation. Gradually I noticed pain in foot when awakening for about 4 months. Patients often notice pain at the beginning of activity that lessens or resolves as they warm up. Apply ice. Unfortunately, the time until resolution is often six to 18 months, which can lead to frustration for patients and physicians. For some individuals, the Age. Plantar fasciitis is most common between the ages of 40 and 60. Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue such as long-distance running, ballet dancing and aerobic dance can contribute to the onset of plantar fasciitis. In more severe cases, the pain will also worsen toward the end of the day. Of these three bands, the central band is considered most important in plantar fasciitis, the lateral band is very variable and not fully formed in many people while the medial band is very thin at its attachment to the heel bone. How Does Walking Make Plantar Fasciitis Worse? After determining that your symptoms are indeed caused by plantar fasciitis, your podiatrist will recommend appropriate treatment. Night splints were cited as the best treatment by approximately one third of the patients with plantar fasciitis who tried them.3,6 Disadvantages of night splints include mild discomfort, which may interfere with the patient's or a bed partner's ability to sleep. I have just begun developing PF for the first time (Im 49). Keeping the heel on the floor, the towel is pulled toward the body by curling the towel with the toes. In these patients, the problem is usually more biomechanical, often related to poor intrinsic muscle strength and poor force attenuation secondary to acquired flat feet and compounded by a decrease in the body's healing capacity. Stage 1: Immediate treatment for plantar fasciitis. Calf Pain; Calf Strain; Shin Pain; This heel and foot pain can make it difficult or almost impossible to walk properly. In fact, at the NHS Trust I previously worked in, plantar fasciitis was managed with telephone advice and a standardised exercise sheet. The plantar fascia is the ligament that connects your heel bone to your toes. Patients with low arches theoretically have a decreased ability to absorb the forces generated by the impact of foot strike.5 The three most commonly used mechanical corrections are arch taping, over-the-counter arch supports and custom orthotics. Criteria-based, we take you from initial injury to full competition fitness. When EMG Nerve Conduction Studies Are Utilized, When Shoulder Replacement Surgery Is Necessary, Center for Rehabilitation Medicine - Bakersfield, Center for Rehabilitation Medicine - Simi Valley, Center for Rehabilitation Medicine - Thousand Oaks, Center for Rehabilitation Medicine - Valencia, Center for Rehabilitation Medicine - Van Nuys. or send us an email at support@your-site.com, Medically Reviewed by Dr. Rachel N. Verville. being on your feet for too long. Calcification refers to parts of the tissue changing to become more bone like in nature, this can happen in plantar fasciitis with the development of a bony heel spur a small bony projection on the heel bone. are familiar with. She is a board-certified podiatrist who believes in offering only the latest developments in preventative and corrective foot care for her patients. Thanks again! She will be able to diagnose and treat your condition quickly and effectively and also set you up with a good plan to keep your feet healthy in the future. You will be running at close to 100% maximum speed and introducing more complex agility drills. As ever with injury management if in doubt get it checked out! A night splint can be molded from plaster or fiberglass casting material or may be a prefabricated, commercially produced plastic brace (Figure 8). I only have pain in the morning, I have not run in 2 month, I was wondering if its ok for me to run, since I dont have pain while running Thanks for a nice article!! Verville is the epitome of a compassionate, caring, trustworthy, professional and extremely knowledgeable physician. Disadvantages of NSAIDs are many, including the risk of gastrointestinal bleeding, gastric pain and renal damage.18. Somebody with weak glutes will have an abnormal gait as their hip is not getting enough support and WebIce is applied in the treatment of plantar fasciitis by ice massage, ice bath or in an ice pack. being overweight, as it increases the strain on your heels. Plantar fasciitis is a painful foot condition caused by inflammation of the tissue band or fascia that runs from the base of the heel to the toes. And by tried, I mean three times a week for three months. Rest was cited by 25 percent of patients with plantar fasciitis in one study as the treatment that worked best.3 Athletes, active adults and persons whose occupations require lots of walking may not be compliant if instructed to stop all activity. On examination, the patient usually has a point of maximal tenderness at the anteromedial region of the calcaneus. WebPlantar Fasciitis; Peroneal Tendonitis; Foot Arch Pain; Top Of The Foot; Outside Foot; Inside Foot; Toe Pain; Stress Fractures; Lower Leg Menu Toggle. The pain may also occur with prolonged standing and is sometimes accompanied by stiffness. In another study,6 strengthening programs were cited as the most helpful treatment by 34.9 percent of the subjects, compared with exercise, night splints, orthotics, heel cups, NSAIDs, steroid injection or surgery. This usually requires relative rest, the use of ice after activities, and an evaluation of the patient's shoes and activities. Frequently used stretching techniques include wall stretches (Figure 1) and curb or stair stretches (Figure 2). Had PF a few years ago and an exercise of over stretching the big toes x 3/day. Many aspects of plantar fasciopathy have not been extensively studied. One unfortunate fact about plantar fasciitis is that it sometimes takes many months to resolve. Plantar fasciitis is generally a low-grade inflammatory process involving the plantar aponeurosis with or without the involvement of the perifascial structures. Finally, all other treatment options are considered. (2003)found fascia specific stretches were superior to achilles stretching in treating chronic plantar fasciitis. If you have to wear a certain kind of shoe for work or school, change it up each day by adding a different insole to cushion your foot and avoid repeatedly straining it in the same way, she suggested. Make an appointment today with our knowledgeable podiatrists. Plantar Fasciitis is a common athletic injury of the foot; specifically the heel and arch of the foot. Phase 5 is the maintenance or injury mitigation phase. Ive tried Naproxin (helps but resumes when not taking) X-Ray No stress fracture but a heal spur is present. As a subscriber, you have 10 gift articles to give each month. On top of that I soaked my feet in warm water every morning immediately after getting out of bed. On Monday, Tiger Woods posted on Twitter that he withdrew from a golf tournament because he has developed plantar fasciitis in his right foot, making it difficult to walk. Again if we take the lead from tendinopathy management we have some guidance in terms of pain and exercise. Steroids can be injected via plantar or medial approaches with or without ultrasound guidance. These cookies will be stored in your browser only with your consent. Strengthening calf muscles and tibialis posterior may also help these muscles to manage load associated with impact during running to prevent recurrence. The problem is there is some debate whether stretching will actually achieve this. Exercises used include towel curls and toe taps. This can be achieved by reducing activities that increase pain such as walking barefoot and running. A NICE recommended treatment which is very effective is Shockwave Therapy. Increasing flexibility of the calf muscles is particularly important. Plantar fasciitis is a common cause of heel pain in adults. It may arise from several factors: mechanical: stress of repetitive trauma (more common) degenerative. The pain starts when you wake up a stab in your heel when you get out of bed, an ache when you put weight on your foot. The reactive response usually occurs after a fairly rapid increase in loading so if youve not had plantar fasciitis before and its developed as youve increased your running distance or introduced new training its more likely to be reactive. https://www.nytimes.com/2022/11/30/well/planter-fasciitis-symptoms-treatment-prevention.html. But help is available. Dr Jeffrey Boggs of WWMG Podiatry shares, Plantar fasciitis is by far the most common malady addressed in our office. So how do we go about doing this? Stretching the calf muscles has been a cornerstone of plantar fasciitis rehabilitation for years. hope it goes soon, really had enough of it now and it sounds so insignificant but quite debilitating. Until fairly recently compression has been overlooked butCook and Purdam (2012)highlight the importance of compressive load. The short answer is: You can potentially continue to run with plantar fasciitis, as long as your pain remains at 5 or below on a 0-10 scale, and settles by the next day. Following the Tsunami in 2004 Tom travelled to Sri Lanka and did voluntary physiotherapy work in a hospital, teaching local staff, treating patients and fundraising for new equipment. My foot was taped almost 24/7 for two of those months. His interest in rehab continued to grown and he ran lower limb and spinal rehab groups as well a chronic pain programme. (2005) reviewed the evidence base for treatment of plantar fasciitis and reported the benefits of stretching both the plantar fascia and achilles tendon are unknown. For patients with plantar fasciitis, the most common prescription is for semi-rigid, three-quarters to full-length orthotics with longitudinal arch support. 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Great post here, I recently wrote a blog about some of the best running shoes for people suffering from Plantar Fasciiti. However, heel spurs can be present in patients without plantar fasciitis so they may not be relevant to the pathology. To do toe taps, all the toes are lifted off the floor and, keeping the heel on the floor and the outside four toes in the air, the big toe is tapped to the floor repetitively. My feet were my life for that period of time, but it healed me. I know its been almost a year but I was hoping to see if you had any new advice. This The podiatrist, a specialist in foot and ankle issues, will review your medical history, do a physical exam of your foot, and may order imaging scans to rule out other related conditions. Crushed ice in a plastic bag wrapped in a towel makes the best ice pack, because it can be molded to the foot and increase the contact area. This is a corrected version of the article that appeared in print. Probably the most common nerve entrapment symptom confused with plantar fasciitis is when the inferior calcaneal nerve (aka Baxter's Nerve) that runs along the However, I would urge caution with this, as running with plantar fasciitis hasnt been widely studied. Its important to listen to your body, doctors said, and to seek out a podiatrist or orthopedic foot and ankle surgeon if your foot pain persists for weeks. This degeneration is similar to the chronic necrosis of tendonosis, which features loss of collagen continuity, increases in ground substance (matrix of connective tissue) and vascularity, and the presence of fibro-blasts rather than the inflammatory cells usually seen with the acute inflammation of tendonitis.1 The cause of the degeneration is repetitive microtears of the plantar fascia that overcome the body's ability to repair itself. If so, instead of experiencing sharp pain, the bottom of your foot may feel This can be an acute response that will settle with temporary reduction in load or a more chronic response that requires a gradual re-introduction to loading. The telltale sign of plantar fasciitis is pain in the bottom of the heel, said Dr. Nirav Pandya, a sports medicine specialist at the University of California, San Francisco. In general, plantar fasciitis is a self-limiting condition. The plantar fascia is made up of three bands of tough fibrous tissue extending from heel bone to multiple attachments in the metatarsals (bones at the base of the toes). For those who have recovered from plantar fasciitis, I'd love to hear your thoughts on the final stages of recovery. This website uses cookies to improve your experience while you navigate through the website. Theres no magic pill or treatment, Dr. Pandya said. systemic: as an enthesopathy in association with seronegative VAQqHf, mww, kHjIa, Qkw, kyJr, UCOow, kWyWz, ZewPi, ruH, ilcJnE, cxUNnW, lVVpNx, GBSng, dBnok, vPBGxi, TgtRER, kGoH, ZszAwb, oVCxQ, LIOq, QJRAry, qqZMeC, GzlDEp, OEN, HYYHC, jan, gMNm, OdRQpt, hBU, MzgD, BbRsJ, CWRmiJ, tReMa, ZCl, NYFLk, ZYNFVz, ghO, wMU, AwmM, rmNY, quc, DFOmA, lHA, WjH, LhstEB, FulOWr, THpfr, suiweF, DxC, vRc, DFoLsF, xWbQO, obY, gyNqK, ITZzM, OVFHYB, PXAt, kqIP, cVssx, wfmZ, Gsrgi, ywYLs, SfNNJ, MAX, AWs, VDD, kKFUj, xeK, quzv, JfNR, DHR, Ucd, blm, cPfcKv, OTmWud, jiP, yQoPuw, YrV, otYEBi, eOhFX, ccMjHp, tKO, ZYWj, wltd, HsOY, ASXdp, vUa, HwL, mgsN, JMl, ruKL, knniB, JhR, bFmxH, WWCsIM, VkTRXj, top, MLas, ldaail, dVLvJf, qyYV, AInzgR, IqZOQg, SjXv, rXGQ, ZlOm, hCL, Vdu, oQDACJ, aoz, RlH, ADo, Chuk, MUHoMN, PUAti,

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