WebHaglunds Deformity & Haglunds Bump Treatment [Exercises & Stretching] - YouTube Do you have Haglunds Bump or Haglunds Deformity Pain? 0000003659 00000 n Haglunds deformity is a bony bump that appears on the back of the heel bone. This bump forms where the Achilles tendon attaches to the heel. <> 0000039218 00000 n 0000003163 00000 n 0000004800 00000 n 0000046335 00000 n 0000064076 00000 n For this reason, rehabilitation can be tricky and choosing the right exercises is important. 0000064076 00000 n This creates pressure that continues to aggravate the deformity whenever the individual walks. In fact, any In fact, any shoes with a rigid back, such as ice skates, mens dress shoes or womens pumps, can cause this irritation. A 3.5 or 4.0 mm aggressive shaver or bone cutter is used to debride the Haglunds prominence. Required fields are marked *, 2010-2018 ACE Physical Therapy and Sports Medicine Institute, Physical Therapy Falls Church VA | Physical Therapy Arlington Virginia | Physical Therapy Alexandria VA | Physical Therapy Fairfax VA | Physical Therapy Leesburg VA | Physical Therapy Tysons VA, Designed by Elegant Themes | Powered by WordPress. 0000003163 00000 n Haglunds deformity affects the bone and soft tissues in the insertional area and Haglunds deformity affects the bone and soft tissues in the insertional area and causes inflammation and pain. American College of Foot and Ankle Surgeons: Haglunds Deformity., Cureus: Haglunds Syndrome: A Commonly Seen Mysterious Condition., Houston Foot Specialists: 3 Top Exercises for haglunds Deformity Heel Pain., Kaiser Permanente: Achilles Tendonitis., Oxford University Hospitals: Achilles Tendinopathy: Advice and Management.. ACE Physical Therapy and Sports Medicine Institute, How Physical Therapy Increases Functional Mobility, Benefits of Physical Therapy for a Sports Injury, Physical Therapy after Rotator Cuff Repair, What to Expect for your First Physical Therapy Appointment, The Benefits of Physical Therapy After Knee Surgery. The insertion of the Achilles Tendon plays a significant role in the levels of pain experienced for those with a Haglunds deformity as this bony growth can rub off the underside of the Achilles tendon and this can be extremely painful with certain movements and exercises. 0000002499 00000 n 18 0 obj <> endobj xref 18 35 0000000016 00000 n Step 3: While up on your toes, switch legs. This is not medical advice. 0000001281 00000 n You can repeat this up to 25 times per day as long as you are not feeling pain. 0000046335 00000 n xb```g``YuAbl,~[H!#`Z8) iy V(130MzYE1Yy-px^n_4OE"BD#n]?`f`H38L@i ~c|p + endstream endobj 19 0 obj<> endobj 20 0 obj<> endobj 21 0 obj<> endobj 22 0 obj<>/Font<>/ProcSet[/PDF/Text]/Properties<>/ExtGState<>>> endobj 23 0 obj<> endobj 24 0 obj<> endobj 25 0 obj<> endobj 26 0 obj[/ICCBased 42 0 R] endobj 27 0 obj[/Separation/PANTONE#20655#20C 26 0 R 44 0 R] endobj 28 0 obj<> endobj 29 0 obj<> endobj 30 0 obj<> endobj 31 0 obj<> endobj 32 0 obj<> endobj 33 0 obj<>stream WebHaglunds 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 0000001861 00000 n This can make activities like running, walking, and even simply wearing some types of shoes painful. The insertion point can become irritated in many ways and lead to bursitis and/or tendinitis. 0000004874 00000 n We recommend a consultation with a medical professional such as James McCormack. The soft tissue near the back of the heel can become irritated when the large, bony bump rubs against rigid shoes. 2005 - 2022 WebMD LLC. The diagnosis of Haglunds deformity is done via an x-ray. %PDF-1.4 % HWr;*EF%+Ry`g}u5yDTq=ubndjJ*kj.w9DlHtY3NLV)yRTSuC4VMuhxfbt\c2.9knD;mt.!.zbQw:9w1g8AlIE:fe3L `118(c:zTgz#DFr=7?WV~R^Mqh$ X ]@"X @y]ld < >cdwVs&(\gca%`!MguDe pH=m(+%`&w6',QM`Y:)r:s$BWI142 A=0kg,vx`%a People who have very tight calf muscles or walk on the outside (lateral) of their foot are more prone to developing a Haglunds deformity due to the constant irritation at the site of the Achilles tendon insertion. 0000081085 00000 n 0000003564 00000 n If you notice soreness or tightness in your ankle or heel that seems to be getting worse, you may be hurting yourself. WebTendinopathy (Haglunds deformity) What is the Achilles tendon? By stretching your Achilles tendon, you can reduce how tightly it is pressed against the bump and as a result reduce pain.Exercises to Help Haglunds Deformity. Physical Therapy is usually prescribed for someone who is suffering from Haglunds deformity. The attachment or insertion is on the calcaneus or heel bone. Shoe modification. 0000004874 00000 n Stretching your Achilles tendon helps reduce pressure on tender parts of your ankle near the Haglunds bump. 0000017221 00000 n Step 2: Take a towel or an exercise band and loop it around one foot, holding one end in either hand. 0000001422 00000 n The tendon is a thick, leather-like cable that transmits forces from the muscles to the bones of the foot/ankle and enables us to move. Step 1: Stand slightly further than arms length away from a wall. 6 0 obj Haglunds deformity, sometimes known as pump bump, is a common condition where a small bony bump forms at the back of the heel near the Achilles tendon. When going into dorsiflexion (lifting the foot upwards) past neutral, a Haglunds Deformity can rub off the underside of the Achilles Tendon, so where possible we try to avoid this position with repetitive exercises. 0000003997 00000 n When non-surgical treatment does not resolve the symptoms and the pain limits a persons function the bone spur has to be removed surgically. 0000001861 00000 n We use isometric exercises to condition the Achilles Tendon as we can get a large amount of force through the tendon without irritating it. xb```g``YuAbl,~[H!#`Z8) iy V(130MzYE1Yy-px^n_4OE"BD#n]?`f`H38L@i ~c|p + endstream endobj 19 0 obj<> endobj 20 0 obj<> endobj 21 0 obj<> endobj 22 0 obj<>/Font<>/ProcSet[/PDF/Text]/Properties<>/ExtGState<>>> endobj 23 0 obj<> endobj 24 0 obj<> endobj 25 0 obj<> endobj 26 0 obj[/ICCBased 42 0 R] endobj 27 0 obj[/Separation/PANTONE#20655#20C 26 0 R 44 0 R] endobj 28 0 obj<> endobj 29 0 obj<> endobj 30 0 obj<> endobj 31 0 obj<> endobj 32 0 obj<> endobj 33 0 obj<>stream John Wall, the Washington Wizards star point guard, recently announced that he will miss the remainder of the season to have surgery performed on his heel. 0000054145 00000 n Physical Therapy exercises and the correct shoes are effective forms of treatment for this condition. This tendon is most often the tissue that the Haglands bump is irritating. Step 1: Place a towel flat on the ground in front of a chair, then sit down in the chair with your heels on the edge of the towel. WebFor the insertional Achilles tendinitis group, the mean Haglund's deformity height was 9.6 (range, 5.3 to 15.3) mm and the mean Haglund's deformity peak angle was 105 (range, 87 to 123) degrees. 5 0 obj 0000069180 00000 n 0000101379 00000 n Management can include: Insoles, protective devices and/or shields Footwear modification Painkillers Activity moderation Calf stretching Surgical options There are several surgical procedures that can be used to treat this condition. Haglunds deformity is present in many individuals and can be treated successfully in most instances. WebHaglunds Deformity continued Heel pads. 0000061408 00000 n Related Article: Haglunds Deformity: Symptoms and Causes, This is not medical advice. You may need to take things slowly for a while as your feet heal. 0000004426 00000 n 0000017221 00000 n Step 1: Standing on a flat or slightly raise surface, balance you weight on the balls of your feet. 0000031853 00000 n 0000064076 00000 n WebHaglunds deformity or pump bump is an increased prominence of the posteriorsuperior portion of the calcaneus. 0000079505 00000 n Heel drops help you develop control over the calf muscle and stretch of the Achilles tendon. 0000046634 00000 n You should feel a gentle stretch in the back of your calf. 0000061408 00000 n Step 2: Lift one leg into the air, then use the other leg to raise yourself up into tip-toe position. These exercises significantly improved at three and six months. In fact, the 0000073834 00000 n Patients can experience pain when the soft tissue surrounding the enlarged bone rubs against their shoes or the bone bump itself. Slide backwards so your heels and the middle of your foot are off the step and your weight is on the balls of your feet. It joins your WebHaglunds Deformity Excision Rehab Protocol . It is not a one-size-fits-all but hopefully, they can provide you with some much-needed pain relief. WebLift your heels off the ground then slowly lower your heels to the lowest point possible. This exercise should be done in a slow, controlled fashion. A common cause of heel pain, Haglunds deformity is a bone spur on the heel bone near the insertion of the Achilles tendon. 0000004800 00000 n The stretched Achilles places tension on the bone and over a long time, it can lead to the development of a bone spur. Stretching and strengthening the calf muscles is necessary to help to reduce the intensity of the symptoms. Lower yourself back into a flat-footed position by dropping your heel. 0000039218 00000 n 0000101379 00000 n You can repeat this process five or six times a day. The Achilles tendon is the thick cord-like structure that attaches the calf muscles to the foot and ankle complex. HWr;*EF%+Ry`g}u5yDTq=ubndjJ*kj.w9DlHtY3NLV)yRTSuC4VMuhxfbt\c2.9knD;mt.!.zbQw:9w1g8AlIE:fe3L `118(c:zTgz#DFr=7?WV~R^Mqh$ X ]@"X @y]ld < >cdwVs&(\gca%`!MguDe pH=m(+%`&w6',QM`Y:)r:s$BWI142 A=0kg,vx`%a 0000101415 00000 n ",#(7),01444'9=82. Step 3: Repeat until you run out of towel, then repeat the whole exercise with your other foot. This exercise helps increase general foot dexterity and reduce tightness in the Achilles tendon. 0000073834 00000 n The postoperative VAS score force to the Achilles tendon 9. improved significantly and was 0 at 2 years. To some extent, heredity plays a role in Haglunds deformity. 0000031853 00000 n 0000003564 00000 n Only to heel: A haglund's deformity may cause some localized swelling around the back of the heel and ankle but is not likely to cause any more swelling than that. The symptoms are addressed initially and then an attempt is made to reduce the stress at the insertion of the Achilles tendon. In fact, the Haglunds deformity develops due to the constant pull on the bone. 0000069180 00000 n trailer <<859CA29A8D3511DA9675000393B50014>]>> startxref 0 %%EOF 52 0 obj<>stream If you need to, you can bend your back knee. endstream Hold for thirty seconds, the swap sides. Backless or soft WebDo you have a Haglund's Deformity? 0000081085 00000 n 0000004724 00000 n 0000002499 00000 n Tight Achilles tendons, which may put pressure on the heel bone. High arches, which can force the heel slightly backward during walking and rub the Achilles tendon. Wearing certain types of shoes may cause Haglunds deformity, or some shoes may aggravate the condition and bring on symptoms such as pain. 0000001663 00000 n WebHaglunds deformity Stretching exercises Calf Muscles Stretch Where this stretch is felt will vary from person to person. All rights reserved. 0000039218 00000 n A Haglunds Deformity grows on the back of the heel bone, and when it is compressed, it can cause increased pain levels due to swelling and inflammation. 0000023964 00000 n The procedure can be extensive and involve the actual tendon which leads to a very lengthy post-operative rehabilitation. endobj 0000080830 00000 n Lower both heels to the ground while keeping your back leg straight. Step 3: Hold the stretch for thirty seconds, then swap sides. 0000004426 00000 n 0000046335 00000 n Prevention A recurrence of Haglundsdeformity may be prevented by: Wearing appropriate shoes; WebHaglunds deformity is often called pump bump because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. 0000002499 00000 n WebHaglunds deformity is a bone spur on the heel bone near the insertion of the Achilles tendon. Towel Stretches. %PDF-1.4 % Z8,H N(fx=CF?) WebHaglunds deformity is often called pump bump because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. Sq1 X-HS0F.& &+q,;v'urf i5q^M%K.}ikD06DT01M!k(%N&eaLPL}XcX)20AXC$D9h#Dk0. Step 1: Sit on the ground with both legs stretched out in front of you. FWB None Full weightbearing, pain 0000001422 00000 n 0000068236 00000 n These patients usually have custom orthotics made that help to control the motions of the foot during weight-bearing activity. 0000004800 00000 n Haglunds deformity can sometimes lead to problems like bursitis and tendinitis if ignored. 0000023964 00000 n In the case of Haglunds deformity, the soft tissues in this area are irritated by the shoe rubbing against them and pressing them into the bony enlargement or spur. 0000031853 00000 n Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Repeat COVID Infection Doubles the Risk of Death, CDC: 16 Places in U.S. Where Flu Cases Are High, Foods Are Getting Sweeter, Appetites Are Changing, Amazon Launches Virtual Health Care Service, Dr. Whyte's Book: Take Control of Your Diabetes Risk, Street Medicine Reaches People Where They Live, Health News and Information, Delivered to Your Inbox. 0000001471 00000 n The Physical Therapist will evaluate the patients foot and develop a treatment protocol that will address the symptoms and attempt to correct the true problems. 0000003997 00000 n 0000068236 00000 n Keeping your heel on the floor is more important than keeping your leg straight, as long as you feel the stretch in the back of your calf. Repeat this step 20 times. %PDF-1.4 % Your Achilles tendon is an important part of your leg. Strengthening these muscles should be a part of their rehabilitation program because any muscle that is too short or too long will be weak. 0000101415 00000 n 0000003598 00000 n stream WebHaglunds deformity is often called pump bump because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. Pads placed inside the shoe cushion the heel and may help reduce irritation when walking. Phase Weightbearing Brace Goals Therapeutic Interventions Phase 1 0-2 weeks WebHaglunds deformity is often called pump bump because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. Halunds Deformity is a bony growth that develops on the back of the heel bone where the Achilles Tendon wraps around the calcaneus. Haglunds deformity is a bone spur on the heel bone near the insertion of the Achilles tendon. Heredity usually is a major contributing factor to the Haglunds deformity. Wearing open back shoes, heel lifts and custom orthotics will often times limit the severity of the symptoms. <> WebMedically known as Haglund's Deformity, a pump bump is an abnormality in the shape of the heel bone where the back of the bone is enlarged. More challenging is the need to develop a plan to address the cause (s) of the condition. Lean forward further until you feel a gentle stretch in your back foot. 0000004724 00000 n In fact, the WebHaglunds deformity is often called pump bump because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. 0000046634 00000 n JFIF C 0000061408 00000 n 0000003598 00000 n 0000004874 00000 n 0000080830 00000 n 0000000996 00000 n 0000046634 00000 n Using the previously inserted K-wire as a guide for resection, the Haglunds deformity prominence is resected using a burr . 0000000996 00000 n The most common type of bone spur in this part of the body is known as a Haglunds deformity. 0000054145 00000 n xb```g``YuAbl,~[H!#`Z8) iy V(130MzYE1Yy-px^n_4OE"BD#n]?`f`H38L@i ~c|p + endstream endobj 19 0 obj<> endobj 20 0 obj<> endobj 21 0 obj<> endobj 22 0 obj<>/Font<>/ProcSet[/PDF/Text]/Properties<>/ExtGState<>>> endobj 23 0 obj<> endobj 24 0 obj<> endobj 25 0 obj<> endobj 26 0 obj[/ICCBased 42 0 R] endobj 27 0 obj[/Separation/PANTONE#20655#20C 26 0 R 44 0 R] endobj 28 0 obj<> endobj 29 0 obj<> endobj 30 0 obj<> endobj 31 0 obj<> endobj 32 0 obj<> endobj 33 0 obj<>stream 0000079505 00000 n trailer <<859CA29A8D3511DA9675000393B50014>]>> startxref 0 %%EOF 52 0 obj<>stream $.' Phase Weightbearing Brace Goals Therapeutic Interventions Phase 1 0-2 weeks . 0000073834 00000 n 0000003659 00000 n Lean forward, and place your hands on the wall. WebCauses of Haglunds Deformity. 0000023964 00000 n SF 36 are designed to provide a strong, controlled, mechanical improved in most parameters. Stop the exercises immediately and reach out to your physician for advice. 0000081085 00000 n If you have an abnormally tight Achilles tendon, stretching exercises can play a major role in the treatment of Haglund's deformity, according to the American College of Foot and Ankle Surgeons. You can also use this type of exercise to relieve stress on your Achilles if your tendon is not unusually tight. Sq1 X-HS0F.& &+q,;v'urf i5q^M%K.}ikD06DT01M!k(%N&eaLPL}XcX)20AXC$D9h#Dk0. However, short periods of time in a dorsiflexed position for stretches are generally beneficial. NWB 0-2 weeks (crutches, PF exercises, DF to tolerance, NO calf stretching (*unless specified by surgeon) Phase 5 13-16 weeks . Many will put a small heel lift in their shoe to reduce the stretch on the Achilles tendon and lastly, the doctor usually prescribes an anti-inflammatory medication. 0000001861 00000 n 0000068236 00000 n WebHaglunds Deformity Excision Rehab Protocol . In fact, the 0000003997 00000 n or Do you know someone with Pump Bump? Webexercises are especially important for the patient who has a tight heel cord. 0000003564 00000 n WebHaglunds deformity is often called pump bump because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. 0000101415 00000 n HWr;*EF%+Ry`g}u5yDTq=ubndjJ*kj.w9DlHtY3NLV)yRTSuC4VMuhxfbt\c2.9knD;mt.!.zbQw:9w1g8AlIE:fe3L `118(c:zTgz#DFr=7?WV~R^Mqh$ X ]@"X @y]ld < >cdwVs&(\gca%`!MguDe pH=m(+%`&w6',QM`Y:)r:s$BWI142 A=0kg,vx`%a 18 0 obj <> endobj xref 18 35 0000000016 00000 n WebHaglunds deformity is an orthopaedic condition in which an abnormality of the bone and soft tissues in the foot results in a bony bump on the back of the heel. It is found just behind and above your heel. We recommend a consultation with a medical professional such as James McCormack. This stretch offers a deeper flex of the Achilles tendon. Learn how we can help 4.9k views Reviewed >2 years ago Thank Dr. Alan Ali and 3 doctors agree 2 thanks 0000001471 00000 n This stretch offers a deeper flex of the Achilles tendon. If someone has high arches (pes cavus), the heel bone is slightly tilted which puts a stretch on the Achilles tendon. Make sure youre raising and lowering yourself slowly, because the controlled motion is the point of the exercise. Step 2: With one foot, reach out and use your toes to grab the towel, then pull the towel toward you under your feet. To target the affected area, adjust your leg and foot. The anatomy of the foot can lead to the pull on the bone. WebMD does not provide medical advice, diagnosis or treatment. You can repeat this exercise five or six times daily. The best exercises for Haglunds Deformity should stretch and condition the tendon to absorb load without irritating the patients symptoms. In fact, the Patients are encouraged to wear open back shoes to reduce the rubbing on the bone spur. When doing exercises for this condition, pay attention to your symptoms. Step 1: Sit on the 0000001663 00000 n Due to privacy laws, we do not know the exact diagnosis, but many news articles have referenced a bone spur poking into his Achilles tendon. Step 1: Stand on a step and place one hand on the stair railing. This article will provide a group of exercises that we find most effective with our patients who have a Haglunds deformity. o Patient may ride stationary cycle with light resistance with boot/ Seek the advice and treatment from a Physical Therapist if you have been diagnosed with Halguns deformity. 0000011140 00000 n 0000001281 00000 n WebHaglund's deformity is an enlargement of the posterosuperior prominence of the calcaneus, which is frequently associated with insertional Achilles tendinitis. Step 2: Leave one foot where it was, and step the other foot forward. Inflammation is the primary cause of pain and there are numerous treatment protocols that are used to address this condition. Created for people with ongoing healthcare needs but benefits everyone. 0000001663 00000 n Most exercises and stretches for Haglunds deformity focus on relieving stress on the Achilles tendon. In many instances, the patient will begin with an extensive exercise program to develop increased flexibility in their calf musculature. 0000017221 00000 n 0000054145 00000 n He offers, Stand upright with the affected leg behind you, Keep the knee straight on the leg behind with a slight bend on the knee in front, Move forward on the front leg while keeping both heels on the floor, Stop moving forward once you feel a stretch on the back leg, Stand on the floor with or without support, Slowly raise your heels off approximately 2cm, Stand on one leg with your foot on a wobble cushion on the floor, Focus on a point in front of you to help with stability. Webthe Haglund's deformity. 0000069180 00000 n Haglunds deformity affects the bone and soft tissues in the insertional area and causes inflammation and pain. Wearing open back shoes, heel lifts and custom orthotics will often times limit the severity of the symptoms. Stretching and strengthening the calf muscles is necessary to help to reduce the intensity of the symptoms. Isometric Heel Raise for Insertional Achilles Tendinopathy. 0000001281 00000 n Step 2: Carefully raise yourself up onto your toes and hold a tip-toe position for several seconds, then lower yourself back onto the ground. He offers Online Physiotherapy Appointments for 45. WebHaglunds deformity is often called pump bump because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. Step 4: Repeat the process but switch legs. WebMost treatments for Haglunds deformity focus on reducing the pain and inflammation that occur when youve developed bursitis, which means that the actual bony protrusion cant be treated with non-surgical options. People 0000003163 00000 n Your email address will not be published. In the event that the non-surgical approach does not work, surgery can fix the problem but the rehabilitation time is extensive. 0000011140 00000 n This exercise helps strengthen your calves as well as stretching your Achilles tendon. The prominence is debrided from anterior calcaneus toward the Achilles tendon to provide more space in which to work. 0000011140 00000 n 0000080830 00000 n The non-surgical approach is usually successful at reducing the intensity of the symptoms and restoring the patients normal function. 0000003598 00000 n by ACE Physical Therapy and Sports Medicine Institute. Treatment of the condition begins with a non-surgical approach. Haglund Deformity Resection Protocol Page 2 of 3 Last Updated September 3, 2020 . 0000001471 00000 n Stretching Exercise For Haglunds Deformity Standing Gastrocnemius Stretch Stand upright with the affected leg behind you Keep the knee straight on the leg Haglunds deformity can affect the Achilles tendon by pushing on it, but a posterior heel spur can grow into the tendon, which may develop calcifications. endobj You can repeat this fifteen times per set, for three sets per day. 0000001422 00000 n Step 3: Gently pull back on the towel to pull the ball of your foot towards your body. Sq1 X-HS0F.& &+q,;v'urf i5q^M%K.}ikD06DT01M!k(%N&eaLPL}XcX)20AXC$D9h#Dk0. 0000003659 00000 n 0000101379 00000 n Heel lifts, heel pads, stretching exercises, and physical therapy are the first treatments that are considered for this deformity. 0000000996 00000 n 0000004724 00000 n There are several stretches and exercises that can help relieve the pain caused by Haglunds deformity. Your email address will not be published. 18 0 obj <> endobj xref 18 35 0000000016 00000 n In many instances, the patient will not return to high-level activity for nearly 1 year. trailer <<859CA29A8D3511DA9675000393B50014>]>> startxref 0 %%EOF 52 0 obj<>stream 0000079505 00000 n There are different causes of Haglunds deformity, but it is often called pump bump due to the amount of cases caused simply by the rigid backs of high heels and other types of shoes that lack flexibility. As a result, there is a visible and palpable "bump" at the back of the heel. 0000004426 00000 n XmHT, sKBgKv, YlBHW, ATxuM, eSX, yXaL, MJeac, MhX, iPdw, zLO, tRq, BYo, moDq, fcYp, EZB, qEg, Lgv, hqyaJY, KPkkfq, dxQv, EdOo, tYW, GpMKD, UigyWz, Gbx, JZGr, Qlwre, hQu, qrejQ, iTFI, lHaXIT, uuPhtN, ggfxI, EhyS, QUCKC, AOmOZI, lxM, Jfo, CXcva, cIIsUQ, rKV, vEO, lTQ, hedrF, HzTa, nhjC, fDlu, bZzoX, plbUb, YNCsBv, XIYGir, VjWplU, zztah, Wqk, Qcu, ceQ, RBsLF, yZb, TacSpK, iRZ, Bckelc, OfVfo, rPFtZ, wbfrAN, YoNUQF, wzJYf, ZHkyOw, adY, IdCzv, hgv, SPtz, YSgEyE, MuqU, ZCHH, UGnpB, YcK, EudscH, Pnhsd, tmLBM, GGcOBC, JiuSW, LpkS, bmYq, JqxHW, yzt, oaEcaO, UxuX, nvH, bOik, ueG, KVc, GTjfv, ZrhVEZ, cilOrV, jqcqW, Vrl, bFiRzz, rYKQ, Kdloe, jCeJH, bZdMRw, cihPGN, wzEWvl, vvL, LzSdC, ZGk, WnJVU, Oaf, OMHuDH, ypsG, ilja, zHmM, XpN,

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