1-800-273-8255 For help with MyChart, call us at 1-844-442-4278. Stress fractures can occur to any bone in our bodies, but our feet are the most common location. A stress reaction that goes untreated will develop into a stress fracture. What Causes Stress Fractures Stress fractures can occur from abnormal force on . Yong JR, Silder A, Montgomery KL, Fredericson M, Delp SL. Anti-inflammatory medication is used for pain. Schedule your appointment online for primary care and many specialties. Ice after runs if you are sore, and avoid hard surfaces when possible. If the activity that caused the stress fracture is started too quickly, you may develop a larger fracture that is harder to heal. According to a new report, it looks like Cunningham, the No . With shin splints, pain often occurs over a broad area, although it may be localized, affecting a small area. Wear the proper running shoes. In addition, shin splint pain may be more tolerable than pain from a stress fracture. (https://www.aafp.org/afp/2011/0101/p39.html), (https://kidshealth.org/en/teens/stress-fractures.html), (https://orthoinfo.aaos.org/en/diseases--conditions/stress-fractures-of-the-foot-and-ankle). You also can take an over-the-counter pain reliever such as ibuprofen (such as Advil or Motrin), naproxen (such as Aleve) or acetaminophen (such as Tylenol). They are more common in people who carry out certain activities, such as runners or those who do a specific sporting activity. See All Healthcare Professionals Information, Molecular and Genomic Diagnostic Laboratories, Jennifer Moriatis Wolf named president of largest hand surgical society, Groundbreaking new device helps correct Chicago mans severe bow legs, UChicago Medicine breaks ground on $121M multispecialty care facility in Crown Point, Indiana, UChicago Medicine, WNBA Chicago Sky renew partnership agreement, How to better protect young athletes from sports injuries, Spring and summer exercise: How to safely transition back into outdoor sports, Q&A: What parents need to know about pediatric scoliosis, New embolization treatment under study aims to relieve osteoarthritis knee pain. Pain may persist even when youre at rest. What are the symptoms of a stress fracture in the shin? If you decide to increase your activity level, ask your doctor for a recommendation of how much to add and when to add it. Stress injuries can be classified on a spectrum upon diagnosis: early (stress reaction) or late (stress fracture). Note this bridge is done with the forefoot on the edge of a step. Some can be managed to a certain degree and others are not within your control. Shin Splints can hurt a ton, but will hurt a little less than a stress fracture. Ignoring your recovery plan and returning to your full activities too quickly can lead to more severe injuries in the future. They most often occur in the weight-bearing bones of the lower limbs. Healing occurs by a bony bridge that forms over the fracture gap in the small clot of blood under the periosteral layer (medullary callus) and under the skin of the bone (periosteal callus). Shin splints are a frequently occurring problem in gymnasts, runners who have intensified their training, runners who have returned to sports after a prolonged time, and new runners [1]. Brendon Ross, MD. Depending on the location of fracture, the surgeon may use pins, screws or metal plates. A stress fracture of the shin means theres a crack in your shin bone. Navicular stress fracture symptoms. UChicago Medicine and Ingalls Memorial offer a broad range of challenging clinical and non-clinical career opportunities doing work that really matters. It is common to see magnetic resonance imaging (MRI) being used as first line of investigation for patients with bone pain. Doing repetitive activity in certain high-impact sports, such as: Gymnastics (wrist stress fractures from weight bearing on hands/wrists, low back). Subscription Request Successfully Submitted! Elevate and ice.. What typically causes stress fractures in theshin? Pain thats present throughout the activity and does not go away after the activity has ended. Symptoms of tibia fracture. Whats the Difference Between a Fracture and a Break? Certain stress fractures (hip) are considered high risk stress fractures because they may have a poor outcome (such as needing surgery) if not identified early. Youth who play one sport year-round without a break are at risk of stress fractures. November 19, 2022. Policy. Pain that begins after starting an activity and then resolves with rest. Learn about the symptoms and treatments of stress fractures, and where they occur, including the shin, ankle, fibula, and more. . Poorly fitting footwear, running on hard surfaces, and a lack of flexibility and muscle imbalance can also play a role. With a stress fracture, the pain gets worse as you run and persists in a smaller location after you run, Dr. Goldberg says. Maintaining overall flexibility with the help of a good training program. Cross-train with a focus on strength and resistance training, especially for the core, hips and legs. Stress fractures are the result of repetitive abuse, or repeated application of stress to the boneshence the name. Adopting preventive measures can help reduce the risk of both these overuse injuries Pain, swelling or aching at the site of fracture. Ensure a well-balanced diet with adequate calorie intake for your activity level and target a healthy body weight. Stress fractures are common in foot and ankle bones because we continually place force on them by standing, walking, running and jumping. In time for running season, heres what you need to know about how to prevent and treat shin splints and stress fractures. Your doctor may recommend a combination of treatments and lifestyle changes, such as: Severe stress fractures may require a cast or surgery to ensure proper healing. This pain concentrates in the lower leg between the knee and ankle, Shin splints can make it painful to exercise, but they can usually be treated at home. Get an online second opinion from one of our experts without having to leave your home. For runners, athletes, and other active people, shin splints can be a common soreness or pain that you learn to work through. How are stress fractures in the shin treated? But the pain between your knees and ankle may also indicate a stress fracture. When you are recovering from a stress fracture, it is important to follow your doctors instructions. Terminology A pathological fracture, although a type of insufficiency fracture, is a term in general reserved for fractures occurring at the site of a focal bony abnormality. An example of this schedule is: Alternating your activity and rest days allow your body to ease back into fitness. Stress fractures are not always seen on X-rays. [1] The most common bone is the shin bone or tibia (20% to 75% of all stress fractures often running injuries). First, make sure youre treating conditions such as osteoporosis and vitamin deficiencies. In addition, several muscles attach to the . These steps can help prevent a stress fracture: As long as you can feel pain, the bone is still fragile in that area, and could break again in the same place. Tenderness and swelling at the fracture site. X-rays of the affected area, taken as part of any investigative work-up in people with shin splints, are typically reported as being entirely normal. A distal radius fracture is one of the most common bone injuries. repetitive movements in high-intensity activities, such as: increasing training or weight-bearing exercises too quickly, working out on a different type of surface than usual, drinking more than 10 alcoholic beverages a week, not taking in enough calories to match your activity level, taking a break from high-impact activity until youre fully healed, elevating your leg and applying ice for 10 minutes to ease pain and swelling, taking over-the-counter (OTC) anti-inflammatory medicine, using crutches to keep weight off your shin while you heal. Shin splints can improve with home-care measures like icing, rest, and avoiding high-impact activities until it improves. Extrinsic factors happen outside of the body. 2022 The University of Chicago Medical Center. Shin Splints is a general term used to describe pain all up and down your shin. Flexibility exercises and strength training are also very important as part of the comprehensive treatment plan and to prevent recurrence. caused by repetitive stresses or overuse, such as the repetitive impact on the bones of the lower leg and foot during running and jumping activities.. To make the diagnosis, I start with with a complete history from athletes about their running routine, including mileage, intensity, pace, terrain and footwear, as well as any recent changes in training regimen. Learn how to, Most people recover from a broken wrist in a few months, but sometimes complications can occur. Stress fractures are also called hairline fractures. A stress fracture is a fatigue-induced bone fracture caused by repeated stress over time. (https://www.foothealthfacts.org/conditions/toe-and-metatarsal-fractures-(broken-toes%29), (https://www.niams.nih.gov/health-topics/sports-injuries), Visitation, mask requirements and COVID-19 information. These common overuse injuries are usually caused by training errors and running too much, too quickly. American Family Physician, 83(1), 39 . Symptoms: Pain while running, but over time, runners also will experience pain while walking and doing other activities. This includes a proper diet with enough calories as well as calcium and vitamin D supplementation to optimize bone health. It is due to repetitive loading of a bone that is not able to normally maintain the repetitive frequent stresses applied to the leg. You can get health news and information from The Science of Health blog delivered right to your inbox every month. Running shoes should be replaced every 300 miles. 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. In a sport and exercise medicine clinic, such as OxSport, up to 5% (5 in 100) of people seen will suffer with bone stress . You can still feel pain while walking or running. Toe and Metatarsal Fractures (Broken Toes). You should slowly increase how often and how vigorously you exercise. Tags: Acute changes in foot strike pattern and cadence affect running parameters associated with tibial stress fractures. Effects of load carriage on biomechanical variables associated with tibial stress fractures in running. Sign up for our Newsletter Enter your email. The Sports Medicine program at University Hospitals provides specialized, integrated services for the diagnosis and treatment of conditions that affect athletes of all ages and abilities. A deep, throbbing pain, which is localized to the bone itself. Your doctor may need to do several tests to see if you have a stress fracture and the severity of the fracture. The symptoms indicative of pain include: The following are common factors that may trigger shin splints in runners: The following are treatment options for relieving pain caused by shin splints: A stress fracture is a severe bruise, tiny crack, or a group of cracks formed in a bone due to cumulative strain on the bone. The Detroit Pistons have been without the services of Cade Cunningham for the last five games due to a shin injury. This is called internal fixation. Stress fractures result from cumulative strain on the bone, without enough time for proper recovery. Optimize your bone health. A stress fracture means the structure of the bone has been compromised by a crack or fracture. In addition, you can log into your UH Personal Health Record and schedule an appointment. You may not have much pain at rest or with low-impact activities like walking, but pain increases sharply with high-impact exercise. There is also a risk that the fracture may become displaced (the fractured bone moves out of normal alignment). A stress fracture of the tibia causes shin pain that increases in intensity over a period of weeks. The symptoms of a tibial plateau fracture are: Pain when weight is applied; Deformity . Shin splints or a stress fracture? Learn more about these injuries along, Fractures occurring in the outer bones of the foot are called 5th metatarsal fractures. Can't find what you're looking for? The pain is felt when youre running at top speeds. Overview Causes Symptoms When to see a doctor Non-operative treatment Surgical Treatment Recovery This can happen from repetitive trauma and is commonly seen in athletes particularly long-distance runners. If youre limping, you shouldnt be running.. There are some things you can do to help prevent recurrence. If you develop shin splints, avoid activities that cause pain, swelling or discomfort, but dont stop all physical activity. On the left a 25-year old professional soccer player with complaints of the ankle. This injury, common among athletes, is usually caused by overuse and can significantly interfere with exercise and sports activity. Start cross-training. All rights reserved. Further Also, your provider will aim to treat any risk factors you have for future injuries. Any pain that persists after you rest should be evaluated by a sports medicine specialist, and anything that causes you to limp should be evaluated, she says. Stress fractures are tiny cracks in a bone. . A stress fracture is a small crack in a bone, or severe bruising within a bone. American College of Foot and Ankle Surgeons, Foot Health Facts. Having a poor diet that has inadequate caloric intake for volume of sport. Pain doesnt go away easily. These are small breaks in your tibia, caused by repeated stress on the bone. What Causes Shin Pain When Walking or Running? Causes of stress fractures of the shin include: Other things that can increase your risk of stress fractures are: It can be tempting to push through the pain, but if you dont take care of a stress fracture, it can get considerably worse. But how do you know your shin pain is due to a stress fracture or shin splints? See your doctor as soon as possible if you have a persistent area of concern or discomfort. Cleveland Clinic is a non-profit academic medical center. Pain that's present throughout the activity and does not go away after the activity has ended. Costa Astur D, Zanatta F, Goncalves Arliani G. American Academy of Orthopaedic Surgeons, OrthInfo. With a stress fracture, the pain gets worse as you run and persists in a smaller location after you run, Dr. Goldberg says. They're common injuries in athletes or dancers but can happen. Stress fractures of the anterior tibial midshaft cortex are injuries that require particular attention, because they are prone to delayed healing and nonunion. You're more likely to get shin splints if: you have started exercising after not being active for some time you run or jump on hard surfaces you do not have a good running technique Page last reviewed: 10 December 2019 Next review due: 10 December 2022 Support links Home (2020). This damages some of the muscle fibres. Stress fractures are tiny cracks in the bone. ultrasound) taping. Single leg soleus bridge. Stretching and low-impact activities that dont cause pain, like swimming and cycling, can help maintain strength and conditioning. Stress fractures can take anywhere from 4 to 12 weeks and sometimes longer to heal. Mild swelling in the lower side of the leg. Overuse and minor injuries can result in a stress reaction or deep bone bruise. If you start to feel shin pain, ease off your exercise routine to allow for healing. Our website services, content, and products are for informational purposes only. Consult a physical therapist, coach or personal trainer to set up a smart running program. How does a stress fracture of the navicular happen? The pain intensified while walking, running, and doing other activities. The sports medicine specialist also will look for an underlying cause, which might be a gait abnormality or a bone problem, to pinpoint how and why its happening. Smoking will slow down your healing. Lower leg pain is the most frequently occurring symptom of shin splints that usually worsens after weight-bearing or running activities. Follow all the rules your doctor gives you. They occur through overuse or poor foot biomechanics. Caring for your foot A stress fracture will need about 6 weeks to fully heal. To avoid shin splints, make sure youre wearing the right shoes for your foot and ones that are not too well-used. Get health news and advice you need to live your best, delivered right to your inbox every month: The Science of Health e-newsletter. Shin splints go quite away quite quickly. Foot Stress Fracture NHS Virtual Fracture Clinic - Stress fracture of Foot Healing: It can take up to 6-12 weeks for this fracture to heal. This means that it is commonly not the only injury to occur, possibly increasing the time it takes to recover. Medial tibial stress syndrome (MTSS), also known as shin splints, describes a spectrum of exercise-induced stress injury that occurs at the medial tibial mid-to-distal shaft. A lot of people try to treat it themselves, but it if recurs, it needs evaluation, she says. Healthline Media does not provide medical advice, diagnosis, or treatment. Calcium and vitamin D intake can help strengthen bones and avoid cracks or fractures. Stress fractures wont go away without some modification to your training routine, Dr. Goldberg says. Risk factors for stress fractures can be divided into two basic categories: extrinsic and intrinsic. Symptoms: Lower leg pain while running, especially at faster speeds. A stress fracture in the foot is an overuse injury. Physiotherapy treatment is vital for all patients with a calcaneal stress fracture to hasten healing, reduce the likelihood of recurrence and ensure an optimal outcome. The muscles in your lower leg lie within an enclosed compartment of tissue. Pain which occurs while at rest, during normal activity or with everyday walking. Whats the difference between a stress fracture of the shin and shin splints? Medial Tibial Stress Syndrome (MTSS) is a common overuse injury of the lower extremity. The most common symptom of a hairline fracture is pain. Symptoms of a fractured tibia may include: localized pain in one area of the tibia or several areas if there are multiple fractures. Its important to follow the treatment guidelines he or she gives you to prevent further injury. Milgrom C, Zloczower E, Fleischmann C, Spitzer E, Landau R, Bader T, et al. Taking nonsteroidal anti-inflammatory medicines to help relieve pain and swelling. Their diagnosis can be challenging due to their insidious onset and requirement for imaging to confirm a diagnosis. Athletic trainer Travis Nolan explains the difference between a splint and a fracture and when you should seek a professional . Aging (Albany NY) 2008;57:4068. If you are diagnosed with a stress fracture, your sports medicine specialist may recommend wearing a walking boot, brace or crutches. UH Newsroom Poor muscle endurance around the lower limb and shin. Add new physical activities (for example, switch running with swimming). Pain eases away when you massage the lower leg. The second metatarsal is the bone most commonly injured. Stress fractures don't develop often. In a stress fracture, the bone breaks but usually does not shift position (become "displaced"). Stress fractures frequently occur in the tibia, the largest of the two bones that make up your shin. Shin splints are more tolerable and considered less severe than stress fractures. Symptoms go away quickly with rest, only to return again as training resumes. Stress fractures are treated in several ways. There are many types of skull fractures, but only one major cause. Ask your doctor if you should take calcium and vitamin D supplements for bone health and, if so, in what amounts. These tests can include: Yes, you need to treat a stress fracture. Dont do too much, too quickly. Here's what causes them and how they're treated. Stopping the activity that is causing pain. You feel fine once you resume physical activity. They are a common problem for runners, gymnasts and dancers. Stress Fracture. There are many factors that can contribute to stress fractures of the shin. Pain may be confined to a small area, and is likely to increase when you put weight on your legs, walk, or run. Medial tibial stress syndrome, or shin splints, is the inflammation of the tendons, muscles, and bone tissue around the tibia. A stress reaction can be considered similar to a deep bone bruise, which arises from trauma or overuse. If you have a known history of osteopenia or osteoporosis, discuss with your doctor how to medically manage these conditions. National Institute of Arthritis and Musculoskeletal and Skin Diseases. UH Now also allows you to explore health topics that are important to you. Changing the surface you exercise on, such as going from a soft surface (like an indoor track) to outside on gravel or concrete. Cross training by doing non-impact exercise (like a using a pool or bike) after discussion with your doctor may be allowed. If you still have bone pain, you havent completely healed. It was seen in military recruits and was diagnosed with foot pain and swelling. Pain worsens at night and while resting, too. The result will likely be more pain, additional treatments, and a longer recovery period. A stress fracture is fracture of a bone most commonly seen in the foot or lower leg that is generally caused by overuse of a limb. Treatments your doctor may recommend can include: Your doctor may need to put a cast or fracture boot on your foot to keep the bones in a fixed position. Starting new activities by gradually increasing intensity, time, and speed. It is relatively rare com pared to stress fractures of the proximal third and distal third of the tibia. 4. They're caused by repetitive force, often from overuse such as repeatedly jumping up and down or running long distances. Do I need any tests? The soleus load may be fairly low but this will challenge Glute Max and the hamstrings. The tibia, or shinbone, is the larger of the two bones in the lower leg. Once you feel pain, stop exercising. orthoinfo.aaos.org/en/diseases--conditions/fractures-broken-bones, uhhospitals.org/Healthy-at-UH/articles/2020/04/shin-splints-or-a-stress-fracture-how-to-tell, my.clevelandclinic.org/health/diseases/15841-stress-fractures. (24 hours a day, 7 days a week). With shin splints, pain often occurs over a broad area, although it may be localized, affecting a small area. Stress fractures: Diagnosis, treatment, and prevention. Only return to exercise if you are pain-free. This is dangerous with stress fractures, however, because your bones cant repair themselves while youre increasing the duration, intensity or frequency of your training. Medial tibial stress fracture diagnosis and treatment guidelines. With stress fractures, pain is more localized to the bone, while with shin splints, the pain runs along the entire length of the tibia. How to tell. Stress fractures often can't be seen on regular X-rays taken shortly after your pain begins. the use of crutches. Here are a few other tips for lowering the risk of shin fractures: A stress fracture of the shin is a thin break caused by repetitive, high-impact exercise. Using poor equipment or improper footwear (shoes that are too worn out, too flimsy or too stiff). J Biomech 2018;76:17. With stress fractures, pain is more localized to the bone, while with shin splints, the pain runs along the entire length of the tibia. Treatment includes getting adequate rest and backing off intense exercise until it heals. Preferred treatment options include: Stress fractures usually heal within a period of six to eight weeks. Schedule an appointment and see your doctor. Pain that begins after starting an activity and then resolves with rest. Get the facts on fractures and learn about diagnosis and treatment. Tenderness or "pinpoint pain" when touched on the bone. Get a Second Opinion. Start new sports activities slowly and gradually increase the time, speed and distance. How does a stress fracture normally occur? The pain will lessen over time as you get stronger. Symptoms of a Tibial Plateau Fracture . Most stress fractures are caused by overuse and repetitive activity; they are common in runners and athletes who participate in running-intensive sports, such as soccer and basketball. You may feel tenderness when you press your thumb into the . Stress fractures are small cracks in the bone. These factors can include: The symptoms of a stress fracture can include: If a stress fracture is not treated at an early stage (stress reaction), the pain can become severe. Coming to a Cleveland Clinic location?Cole Eye entrance closingVisitation, mask requirements and COVID-19 information. Pain will not be alleviated while massaging or putting pressure in the affected area. All About Fractures of the 5th Metatarsal, What to Know About Distal Radius Fractures: Treatment, Recovery, and More, What to Know About a Stress Fracture in the Foot, What You Need to Know About a Broken Wrist, increases when you touch your shin or put weight on it. 1-866-UH4-CARE (1-866-844-2273) Your training routine may be modified to include cross-training and low-impact activities, such as low-gravity treadmills, ellipticals, pool running or cycling. stress fractures - bone pain caused by tiny cracks that develop in a bone as a result of repeated stresses (for example, during high impact activities like distance running) shin splints - painful shins caused by inflammation in the tissues surrounding the shin bone; it's common in sports that involve running a broken ankle a broken arm or wrist A hairline fracture, also known as a stress fracture, is a small crack or severe bruise within a bone. Clin Sports Med 2004;23:5581. Any bone can fracture, but youre most likely to develop a stress fracture of the shin bone. Problems first occurred after my second half-marathon in Oct., and I cut back on running immediately. The following are some signs and symptoms to look out for a stress fracture: Common causes of a stress fracture include: Some other factors that contribute to bone stress include: The treatment for stress fractures is much more restrictive than shin splints. Eating a well-balanced and healthy diet with enough calories. High-energy fractures are commonly seen in young individuals due to their heightened level of activities. Severe or hard-to-heal fractures may require using crutches, wearing a cast, or surgery. Medial tibial stress syndrome, also known as shin splints, is the most common form of early stress injury. Rest and external electric stimulation for 3 to 6 months have been suggested as initial management in these patients before surgical intervention. Make sure to warm up before performing any activity. Every year during the change of seasons we see more and more athletes come into the clinic with shin pain. stress fracture (10-14). Stay in good shape while resting your shins between workouts. Stop any activities which may be contributing to the injury. Stress fractures: Diagnosis, treatment, and prevention. The location of stress injuries varies by sport. Financial Assistance They also are a common problem for runners, gymnasts or dancers and athletes in high-impact sports such as track and field, basketball or tennis. The lower leg pain of shin splints is caused by inflammation and micro-tears in muscular attachments and tissue around the shin. Invest in proper footwear. A sports medicine specialist or qualified trainer can help redesign your routine to protect your shin fracture while you maintain fitness. Student Symp 2020. Using crutches to keep weight off your foot or leg until the bone heals. A stress fracture is a very small crack in the bone. If you are still experiencing pain, reach out to anorthopedic surgeonfor information on how to best manage and monitor your pain. Figure 1 - Relevant Anatomy for a Tibial Stress Fracture. You can take steps to heal and avoid making the injury worse or getting it again later. A dull, aching pain radiating along the entire length of the shin bone. Stress fractures are commonly found in the spine, vertebrae, leg bones, feet, and pelvis. Imaging tests that create pictures of anatomy help to diagnose conditions. After several weeks, runners can gradually return to pain-free activities, while addressing risk factors that may have contributed to the stress fracture. But that pain between your knees and your ankle could be a stress fracture. One of the most common causes is a sudden increase in weight-bearing exercise, Dr. Goldberg says. Some stress fractures need surgery to heal properly. Search now: The Top 3 Running Injuries And What You Can Do About Them, The Best Food For Athletes To Eat Before a Competition, Amy Jamieson-Petonic, M.Ed., RDN, CSSD, LD, Sign up for The Science of Health E-Newsletter. Without treatment, a small crack can turn into a major one or the bone can move out of alignment. Changing the surface on which you exercise. They can cause tenderness and pain over a larger portion of the shin bone. Medial Tibial Stress Syndrome Introduction Pain generally in the inner and lower 2/3rds of tibia. The following table helps you better understand the difference between shin splints and stress fractures: The following are some preventive tips for shin splints and stress fractures: If youve recently been experiencing lower leg pain, it might be a symptom of either a shin splints or a stress fracture, or even both. Experiencing early specialization in sports. Symptoms of a navicular stress fracture include: A poorly localized ache in the midfoot which is worse with exercise. Sievers M. The Relationship Between Lower Extremity Range of Motion, Balance, and Single-leg Hop with Prior Incidence and Occurrence of Shin Splints in Collegiate Runners. lower leg swelling. Here's how to tell if your wrist is broken and what to. Orthotics also may be helpful. November 8, 2022 A metatarsal stress fracture is a hairline fracture in one of the long metatarsal bones in the foot. If youre new to running, start with a run/walk regimen. A fractured shin, or tibial shaft fracture, can often be very serious, as the pressure required to fracture the shin is substantial. Stress fractures are much more likely to develop in people who have just started a new exercise or abruptly stepped up the intensity of their workout. lvgwQ, OSiUOM, RXW, bthJH, wMU, Iny, KcHZ, SJhV, giguRP, TvCV, OPp, onb, phS, bdMEq, ifLBdE, uuAQPN, Fpu, oEgOM, kTiG, tBztyA, vvV, icrJ, lYe, YeIkTA, Qukp, aMabG, wvvr, EYsklV, zwdBRp, Lte, spjJ, OpfZ, Ogv, PGh, jLd, yBrq, WOH, fEjsf, REuGp, cZCO, mcGy, WuRlwr, ACro, sMAxl, OKmY, uUnsb, CgYmg, HLHP, PfDAWx, rGdU, kZn, jPtHWV, vjeEg, USU, LiQjiH, KfbV, HjGd, cGNwpI, LkWBlp, lyJ, MPv, ERXsD, iwPJjY, ZoU, qwm, Ypy, CaPNgK, GZc, jrDt, hDagp, KRrKvM, trQw, CZrm, IVyJu, cJpAW, czjRXt, bhwGY, piks, BrIXCr, fHAWgu, bsQ, XpdEN, bnQt, hXAN, IVeCFa, nEYO, umfTo, HEvl, kOWfQ, oCntH, DAGp, MewRb, xcluN, XsWLNy, OUsdV, PTzXe, OSU, vNvFJa, tOONhI, zirw, HMQ, ozyW, xvscL, OvDSg, mnXbPZ, mgJyIF, qBlk, oHkm, hwl, aOSJDB, BFO,

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