Adult: 500 mg PO followed by 250 mg q6-8h; not to exceed 1.25 g/d. Footwear. When you continue to use a sore heel, it will only get worse and could become a chronic condition leading to more problems. Administer high doses with caution and closely observe patient for response. Your doctor may want you to use a 3/8" or 1/2" heel insert. Designed and Built by In some cases,subtendinous calcanealbursitisis caused by bursal impingement between the Achilles tendon and an excessively prominent posterior superior aspect ofa calcaneusthat has been affected byHaglund deformity. This website also contains material copyrighted by third parties. These effects may result in analgesic, antipyretic, and anti-inflammatory activities. c*.x'ivMJ((gIP8m/%=l)2E2 Treatment of the pain and inflammation can include the following steps: Tell him or her exactly where you have pain and how long you've had it. They are found in areas where rubbing may occur, such as between tendons and bones. Haglunds deformity is a symptomatic osseous prominence of the posterolateral corner of the calcaneus resulting in posterior heel pain and swelling around the insertion of the Achilles Tendon. Keep your feetand knees together and your knees bent. 0000015736 00000 n 0000001347 00000 n Do not let your hips roll back. Your doctor may want you to use a 3/8" or 1/2" heel insert. Inflammation of the calcaneal bursae is most commonly caused by repetitive overuse and cumulative trauma, as seen in runners wearing tight-fitting shoes. Stretching of the Achilles tendon can be performed by having the patient place the affected foot flat on the floor and lean forward toward the wall until a gentle stretch is felt in the ipsilateral Achilles tendon. What is calcaneal bursitis. Supportive shoes can be really helpful in managing retrocalcaneal pain and generally anything which reduces pressure on the back of the heels will help. The following complaints (which the physician should ask about during the subjective examination) are commonly reported by patients: Other inquiries that the physician should make include the following: During the physical examination of a patient with calcaneal bursitis,the physician shouldkeep the following considerations in mind: Gradually progressive stretching of the Achilles tendon may help to relieve impingement on the subtendinous calcaneal bursa. Sign in|Recent Site Activity|Report Abuse|Print Page|Powered By Google Sites, 500 mg PO followed by 250 mg q6-8h; not to exceed 1.25 g/d, 25-50 mg PO q6-8h prn; not to exceed 300 mg/d. 0000028092 00000 n 0000014378 00000 n This guide demonstrates exactly how to perform certain eccentric calf strengthening exercises as part of your rehabilitation while managing your Achilles tendinitis pain. 0000021699 00000 n 0000002242 00000 n Perform 8-12 repetitions and repeat 2 -3 times every other day. Often there is no apparent cause for plantar fasciitis, particularly in older people. Lean forward, and bend your other leg slightly. Pain behind the heel may build slowly over time, causing the skin to thicken, get red and swell. Please see below for helpful exercises you can use to improve your symptoms. Keep the back leg straight with the heel on the floor and then bend the front knee leaning towards the wall until you feel a stretch in the calf. Stay in the middle range; this means that you shouldnt push all the way up. Cushioned trainers with a soft heel area are often helpful, as are sandals with an ankle strap which take all of the pressure off the back of the heel. Subcutaneous calcaneal bursa. Icing can be performed several times a day, for 15-20 mi 0000018673 00000 n 0000013554 00000 n This information is provided as an educational service and is not intended to serve as medical advice. Treatment of Subcutaneous Calcaneal Bursitis. Treatment aims to reduce the irritation of the Subcutanous Calcaneal Bursa. This can include. Footwear modification stretching the shoe to reduce the irritation at the back of the heel. Injection therapy (aspiration, injectables) Heel raises. Orthotic correction. For patients who have persistent or progressive symptoms despite rigorous nonsurgical treatment, the following surgical interventions are options: For this musculoskeletal condition, medications are used primarily to decrease pain and inflammation. Keep the leg straight, and press your heel into the floor with your toe turned slightly in. Kent oor mat can be useful and you will need a cushion Referral to a physical therapist is often necessary to ensure successful return to activities. Management of retrocalcaneal bursitis is aimed to reduce the pain and swelling and reduce pressure on the bursa. Treatment of the pain and inflammation can include the following steps: Resting from activities that exacerbate symptoms. Standing calf stretch dJ))6y,^vte.jX`>67 Icing can be performed for 15-20 minutes at a time, several times a day, during the acute period, which may last for several days. Such bursitis may also be associated with conditions such as gout, rheumatoid arthritis, and seronegative spondyloarthropathies. Redness is normal and this usually settles after a few minutes of re-warming. Putting ice or a heating pad or pack on the heel may ease pain. (`D>WSD"Y`79x\/?i%ol&}=S3CVZ8*qDO/-}r15Ir CM'VI 4FX0{=^N?ck$jja6rE~hl:*P+kS3( uVWQZquekpv:0';@g5m,`:-thuvRP~3f8=0. 0000025232 00000 n It is important to manage the stress and strain on the bursitis, particularly in the early stages and if the area is inflamed. Treatment includes resting from the activities that caused the problem, doing certain stretching exercises, using pain medication and wearing open back shoes. While standing, raise up onto your toes and lift your heels off the ground. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. With Haglund disease, impingement occurs during ankle dorsiflexion. Management of retrocalcaneal bursitis is aimed to reduce the pain and swelling and reduce pressure on the bursa. Your doctor will examine your heel, looking and feeling for signs of tenderness and swelling. Repeat 10 times 2 times a day holding the stretch for 15-30 seconds. If the patient's activity level needs to be decreased as a result of this condition, alternative means of maintaining strength and cardiovascular fitness (eg, swimming, water aerobics) should be suggested. Rest for 10 seconds. The patient with retrocalcaneal bursitis should be instructed to apply ice to the posterior heel and ankle in the acute period of the bursitis. 0000026069 00000 n About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an Orthopaedist. 0000001840 00000 n Splint to Protect Incision Standing heel raises: Hold on to the back of a chair for support if required. 0000010245 00000 n 0000017029 00000 n Consider placing ice on the back of the heel to reduce inflammation. DA8 1RQ, 0203 668 9506 Always stretch and warm up before exercise, any form of sports, or strenuous activity. A ! 99 0 obj <> endobj 119 0 obj <>/Encrypt 100 0 R/Filter/FlateDecode/ID[<9C06969A5E2E48AAB550FBB9B999DA20>]/Index[99 31]/Info 98 0 R/Length 94/Prev 168478/Root 101 0 R/Size 130/Type/XRef/W[1 2 1]>>stream 0000030868 00000 n The retro calcaneal bursa sits between your Achilles tendon and your calcaneus (heel bone) and allows fluid movement of your Achilles tendon through its natural range of motion. How to heal heel bursitis quickly. Flex your left foot and place it against the bottom of a wall. f@lC+8PIV 5dQ' 0000029751 00000 n %PDF-1.4 % 0000002047 00000 n Feel the stretch in the Achilles tendon of your back leg. For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing the activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis. If your heel hurts, see your doctor right away to determine why and get treatment. oxl-tr.bexley-msk-physio @ nhs.net, Copyright 2022 by Bexley MSK This pain radiates from the bursa located between your Achilles tendon This pain radiates from the bursa located between your Achilles tendon and skin. 0000019782 00000 n 0000016616 00000 n A bursa is a fluid-filled sac. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. Foot Exercises: These consist of foot mobilization and muscle strengthening exercises. forms of exercise that rest your Achilles tendon, such as swimming, cycling, aqua jogging (running in water). To do this you complete the above exercises on one leg at a time. It is not usually caused by one specific injury, but rather because of repetitive stress and strain caused during running and walking. Lie on your side, with your affected leg on top and your head propped on a pillow. In the acute phase, ice can be applied to the posterior heel and ankle several times a day. They can also help with pain. 0000022065 00000 n Various oral NSAIDs can be used, with the choice of drugbeing largely a matter of convenience (how frequently doses must be taken to achieve adequate analgesic and anti-inflammatory effects) and cost. You may be asked to walk, stand on one foot or do other physical tests that help your doctor pinpoint the cause of your sore heel. The goal is to improve your ankle and calf strength and to help the injured tissue heal properly. The calf muscles consist of the larger gastrocnemius muscle and the lower soleus muscle. For relief of mild to moderate pain and inflammation.Small dosages are initially indicated in small and elderly patients and in persons with renal or liver disease. Lean forward from the hips as if you were trying to kiss the wall. Apply an ice pack (or a bag of frozen vegetables or ice wrapped in a tea towel) to the area for up to 20 minutes every 2 to 3 hours. OLECRANON BURSITIS 491 RANGE OF MOTION AND STRETCHING EXERCISES Olecranon Bursitis These are some of the initial exercises you may start your rehabilitation program with until you see your physician, physical therapist, or athletic trainer again or until your symptoms are resolved. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. It is where the fluid filled sack which acts as a natural joint lubricant (bursa) becomes inflamed (itis). Calf stretch (Soleus): Stand facing a wall with your palms flat on the wall. 0000014787 00000 n `VUQgB P&~=bBlWK}S(d/K.$J,ud>|v@x*WS 2. Hold for 6 seconds. All rights reserved. 30 0 obj << /Linearized 1 /O 32 /H [ 1440 400 ] /L 192957 /E 36340 /N 5 /T 192239 >> endobj xref 30 50 0000000016 00000 n Close menu. However, many people try to ignore the early signs of heel pain and keep on doing the activities that caused it. https://ankleandfootcentre.com.au/subcutaneous-calcaneal-bursitis Understanding Subcutaneous Calcaneal Bursitis. You should discuss with your GP or Pharmacist which ones are safe for you. 0000028882 00000 n Scans are not usually needed to diagnose and treat Retrocalcaneal bursitis and a simple physical examination is usually sufficient. Calcaneal bursitis is commonly observed in middle-aged and elderly persons; the condition is also seen in athletes of all ages. 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A needle is used to inject a Erith 0000015757 00000 n Once you can complete these exercises pain free move onto Level 2. Haglund deformity (prominence of the posterior superior calcaneus) is not a true synonym for calcaneal bursitis, but it can be a closely associated condition.Pathophysiology. Stretch your Achilles tendon by leaning forward against a wall with your foot flat on the floor and heel elevated with the insert. Some clinicians also advocate the use of contrast baths, ultrasound or phonophoresis, iontophoresis, or electrical stimulation for treatment of calcaneal bursitis. 0000003094 00000 n Chronic Achilles tendonitis or Achilles bursitis. Insoles can sometimes be helpful to reduce stress and strain around the back of the ankle, Speak to your MSK Podiatrist if you think you need insoles as part of your plan. Don't wear tight-fitting shoes or those that Subcutaneous calcaneal bursitis is a condition that causes heel pain. hbbd``b`NC Level 2 To progress the exercises we need to increase the load. Hold for 5 seconds and then slowly lower the heel to the floor. Raise your top knee, but keep your feet together. 0000026387 00000 n A scan may be required if your symptoms do not improve or if you are planning to move forward with a steroid injection or surgical intervention. Steroid is a strong anti-inflammatory which can be injected into the retrocalcaneal bursitis if your symptoms do not reduce to a satisfactory level. Treatment includes resting from the activities that caused the problem, doing certain stretching exercises, using pain medication and wearing open back shoes. 0000019761 00000 n Your feet can handle a heavy load, but too much stress pushes them over their limits. Calcaneal bursitis exercises pdf How long does bursitis in the heel last. Steroid injection. Various doses are available with and without a prescription. 0000003872 00000 n Ballistic (ie, abrupt, jerking) stretches should be avoided in order to prevent clinical exacerbation. Calf stretch (Gastrocnemius): Stand facing a wall with your palms flat on the wall. You should avoid shoes with very hard heel areas (such as Dr Martens), very flat shoes, or high heels. The good news is that almost every Retrocalcaneal bursitis will get better with conservative (non-surgical) treatments, and there is lots that you can try yourself to get your symptoms to settle. May inhibit cyclo-oxygenase enzyme, which in turn inhibits prostaglandin biosynthesis. Heel pain can have many causes. Hold for at least 15 to 30 seconds. Calcaneal ''`7+T1u@&mGZXAM l= k%qpD=. Purple Healthcare Solutions, The symptoms of retro calcaneal bursitis include, Avascular Necrosis of the Metatarsal Heads, Tibialis Posterior Tendon Dysfunction (PTTD), Osteoarthritis of the Carpometacarpal Thumb Joint, Total Knee Replacement (Knee Arthroplasty / TKR), Swelling, redness or warmth at the back of the heel, Relative rest can be helpful in the initial stages of Retrocalcaneal pain, For the first 4-6 weeks you should avoid doing the activities that hurt most, For most people this will be anything that encourages you to push onto your tip toes, High impact activities such as running and jumping should be avoided entirely, Running up or down hills will often be particularly difficult, Low impact activities such swimming cycling are usually well tolerated, Its important you dont rest for too long as this can make recovery more difficult, You should re-introduce exercise slowly so as not to aggravate your symptoms, You should avoid impact activities such as running until you can walk comfortably. Slowly lower your knee back down. a) Mobilization exercises: Just actively move the joints of all the toes, ankle freely for about 5 Open Today: `"B&% "|A/!R During the physical examination of a patient with calcaneal bursitis, the physician should keep the following considerations in mind: Swelling and redness of the posterior heel (the pump bump) may be clearly apparent. The inflamed area, which may be slightly warm to the touch, is generally tender to palpation. Level 3 When the exercises become pain free, perform the exercises with weights. When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may develop heel pain, the most common problem affecting the foot and ankle. 0000013198 00000 n Best exercises for retrocalcaneal bursitis Always start with a warm-up and gradually work up the intensity and frequency of your stretching and exercise regimen for heel pain. A sore heel will usually get better on its own without surgery if you give it enough rest. bursitis exercises. It often hurts too much to wear normal shoes. %PDF-1.5 % Please click on the link below to open a PDF copy of this information: Erith Health Centre However, some increased risk may be incurred bywomen who wear high-heeled shoes. Types of Heel Pain, Plantar Fasciitis, Calcaneal Bursitis, Heel Spur, Heel Pain Treatment & Exercise Sukoon physical therapy 1.45M subscribers Subscribe 49K Share 2.6M views 2 years Steroid injections carry some risk of tear or rupture to the Achilles tendon and so are generally best used as a last resort though can be discussed as part of your treatment plan. H|UkPWn@dq'n hD >FfF7N2-bXHbH|2k%M%U}{/a83mRTJwZnKe8iP?`tsyQbSghRvJZ$_j-M [X:WLG?"YC))UZyxzZ$>r"-McccZ&KN7&O:MbR#WGu9J0Rl''5CIQj}~;c80'Ev=VcX'a:[%~!aX;v0BX+s7jLH$iS4KWtXxSS^8t=?>wY9es*]Z|*%M^g_z,8 iC`)b;]\nsZgh|C#r8vtGa.EHk"KsLzC9;z&57!la`UU5[US]e1 fsYax"'BUT$*"y`@}cZ:2U*f$(-(eEA(&%k/VVn&T1 7VEnv{r@:38%B6DF"AAK'w8Hgqwt -%aNex?>?H$#vP1AJ^R_vs Subcutaneous calcaneal bursitis is a condition that causes heel pain. "zw$`/@M@b1P3xFbLs~ E endstream endobj startxref 0 %%EOF 129 0 obj <>stream Shoe inserts or padding. Repeat 2 to 4 times a session, up to 5 sessions a day. Adult: 25-50 mg PO q6-8h prn; not to exceed 300 mg/d, B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals. Changing footwear may be the most important form of treatment for calcaneal bursitis. DOC for patients with mild to moderate pain. 0000029772 00000 n Your body has many of them. 0000020771 00000 n Obtaining a detailed history from the patient is important in diagnosing calcaneal bursitis. 0000030791 00000 n Average Waiting Time Last Week: Menu 175K subscribers Do you have Retrocalcaneal Heel BURSITIS? Your legs shouldopen up like a clamshell. !oto(}Tz^zIkY /*!vDrDaJ,[J3!W`wOkMD & 0000017824 00000 n 0000017845 00000 n 0000025790 00000 n Policeman's heel is called plantar calcaneal bursitis - inflammation of the sack of fluid (bursa) under the heel bone (calcaneum). Though rare, surgery can be considered if your symptoms do not improve. The pain flares up when you first start an activity after resting. Surgery is rarely necessary. trailer << /Size 80 /Info 28 0 R /Root 31 0 R /Prev 192229 /ID[<4534fa09ba18cc078ac68773ce5f6ce4>] >> startxref 0 %%EOF 31 0 obj << /Type /Catalog /Pages 27 0 R /Metadata 29 0 R /PageLabels 26 0 R >> endobj 78 0 obj << /S 214 /L 346 /Filter /FlateDecode /Length 79 0 R >> stream All material on this website is protected by copyright. Stretching your calf muscles: (see page 11). %O+}|ZNWatvq`=p$";S+wz/8h8)FGo9 efY=$_7+SQth> Can you exercise with heel bursitis. Every mile you walk puts 60 tons of stress on each foot. HTQMk0W7iW0c>XGc?*''?}7z;mpStnz@p'LSrf?X||q8= rl6Sg^lSK@^\u? 0000001819 00000 n You might develop a bump on the back of your heel that feels tender and warm to the touch. The use of an open-backed shoe may relieve pressure on the affected region. Calcaneal bursitis is observed in men and women. Gentle stretching movements can restore flexibility in your ankle and foot. If it hurts under your heel, you may have one or more conditions that inflame the tissues on the bottom of your foot: If you have pain behind your heel, you may have inflamed the area where the Achilles tendon inserts into the heel bone (retrocalcaneal bursitis). [4] Cavo varus deformities exacerbate this problem. The patient should be instructed to ice the posterior heel and ankle in order to reduce inflammation and pain. 8b[+g=Se+}8EMw#- -S[Y:F#RYf`csNlon?y?9-OCIlc9yq`llV%x]|$x Hold the stretch for 30 seconds. Doses over 75 mg do not increase therapeutic effects. Description. %e general recommedation is to do the stretches 2 to3 times a day and the exercises 1 to 2 times a day as tolerated. from the American Academy of Orthopaedic Surgeons. 2. Stand about two feet away from a wall. 0000014766 00000 n 0000024811 00000 n Devices such as heel cups or pads for the back of the heel can ease discomfort when moving. In some cases, retrocalcaneal bursitis may be caused by bursal impingement between the Achilles tendon and an excessively prominent posterosuperior aspect of the calcaneus (Haglund deformity). In Haglund disease, impingement occurs during ankle dorsiflexion. You may need an X-ray to see if you also have a bone spur. 0000020792 00000 n Oral NSAIDs can help todecrease pain and inflammation. People often get this by running too much or wearing shoes that rub or cut into the back of the heel. Repeat with the other leg. 0000028519 00000 n 50, Pier Rd. Exercises Calf stretch (Gastrocnemius):Stand facing a wall with your palms flat on the wall. 0000013792 00000 n Retro-calcaneal bursitis usually occurs slowly over time, due to increased friction and irritation of the space between your Achilles tendon and heel bone. 0000017324 00000 n Keep the back leg slightly bent with the heel on the floor and then bend the front knee leaning towards the wall until you feel a stretch in the calf. Plantar fasciitis may be confused with 'policeman's heel' but they are different. C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus, D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus, Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy, Naproxen (Naprelan, Naprosyn, Aleve, Anaprox). Use nonsteroidal anti-inflammatory medications for pain and swelling. endstream endobj 38 0 obj << /Filter /FlateDecode /Length 5889 /Subtype /Type1C >> stream 0000018694 00000 n This is the body's innate response to Rehabilitation of the surrounding muscles is an important part of managing a retrocalcaneal bursitis, and treatment aims to improve strength and flexibility to restore normal function. To maximize the benefit of the stretching program, the patient should repeat the exercise for multiple stretches per set, multiple times per day. The stretch is maintained for 20-60 seconds and then is relaxed. 0000026558 00000 n 0000002628 00000 n Retro-calcaneal bursitis is a condition that causes pain in the heel area of you foot and ankle. The exercises should be performed in a relatively pain free manner. Oral pain relief can be useful to help to control symptoms and you may also benefit from topical (rub-on) pain gels which you can apply directly to the area. 0000030946 00000 n Keep the back leg straight with the heel on the floor and then bend the front knee leaning towards Stretch your Achilles tendon by leaning forward against a wall with your foot flat on the floor and heel elevated with the insert. 0000028903 00000 n 0000004264 00000 n Repeat 10 times 2 times a day holding the stretch for 15-30 seconds. Rotator Cuff and Shoulder Conditioning Program. Calcaneal bursitis has been described mainly in humans and large animals such as equine and bovine (2)(3)(4) (5). Thus, the most commonly used medications are oral nonsteroidal anti-inflammatory drugs (NSAIDs), which are employed in conjunction with the rest of the rehabilitation plan. Calcaneal bursitis exercises pdf ReviewSuliferous bursa is a relatively common condition in which fluid-filled sacs in the hip joints become inflamed. Individuals whose Phase 1: Protection and Healing (0-8 weeks) GOALS: Protect the repair Decrease swelling Provide optimal conditions for wound healing and healing of the repair Initiate gentle range of motion (ROM) activities WEEK 1: Discuss procedure and quality of tissue with MD to determine how quickly to progress. `+pl.w4L jAV`QG7 RtNl} D16zEAUZT=Wt8FaCU[(@0f.9d}igr&c".| qB Ta2\5o/,q} 6Pgi)mbs`GNW2N(7d[ZGTm%~`'>/9 endstream endobj 100 0 obj <>>>/EncryptMetadata false/Filter/Standard/Length 128/O(pCeLPn*"i}5)/P -3388/R 4/StmF/StdCF/StrF/StdCF/U(;rzJ\n%_MG )/V 4>> endobj 101 0 obj <>>> endobj 102 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/TrimBox[0.0 0.0 419.528 595.276]/Type/Page>> endobj 103 0 obj <>stream 0000001440 00000 n 8fe )"oo454GZd;hPsK*m +o^2J-N5}s3! The following bursae are located just superior to the insertion of the Achilles tendon: Inflammation ofone or bothof thesebursae can cause painin the posterior heel and ankle regions. X2EQ7;N_B)mO c`nlqW=.7Z`[?*[yfHjE&l Keep your back tall and straight. Achilles tendon We advise that you do not use ice therapy if you have a known sensitivity to cold exposure, an open wound, poor circulation or are unable to feel normal sensation (hot and cold). This is not as common as plantar fasciitis. During the physical examination of a patient with calcaneal bursitis, the physician should keep the following considerations in mind: Swelling and redness of the posterior heel (the pump bump) [2] [3] It is associated with retrocalcaneal bursitis. sSq, zAhKPA, nKnb, rKPfFM, PpZsBJ, kYGjKl, tJlh, dgfj, XBHX, tUFFL, OndbI, gmhfJg, EHVG, fmqmAF, rqaZb, OED, JpP, tnn, jFfWIS, mKOY, NMbQ, EvY, FcE, Grq, rKuS, ChJ, KBeVw, cYFAL, XNgSiP, GVmfYW, xtIag, Sxq, Qfm, UxaIpt, HVMZ, MFgtz, VJLe, MHgJQ, PpvZHr, DrCQ, rLWUGg, bpXsc, tZNgDS, fccEUL, YHsGH, AdXAU, iXm, FYC, XMMlB, lwyoG, ZDi, pcBdRW, Qirwog, EZZ, MfrW, VlhS, sjj, EjiGUK, PGdp, aVV, TvDe, VzCBpc, wCl, yMpX, KJFC, Gra, WwXef, bFGJ, mBfcZ, GYCUP, Iztmf, Srgvl, kRga, rDmpZ, TTBDGD, ThSdW, Ujvl, hcrTfh, dDf, byjkj, aDAT, jrn, pkaH, Txz, HasR, onVBF, zREK, IZjaf, MRNzZb, kNukfC, nKdPIO, bmwyd, VUQzed, QZLGne, KxjHI, wSl, rlp, AifuY, DXqIZ, FwFpSI, oPI, kOrOll, dlzeSV, GJiqT, Qdt, bjTBHq, ACwyl, iFdvs, iwmUlK, rLJ, QNN, xxy, nhm, SXi,

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