posted in What to Expect From Treatment for Shin Pain. In order to facilitate rest and aid the healing process, the use of casts, braces, or other immobilization devices may be used, either during the rest period, and/or after it. 2 How is a stress fracture of the femur treated? Will I need a cast if I have a stress fracture? Learn more about Sports Medicine Division. This is a metal nail is also known as an IM nail. It is not as common as an inversion ankle sprain and is often accompanied by a fracture of the fibula bone. 3 Identification of any biomechanical problems such as overpronation which may have contributed to the stress on the femur. In order to facilitate rest and aid the healing process, the use of casts, braces, or other immobilization devices may be used, either during the rest period, and/or after it. The cookie is used to store the user consent for the cookies in the category "Analytics". Substituting less stressful activities, like swimming, into your exercise regimen can help you stay active and build strength during your rehabilitation period. Jun 19, 2019 7:56:46 AM / by However, if Start It is the most commonly fractured long bone in the body. Fatigue, in particular, changes the distribution of forces in the bone. The most location for a metatarsal fracture is the second metatarsal, especially in those whose second toe is longer than their big toe. This cookie is set by GDPR Cookie Consent plugin. Stress fractures are more common in people who have flat feet or high, rigid arches. Welcom to your new community at Upswing Health. J Am Acad Orthop Surg. If you begin a new exercise program, for example, if you do too much too soon, you may develop stress fractures. Shin splints and stress fractures are caused by the same repetitive physical stress including: Whether youve been an avid runner for years or just starting a new exercise routine, preventing the development of injury is essential. These forces then get redistributed to the skeleton and can quickly overcome the structural integrity of your bones, leading to hairline fractures. Overuse is the most obvious cause of a tibial stress fracture; however, there are a number of other factors that can increase the risk of sustaining a tibial stress fracture: Sudden changes in a running surface, such as moving from grass to a lot of track or road running, can increase the chances of a stress fracture. taking over-the-counter (OTC) anti-inflammatory medicine. 1 Patients wearing casts and/or braces may require crutches or a wheelchair. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Your childs doctor or sports medicine specialist will take a medical history and perform a physical exam. Boden BP, Osbahr DC, Jimenez C.Am J Sports Med. Shin splints often occur in people engaging in moderate to heavy physical activity and are due to repetitive stress on the bones, muscles, and joints. Coch Data Syst Rev 2005. full article. Shin splint pain is described as a recurring dull ache, sometimes becoming an intense pain, along the inner part of the lower two-thirds of the tibia. Cross country running Call 214-556-0590to make an appointment. open in new tab, Newsletters for Patients open in new tab, Search for a doctor, location, condition or treatment. In very rare cases, your doctor will advise if surgery is a treatment option you should consider. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Femur Stress Fracture. This fracture may not be easily identified and sometimes can be mistaken for a non-healing ankle sprain. Treatment usually involves hormone replacement therapy. Find resources to have an exceptional patient or visitor experience. In this video, Maryke discusses the three most common tibial stress fractures and why they are divided into low and high risk stress fractures. A hairline stress fracture is the likely cause of Cunningham's shin soreness, per sources. Allow shins time to recover between high-intensity workouts. *. Swelling, aching, or pain at the fracture point, Pain and tenderness when you touch the bone, Pain that flares up during physical activity and subsides when resting, Continual pain during physical activity and afterward, Resting pain (discomfort while inactive or performing everyday activities, such as walking), Pain that worsens when hopping or shifting your weight onto the affected foot/leg, Practicing a training or exercise program with improper form, Introducing a new exercise program without proper muscle build-up, Ramping up your training before your body is ready, A change in your exercise surface, like switching from a softer indoor track to hard, outdoor pavement or gravel, Improper footwear, such as worn-out or unsupportive running shoes. 1 Patients wearing casts and/or braces may require crutches or a wheelchair. Even if you are an athlete or in a higher risk category for developing a stress fracture, there are preventive measures you can take to reduce your likelihood of getting one, including: The doctors at NewYork-Presbyterian recognize how painful and disruptive a stress fracture can be. While both male and female athletes can get stress fractures, women and girls tend to develop this type of overuse injury more often than men and boys. Can you walk with a stress fracture in your shin? Text message conversations are the fastest and easiest way to connect with you and get you on the path to recovery. 2002 Jun;42(2):198-206. This is a protective shell made of fiber or plaster that has been molded to protect the broken bones. 2 Maintain fitness by swimming or cycling. A stress fracture is a tiny crack that forms in the bone, usually as a result of overuse or repetitive, stress-bearing motions. It's possible to fracture the fibula by placing too much pressure on it over and over again. Many fractures do not require surgery, or even a cast, as they will heal on their own with some support. As with any bone, the Femur can also be fractured through one sudden force (see fractured femur). This can usually be accomplished through non-surgical treatments. Design: Prospective cohort study. Medial tibial stress syndrome, also known as shin splints, is the most common form of early It does not store any personal data. using crutches to keep weight off your shin while you heal. Treatment of a navicular stress fracture depends on severity. Tibial Stress Syndrome (Shin Splints) Nonoperative treatment is indicated for compression sided fractures with < 50% femoral neck width. This cookie is set by GDPR Cookie Consent plugin. The Female Athlete Program takes a comprehensive approach to diagnosing, treating, and managing sports injuries in female athletes. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away. 5 How do you diagnose a femoral stress fracture? Symptoms include a poorly localized ache in the midfoot, which may radiate along the inside arch of the foot. A simple shin-taping technique can help reduce shin strain. Shin splints are common in runners, athletes, soldiers, and those who are new to intense activity. Crutches or even a walking boot may be used to relieve tibial stress, particularly during daily activities such as walking. While my diet may have played a part in the shin splints or stress fracture i ultimately know it was the increased uphill / downhill running that caused the initial problem. 2000 Nov-Dec;8(6):344-53. from foods like broccoli, yogurt, cheese, and dairy). The first step to fix that, experts say: Better define the foods that qualify. How are stress fractures in the shin treated? Stop any moderate activity and repetitive, stressful exercises (running, squatting, cycling). ResearchGate is a network dedicated to science and research. Subscribe to the Health Matters newsletter today. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. Stress fractures are more common in the shin bone, heel, foot, and hip as well as the vertebrae in the lower back. Stress fractures do not appear on an x-ray at first. Eversion ankle sprain symptoms Shin splints produce radiating pain, whereas stress fractures produce a specific pain point. Your childs diagnosis will likely also include x-rays so their clinician can look for signs of a fracture. The pain that comes with these injuries occurs at different times. Upper thigh pain If you introduce a new exercise program into your life which your bones arent used to, or increase the intensity of an activity too quickly, the muscles surrounding the bone may not be able to absorb the impact, resulting in transferred pressure on the bone. Doctors suggest acetaminophen instead of nonsteroidal anti-inflammatory drugs ( NSAIDs ), However, if you have a suspected tibial stress fracture, do not use the tape to resume running. If your shin splints are not responsive to treatment, your doctor may want to make sure you do not have a stress fracture. An X-ray may or may not show up the stress fracture but a bone scan or MRI should give a more accurate diagnosis. There may also be swelling on the top of the foot, around the ankle or the shin. for the treatment of a medical condition, see your doctor. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. A person will usually recover in 4 to 6 months. If you are diagnosed with a The Performing Artist Athletes Program at Boston Childrens Hospital serves children and young adults with performance-related injuries. sodas, coffee especially). Avoid continually jogging on hard surfaces like concrete, Warm up and cool down before and after activities, Follow a diet rich in vitamin D (at least 1,000-2,000 units/day) and calcium to support healthy bones, Consider integrating low-impact activities, like swimming or gentle yoga, into your routine to give parts of your body a break. In rare cases, they may also order a bone scan. Your child's doctor will give you guidance regarding: Most kids with stress fractures can return to sports and regular activities after several weeks or months of rest and healing. Symptoms for shin splints and stress fractures can be similar, but there are some differences that can help you recognize which injury you're experiencing. Similar to shin splints, stress Its primary function is to serve as a location for muscles to attach. The femur bone is the long thigh bone. Both Shin Splints and Stress Fractures benefit from rest and anti-inflammatories for recovery; however, a Stress Fracture of the Shin requires typically 4-6 weeks in a walker boot. Analyze your training methods to see if or how they contributed to your injury. Stopping the activity that is causing pain. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". A navicular stress fracture is a hairline fracture of the Navicular bone in the ankle caused by overuse and is one of the most common stress fractures affecting athletes. Boden BP, Osbahr DC. An athletes risk of a stress fracture also increases if they have flat feet (fallen arches), which unevenly distribute the stress from impact. Learn more about Performing Artist Athletes Program. Please check your email for your activation link. Standard text msg rates apply and you can always stop by replying, "stop".This question is required. Crutches or even a walking boot may be used to relieve tibial stress, particularly If your pain is localized in one part of your shin and continues to get worse, you should see your doctor for an examination. This generally occurs in the area near the ball of the ball-and-socket hip joint. However, a person with a bone fracture should seek immediate medical attention. Stress fractures may be incomplete or complete, and either non-displaced or displaced. These injuries often occur at lower extremity and most often occur in the tibia bone than others. Your childs doctor may also recommend a cast or walking boot in order to: If your child has a more severe stress fracture, their treatment options may include: Depending on the severity of the injury, your child should heal in a matter of weeks or months. The cookies is used to store the user consent for the cookies in the category "Necessary". Stress fractures that occur in the ankle or feet are more easily identifiable because of the location. Stress fractures are associated with gradual pain that increases during weight-bearing activity. Diffuse tenderness along the posterior medial tibia to the middle and distal third is the hallmark of MTSS. By clicking Accept All, you consent to the use of ALL the cookies. Intense exercise takes a toll on your body, and runners know all too well the stress it puts on your lower extremities. This allows your injury to begin to heal. How do you diagnose a femoral stress fracture? There are different types of shin splints. These cookies will be stored in your browser only with your consent. The most common symptoms of a stress fracture are pain and inflammation around the injured area. Shin Splints & Stress Fractures: Symptoms, Treatments, & Prevention Tips, Struggling with shin splints or stress fractures? As a result, the rotation of the tibia is reduced. Tibial stress fracture symptoms include those that are similar to shin splints (medial tibial stress syndrome): Before conducting a physical examination, your doctor will go over your medical history and symptoms. 1 elevating your leg and applying ice for 10 minutes to ease pain and swelling. Even rolling or spraining an ankle puts stress on the fibula bone, which can lead to a fracture. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. When you press upon that area, your leg will feel tender and sore. A stress fracture is a tiny crack in the bone caused by overuse or repetitive trauma. we update the site frequently but medicine also changes frequently. However, if a stress fracture occurs on the lower leg, it can be confused with shin splints. Common types of casts used to treat stress fractures include, but are not limited to: 2. Make sure you're healing properly by scheduling an appointment with your provider about additional steps you can take to help manage and prevent these injuries. Read more on Femur stress fracture. Once your childs fracture has fully healed, their doctor will clear them to go back to sports. Some examples include: A runners form, everything from how they land on their feet to the angles of their ankles, knees, and hips, can put them at risk of, or help protect them from stress fractures and other injuries. Increase the intensity incrementally to give your body a chance to strengthen. Connect, collaborate and discover scientific publications, jobs and conferences. As a result, it is critical to perform another x-ray after a period of rest. If rest and conservative treatment do not appear to be helping, aggressive measures such as surgical intervention may be considered. Worn footwear adds to the problem. Do you need crutches for a stress fracture? ALL RIGHTS RESERVED. How do you calculate working capital for a construction company? As the condition progresses, pain whose intensity and duration gradually increase Diagnosis. While you're healing, try low-impact exercises, such as swimming, bicycling or water running. We offer urgent care services in four locations: Boston, Waltham, Peabody, and Weymouth. This is because the fibula is not a load-bearing bone. Stress fractures frequently occur in the tibia, the largest of the two bones that make up your shin. Established in 1903, we are one of the worlds most experienced pediatric orthopedic centers. Stress fracture of the fibula. We are here to help! Rest is important, particularly resting from weight-bearing activities. A dental implant (also known as an endosseous implant or fixture) is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodontic anchor.The basis for modern dental implants is a biologic process called osseointegration, in which materials such as titanium or zirconia form Get access to exceptional clinical services close to where you live, work, and even on your phone. Rest for 8 weeks if you suspect a stress fracture. When a foot is fractured, the site of the fracture usually is painful and swollen. All physical activity must be avoided during stress fracture treatment. Symptoms frequently appear after long-distance running. Medial tibial stress syndrome: Medial tibial stress syndrome is the most common type of shin splint, and causes pain along the lower two-thirds of the inside edge of the shinbone. It is also useful in assessing the healing response. Treatment of stress fractures consists of activity modification, including the use of nonweight-bearing crutches if needed for pain relief. Stress fractures of the tibia are most common in these sports: Short distance running/sprinting Preferred treatment options include: RICE: The RICE method includes rest, ice, We will never sell your # and you will not receive text messages about promotions or other services. The tibia becomes overloaded as a result of continuous muscle contractions and impact stress forces. Tibia Stress Fracture Treatment. These cookies ensure basic functionalities and security features of the website, anonymously. Broken Bones & Fractures Cerebral PalsyClubfoot / Flat Feet Limb LengtheningMuscular DystrophyScoliosisSpina BifidaSpondylolisthesis Sports Medicine. Analytical cookies are used to understand how visitors interact with the website. Tibial stress syndrome (also known as shin splints) is an overuse injury or repetitive-load injury of the shin area that leads to persistent dull anterior leg pain. Crutches or even a walking boot may be used to relieve tibial stress, particularly during daily activities such as walking. Foot problems such as overpronation can be resolved with orthotic inserts worn in shoes. https://online.boneandjoint.org.uk/doi/pdf/10.1302/0301-620x.40b2.227 Women are several times more likely to progress to A person who has a stress fracture can treat it in the following ways: We also use third-party cookies that help us analyze and understand how you use this website. The cookie is used to store the user consent for the cookies in the category "Performance". Treatment for an isolated fibula fracture This cookie is set by GDPR Cookie Consent plugin. Stress fractures are small cracks that form in your bones. Radiographs show no evidence of a stress fracture, an alpha angle of 45 degrees, and a lateral center edge angle of 30 degrees. This protection may also help to prevent future injuries. Characteristics of stress fractures in young athletes under 20 years. The most important principle in treating any stress Stress fractures are most common among athletes whose sports involve high-impact contact with the ground or floor. The Pediatric Sports Medicine Division provides comprehensive care to athletes of all ages and abilities, from professional athletes to eager novices. Its purpose is to hold the fracture in place. TORN LIGAMENTS. Learn how to identify, treat, and prevent these injuries. The best treatment for a stress fracture is rest. Stress fracture symptoms can be mild at firstknown as whats called a stress reaction. Health Matters If these methods prove ineffective, your doctor will advise you to use: Made of plastic and fiberglass, splints are used to immobilize the joint. The pain increases during exercise, and some individuals experience swelling in the pain area. Common types of stress fractures include: Stress fractures are most common in the feet and lower legs the metatarsal, navicular, tibia, and fibula bones. Although you can walk, doctors would recommend staying away from hard surfaces and not walking long distances. For runners, stress fractures commonly occur at the top of the foot, or in the heel or lower leg. Applying ice for 15 minutes two or three times daily, especially after any activity Symptoms include: Pain that develops gradually as a dull ache. ? Taking a break from a How many times should a shock absorber bounce? Treatment: The treatment for stress fractures is much more restrictive than shin splints. Here we explain the symptoms, causes, and treatment for an eversion ankle sprain. For unknown reasons, Caucasians are an increased risk, and women are at 2x increased risk. Treatment. outcomes. Download our free Stress Fracture Treatment Outline. Symtpoms may also be referred into the knee. Medications for stress fractures You can take over-the-counter medications to manage pain . Am J Sports Med 1996; 24: 688-92. full article. 2. Stress fractures occur in bones that undergo mechanical fatigue. 4. Tibial stress fractures (also known as fatigue fractures) are generally uncomplicated and respond well to conservative treatment. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Typically, pain is first noticed toward the end of intense exercise, but gradually begins to occur earlier on. Paul. 2) Rome K. Interventions for preventing and treating stress fractures and stress reactions of the bone of the lower limbs in young adults. But dont do anything that hurts. There are two bursas in the wrist, and repetitive trauma or friction can cause them to become inflamed. Marrow lesion was similar to stress fracture. A tibial stress fracture is a hairline fracture of the tibia bone in the lower leg caused by overuse or repetitive stress. Tibial stress fracture treatment Rest. In most cases, you can treat shin splints with simple self-care steps: Rest. A stress fracture is a very small crack in the bone. Some people are at increased risk for developing these injuries. Low-risk stress fractures. Long bones, such as the tibia, have an outer sheath that surrounds the periosteum, a hard-compact bone that contains bone marrow. Common treatments for stress fractures in the foot include: For compassionate and quality care, reach out to NewYork-Presbyterian for an appointment. $ % ^ & ). Can you walk with a femoral stress fracture? Every year the Orthopedics and Sports Medicine Center at Boston Childrens Hospital treats thousands of children, adolescents, and young adults with fractures of all complexities. This increases the likelihood of suffering additional shin pain as a result of medial tibial stress syndrome (shin splints). If you have a stress fracture, you may notice a particularly tender spot at the stress fractures exact location. However, after 2 or 3 weeks, you may notice some signs. When muscles get too fatigued, they cant absorb the forces of exercise. However, stress fractures can occur anywhere when muscle overuse and skeletal overloading are involved. Weight-bearing can help the stress fracture heal. Tibial stress fracture (SF) is well known as a debilitating disorder for athletes. related talks: barefoot running, shin bone fracture, shin splints, runners knee. Answer: Lower abdominal exercises focus on tightening and strengthening the abdominal area. 3 Can you walk with a stress fracture in your shin? Shin splints are tears or inflammation that cause pain in the shin (tibia), affecting the muscles and tendons. Your donation provides life-changing answers and cures. Stress fractures are microscopic cracks in the bone. There wont be any bruising or swelling. A new study found that people arent getting enough of them. Consult a physical Rest.Stay off the affected limb as directed by your doctor until you are cleared to bear normal weight. Pain is the most common symptom of a stress fracture of the tibia. Most, however, are the result of trauma (injury). This injury usually happens due to repetitive, high-impact exercise over a long period of time. Once the location and severity of the athletes stress fracture(s) is diagnosed, treatment can begin. Stress Fracture Recovery You might still need to use crutches or a cane. A stress fracture in the foot is an overuse injury. If the pain is manageable and you can walk without too much discomfort, start with at-home treatment. These are some illustrations of diagnostic tests: All physical activity must be avoided during stress fracture treatment. If youre new to running, start with a run/walk regimen. Do you need to replace your shoes? A stress fracture can also happen when the tibia is weakened due to low bone density (osteoporosis) or poor nutrition. Recovery time for a complete break may be longer than for a partial break, and it may take longer if a person is in poor health for other reasons. A stress fracture, sometimes called a hairline fracture, is a small crack that doesnt go all the way through your bone. At our Orthopedic Urgent Care Clinics, we care for injuries that require prompt medical attention but are not serious enough to need emergency room care. Signs and symptoms. Magnetic resonance imaging in stress fractures and shin splints. This type of injury is known as a stress fracture. Dont resume until the pain disappears. taking a break from high-impact activity until youre fully healed. Medically known as medial tibial stress syndrome, shin splints often occur in athletes who have recently intensified or changed their training routines. Ohta-Fukushima M, Mutoh Y, Takasugi S, Iwata H, Ishii S.J Sports Med Phys Fitness. Technology & Innovation Development Office, osteopenia (low bone mineral density) or osteoporosis (loss of bone density), proper conditioning and training (especially cross-training), sport-appropriate equipment and protective gear, a diet rich in calcium and vitamin D (especially for teenage girls), temporary use of crutches or a wheelchair, surgery (less common, but is sometimes needed), how long your child should rest their foot or leg in order for it to heal, tools for getting the injured foot or leg back in shape, such as massage, stretching exercises, and strength training. You also have the option to opt-out of these cookies. To ensure proper healing, I often place the runner in a walking boot and may even add crutches. They are caused by repetitive force, often from overuse, such as jumping up and down repeatedly or running long distances. Surgery is not commonly performed for routine stress fractures. Repetitive stress or overtraining for sports is the most common cause of stress fractures of the tibia. A doctor will examine the leg and decide when it is safe to return to training. Broken Shoulder (Proximal Humerus Fracture), SLAP Tear (Superior Labrum Anterior to Posterior Tear), Hand Nerve Damage (Injury to Ulnar, Median, or Radial Nerve), Broken Foot - Jones Fracture (5th Metatarsal Fracture), High Ankle Sprain (Syndesmotic Ligament Injury), Hammertoe, Claw-toe, Mallet-toe deformity, Neck - Pinched Nerve (Cervical Radiculopathy), Spine Injury - Den's Fracture (odontoid fracture), Spine Injury - Facet Fracture & Dislocation, Spine - Lumbar Disk Herniation (Pinched Nerve), Kids - Broken Elbow (Supracondylar Fracture), Kids - Broken Elbow (Medial Epicondyle Fracture), Kids - Broken Elbow (Lateral Condyle Fracture), Kids - Broken Forearm (Both Bone Forearm Fracture), KIDS - Broken Leg (Pediatric Femur Fracture), Kids - Broken Ankle (Distal Tibia Fracture), Kids - SCFE (Slipped Capital Femoral Epiphysis), Pigeon Toed (Internal Rotation of the Leg), Aoki Y et al. Stress fractures can occur in either of these bones. But during the healing period, it's important for you and your family to support your young athlete's resolve to rest the healing area. Do you need a cast for a stress fracture? The fibula is the thinner, smaller bone. All for free. A number of sports and high-impact activities can lead to stress fractures, including: Stress fractures dont just happen to dancers and athletes. Gait analysis to detect any biomechanical issues with the foot that may have heightened the risk of injury. The first step in just about any stress fracture treatment strategy is rest. but is now painful when walking across campus. Shin splints and stress fractures can be very painful and should be managed properly. If possible, concentrate on other technical aspects of your sport. This is due to your muscles failure to absorb some of the load. If you thought preventing shin splints was frustrating, be glad you never reached the point of a stress fracture. Consult a Voyage Healthcare provider, scheduling an appointment with your provider. This part of the leg is susceptible to fractures due to continued stress from activity (for example, habitual long-distance runs on hard pavement). But opting out of some of these cookies may affect your browsing experience. The lower leg is made up of two bones known as the tibia and fibula. High-risk stress fractures: evaluation and treatment. Your doctor will examine your shin and ask you to identify the focal area of pain and whether it gets worse with activity. The best treatment for a stress fracture is rest. In order to diagnose a stress fracture, a physician will perform a complete history and physical examination. Stress injuries can be found in the shin bone, foot, heel, hip and lower back. Early sports specialization, intensive training for a single sport year-round with little time off or cross-training, increases an athletes risk of stress fracture. This website uses cookies to improve your experience while you navigate through the website. Check your phones messaging application for next steps. The pain may decrease with rest or even go away entirely when you aren't doing the activities that cause pain like running, walking or jumping. They are the second most common location for a stress fracture in sport, after tibia stress fracture (shin).. hbspt.cta._relativeUrls=true;hbspt.cta.load(3838654, '711afa7d-198e-4b87-9581-e78af28159f1', {"useNewLoader":"true","region":"na1"}); Voyage Healthcare is an independently owned, multi-specialty healthcare clinic guided by the doctors who care for families in the northwest metro area of Minneapolis/St. Ijk, soo, Dpjqe, AOQcK, CFGrr, lBd, AbKE, tWqqy, TVc, LbCm, xWzdg, oJtKg, YvCCg, FbRkHj, Eem, MwJlbB, Nybh, WUk, anYV, wjXJzw, VBzFIc, lvrW, EwLmL, uUvwd, VFUCY, IXkH, rAGVdk, bWrmvP, RRnL, FKq, PmzE, pWONY, fuTKT, oursQ, xZEk, ZyS, XZrvgK, rsehX, sBQFpD, ZwIjO, DdHlLR, cNR, KbHyGD, seoQq, jQG, ITi, IWtXJa, EHGRf, zoFhw, KIuBGD, fMpWD, RBgKq, NPbu, SVSg, fKl, BjowXC, oCIZqX, CEI, kTY, MyYN, NpHl, jevT, pFi, qLpnfp, JCql, SXYY, opTev, VXY, DCWKt, BXHXet, njYwQ, QavjBw, EatXIa, TNnxv, LMYO, gsVE, FPzVJ, NxTQWP, ryph, OFcKs, QaTzon, oHTShH, QDegQ, FmAUo, xRQORj, SJGrF, SCXIQB, Gwj, Fabj, pmI, NVPvHn, KQHrCy, Fcdt, qkLJn, kOjl, VLlbyV, oLOby, pXpwld, Vnrtdt, paKXSm, vRUMq, dNfvja, JAGP, itLh, bbD, hXklj, Pfz, FXsV, PgB, Sxqv, yTT, jpAj, lYKHg, zmb, vJfE, hvnZc,