It is considered a pain out of proportion, where the symptoms described do not correspond to the other signs, making an early diagnosis more difficult. Substantial displacement of brain parenchyma may cause elevation of intracranial pressure and potentially fatal herniation syndromes. Coxa valga deformity; Valgus hip: HP:0002683: Abnormal calvaria morphology: HP:0002648 1st metatarsal most commonly fractured in children less than 4 years old. Prognosis highly depends on deformity severity, underlying etiology, & age at presentation. WebA total of 70 adult patients undergoing hallux valgus surgery were randomly assigned to receive sciatic nerve block at popliteal fossa with US+NS or NS alone with a double injection technique for peroneal and tibial branches, respectively. Figure A is the radiograph of a 36-year-old female that presents with a high-steppage gait and claw toes. Which of the following sites identified in Figure A shows the correct destination for the transferred tendon in order to balance the foot and eliminate the supination? In gait, the cavovarus foot demonstrates a compensatory heel varus, a locked midfoot, and a reduction of the flexible phase and decreased shock absorption as a result of plantar fascial tightening. and valgus, hindfoot varus, and forefoot adduction. [16][15] Multiple pathogenetic theories have been proposed over the years. - Cavovarus Foot in Pediatrics & Adults Flashcards (0) Cards All of the following are potential pathologies that may result directly from this condition EXCEPT: (SBQ18FA.11) Which congenital condition most likely contributed to the development of the current foot deformity? WebHallux valgus (acquired), unspecified foot [covered for capsular or bone surgery only] M21.611 - M21.629: Bunion: Debridement of mycotic nails: CPT codes covered if selection criteria are met: 11719: Trimming of non-dystrophic nails, any number: 11720: Debridement of nail(s) by any method(s); one to five: 11721: six or more midfoot and hindfoot conditions. WebMuellerWeiss syndrome, also known as MuellerWeiss disease, is a rare idiopathic degenerative disease of the adult navicular bone characterized by progressive collapse and fragmentation, leading to mid- and hindfoot pain and deformity. Sometimes children are born with flat feet (congenital). However, with time, pressure on your brain increases, producing some or all of the following signs and symptoms: As more blood fills your brain or the narrow space between your brain and skull, other signs and symptoms may become apparent, such as: An intracranial hematoma can be life-threatening, requiring emergency treatment. Figure A shows a lateral radiograph of an 9-month old's dorsiflexed foot. WebA total of 70 adult patients undergoing hallux valgus surgery were randomly assigned to receive sciatic nerve block at popliteal fossa with US+NS or NS alone with a double injection technique for peroneal and tibial branches, respectively. (SBQ12FA.83) A 4-year-old boy demonstrates excessive supination occuring during the swing phase of gait following Ponseti casting for an isolated right clubfoot. [1][2] Avulsion fractures can occur in any area where soft tissue is attached to bone. Treatment depends on the amount of blood and the extent of brain injury that has occurred. Federal government websites often end in .gov or .mil. often bilateral and familial. Acquired pes planus (i.e. The tibialis posterior tendon is the primary dynamic stabilizer of the middle part of the foot and arches. Tibial Torsion. Failure of conservative management is more likely in patients with mid-foot abduction and radiologically noted talonavicular arthritis. Characteristic imaging shows lateral navicular collapse. The and an angle of more than 94 degrees is regarded as talipes valgus. WebHeel eversion angle: Heel eversion or hindfoot valgus is generally accepted as a normal finding in young, newly walking children and is expected to reduce with age. An avulsion fracture is a failure of bone in which a bone fragment is pulled away from its main body by soft tissue that is attached to it. Management should now consist of. Clipboard, Search History, and several other advanced features are temporarily unavailable. J Am Acad Orthop Surg. Web(OBQ07.90) A 45-year-old diabetic male has a Wagner type 3 heel ulcer shown in Figure A that measures 4x2cm and is recalcitrant to debridements and total contact casting for 4 months. Abben et al. WebHallux Valgus Hallux Varus DJD & Hallux Rigidus 5th metatarsal most commonly fractured in adults. Web(SAE07PE.93) A 3-year-old boy had been treated with serial casting for a right congenital idiopathic clubfoot deformity. WebAnkle position in the posterior view allows assessment of the heel. A 5-year-old boy has a history of being treated with the Ponseti technique for a unilateral clubfoot. Careers. Imaging. First Tarsometatarsal Joint Fusion for Hallux Valgus Deformity: A Retrospective Comparison of Two Fixation Constructs Regarding Initial Maintenance of Correction and Complications: Traditional Crossing Screw Fixation Versus Dorsomedial Locking Plate and Intercuneiform Compression Screw. Cavovarus Foot is a common condition that may be caused by a neurologic or traumatic disorder, seen in both the pediatric and adult population, that presents with a cavus arch and hindfoot varus. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment Web1 Cavus: the foot has a high arch, or a caved appearance. Intracerebral hemorrhages and accompanying edema may disrupt or compress adjacent brain tissue, leading to neurological dysfunction. Which of the following is most appropriate as one part of the surgical plan?? X = Peroneus longus, Y = Tibialis anterior, Z = Peroneus brevis, X = Tibialis anterior, Y = Peroneus longus, Z = Peroneus brevis, X = Tibialis anterior, Y = Peroneus brevis, Z = Peroneus Longus, X = Peroneus brevis, Y = Peroneus longus, Z = Flexor digitorum longus, X = Posterior tibialis, Y = Peroneus brevis, Z = Flexor digitorum longus. Anterolateral ankle instability may also result. It's something that is there, and unfortunately, my day by day is difficult, honestly. WebA persons risk of an intracerebral hemorrhage may increase as they age, especially as high blood pressure is more common in older adults. Medical Necessity. CMT is a progressive degeneration of peripheral nerve myelin with decreased motor nerve conduction. Please always ask your doctor for personalized diagnosis, evaluation, assessment, treatment and care management plan. Radiographs. A clinical image and lateral foot radiograph are shown in Figures A and B, respectively. Intraparenchymal hemorrhage is one extension of intracerebral hemorrhage) with bleeding within brain parenchyma. 1st metatarsal most commonly fractured in children less than 4 years old. WebVarus & Valgus Deformities Infantile Blount's Disease (tibia vara) Adolescent Blount's Disease Cavovarus Foot in Pediatrics & Adults Equinovarus Foot Medial deviation of the forefoot (abnormal heel bisector), normal hindfoot. WebFlat feet (also called pes planus or fallen arches) is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. Weak anterior tibialis and weak peroneus longus, Normal anterior tibialis and weak peroneus longus, Weak peroneus brevis and normal posterior tibialis, Normal peroneus longus and weak posterior tibialis. A person may reduce the risk of developing an intracerebral hemorrhage by: controlling diabetes; quitting or never smoking; managing and treating heart disease; exercising regularly; eating a healthful diet [1][2] Avulsion fractures can occur in any area where soft tissue is attached to bone. Forefoot driven pes cavus is most often caused by neurological diseases and is the result of muscular imbalances. The tibialis posterior tendon is the primary dynamic stabilizer of the middle part of the foot and arches. factors that differentiate juvenile / adolescent hallux valgus from adults. Copyright 2022 Lineage Medical, Inc. All rights reserved. Required fields are marked *. WebThis is due to the complex anatomy of the medial aspect of the ankle and hindfoot, which makes localizing symptoms to a specific structure difficult. The eversion of the heel has been repeatedly used for determining the posture of the childs foot. Imaging. Passing the MBLEx is often the last hurdle before new therapists can get their state massage license and begin a new career as a professional midfoot and hindfoot conditions. Tried correcting equinus before heel varus, Used below knee casts instead of above knee casts, Transitioned to the wrong size braces after casting. and transmitted securely. 4 Equinus: the foot is pointed downward, forcing one to walk on tiptoe. With varus and valgus motion of the hindfoot, the position of the talus is considered fixed with respect to the ankle, and the position of the calcaneus is described in relation to the talus. The causes may include malunited pilon fractures and resultant varus angulation of the distal tibial articular surface, malunion of talar neck or calcaneal fractures, or longstanding ankle or subtalar joint instability. WebCavovarus Foot is a common condition that may be caused by a neurologic or traumatic disorder, seen in both the pediatric and adult population, that presents with a cavus arch and hindfoot varus. Laser or ultrasonic waves are transmitted through it to crush the stones into smaller pieces. Abben et al. The frequency of cysts among children and young adults and the older age range of patients with lipomas supports this idea, and transformation from a calcaneal cyst to a lipoma has been reported 9. Radiographs. Peroneus brevis to longus transfer with medial calcaneal slide osteotomy, First ray dorsiflexion osteotomy with plantar fascia release, First tarsometatarsal joint arthrodesis and metatarsophalangeal capsular release, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 30th Annual Baltimore Limb Deformity Course, Ankle Fusion Malunion with Midfoot Cavoadductus: Hexapod Butt Frame - Noman A. Siddiqui, MD, Cavus Foot Reconstruction (Dr. Econopouly), Surgical Treatment of Severe Cavovarus Foot Deformity in Charcot-Marie-Tooth Disease, PediatricsCavovarus Foot in Pediatrics & Adults. WebHallux Valgus Hallux Varus DJD & Hallux Rigidus 5th metatarsal most commonly fractured in adults. (OBQ06.255) Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. Overpull of the flexor digitorum longus is a contributing factor, as is the shortening and fibrosis of the plantar fascia. The patient has palpable pulses, active drainage at the ulcer, and does not have protective sensation with a 5.07 Semmes-Weinstein filament. This Clinical Policy Bulletin addresses genetic testing. This site needs JavaScript to work properly. 2015 Dec 22;3(12) Sometimes children are born with flat feet (congenital). With the forefoot valgus and the hindfoot varus, increased stress is placed on the lateral ankle ligaments and instability can occur. WebHindfoot Talar Neck FX Talus Fracture (other than neck) makes up 1-4% of all fractures in adults. Radiographs. [22] Regarding his injury: I am not injured; I am a player living with an injury. Problems with the blood vessels to the feet, which is usually due to peripheral arterial disease or diabetes. Radiographs. WebVarus & Valgus Deformities Infantile Blount's Disease (tibia vara) Adolescent Blount's Disease Cavovarus Foot in Pediatrics & Adults Equinovarus Foot evaluate for hindfoot and subtalar motion. For example, if someone seems fine after a blow to the head and can talk but later becomes unconscious, seek immediate medical care. Hindfoot Valgus Symptoms, Causes, Exercises, Surgery; Rhombencephalosynapsis Symptoms, Causes, Prognosis, Treatment; In-shoe systems and pressure plates are used to assess plantar pressure during gait, but additional tools are employed to evaluate other gait parameters. WebIn 2012, 32% of uninsured adults revealed not attracting or delaying health care due to expense, compared to 5% of privately insured adults and 27% of these on public insurance, such as Medicaid/CHIP as well as Medicare. [18] Despite its distinctive radiological features, MuellerWeiss syndrome is often a diagnosis of exclusion[15] and is felt to be under-diagnosed.[6][19]. result of insufficient plantar release and/or placement of navicular in dorsally subluxed position, results from overcorrection, often from extensive subtalar capsular release, commonly due to internal tibial torsion and/or internal rotation of the talus within the ankle mortise, results from vascular insult to talus resulting in osteonecrosis and collapse, caused by dorsiflexed first metatarsal (FHB and abductor hallucis overpull secondary to weak peroneus longus) and overactivity of anterior tibialis, may be associated with inadvertent peroneus longus lengthening at the index procedure, treat with tibialis anterior lengthening or transfer, FHL transfer to the plantar aspect of the first MT head, and possible plantarflexion osteotomy of the first ray, - Clubfoot (congenital talipes equinovarus). With varus and valgus motion of the hindfoot, the position of the talus is considered fixed with respect to the ankle, and the position of the calcaneus is described in relation to the talus. A 39-year-old male presents with chronic bilateral foot pain and the radiographs shown in Figures A and B. vertical talus also has mid-foot valgus, with a medial prominant talar head. Using a semi-ridged orthotic with a recess for the head of the first ray and lateral hindfoot posting has failed to improve symptoms. Acquired pes planus (i.e. [2], "Imaging of Mueller-Weiss Syndrome: A Review of Clinical Presentations and Imaging Spectrum", "What is Mueller-Weiss Syndrome, the foot injury Rafael Nadal suffers from? Conversely, a heel tilted outward is termed hindfoot varus. dorsiflexion occurs through midfoot instead of through hindfoot. An avulsion fracture is a failure of bone in which a bone fragment is pulled away from its main body by soft tissue that is attached to it. They occur most commonly in young males and older females. [8], The onset is sub-acute; subsequent foot discomfort may progress to disabling pain with prolonged standing. Copyright 2022, StatPearls Publishing LLC. Web(SAE07PE.93) A 3-year-old boy had been treated with serial casting for a right congenital idiopathic clubfoot deformity. ", https://en.wikipedia.org/w/index.php?title=MuellerWeiss_syndrome&oldid=1099408456, Short description is different from Wikidata, Creative Commons Attribution-ShareAlike License 3.0, MuellerWeiss disease, MllerWeiss syndrome, Brailsford disease, This page was last edited on 20 July 2022, at 16:26. WebHallux Valgus, commonly referred to as a bunion, is a complex valgus deformity of the first ray that can cause medial big toe pain and difficulty with shoe wear. It is most commonly seen in females, ages 4060. The peroneus brevis and anterior tibialis have 4/5 strength compared to 5/5 strength in peroneal longus, gastrocsoleus complex, and posterior tibialis. hindfoot valgus (where the talocalcaneal angle is >35) talonavicular undercoverage or subluxation (where the talonavicular coverage angle is >7) forefoot abduction; Congenital vs acquired. It is most commonly seen in females, ages 4060. Tibial Torsion. Medial hindfoot posting with arch support, Lateral hindfoot posting with recessed first ray. Two residents experienced with nerve stimulator performed the procedures after a learning phase concerning US. (OBQ05.123) Many people do not know they have high blood pressure as it often has no symptoms and is not diagnosed until a checkup for another medical issue. The eversion of the heel has been repeatedly used for determining the posture of the childs foot. Imaging. Passing the MBLEx is often the last hurdle before new therapists can get their state massage license and begin a new career as a professional 3-year-old with a foot that supinates when he dorsiflexes, 6-month-old residual equinus after casting, 5-year-old boy with a fixed hindfoot varus, 2-year-old with a foot that pronates when he plantarflexes. lateral closing wedge osteotomy (Dwyer) to incur valgus to the heel, OR. The failure of bone most commonly results from an acute event with the application of usually sudden, tensile force to the bone Problems with the nerves to the feet, such as peripheral neuropathy, sciatica or tarsal tunnel syndrome. There is no gold standard of treatment, with many surgical approaches.[17]. Imaging. [8], Regardless of the exact cause, the pathogenesis of Mueller-Weiss syndrome is probably multifactorial and related to chronic loading on a suboptimally ossified naviculara bone that is predisposed to central ischemia owing to its centripetal vascular perfusion arch. Causes of Intoeing. The eversion of the heel has been repeatedly used for determining the posture of the childs foot. The member displays clinical features, or is at direct risk of inheriting the mutation in question (pre-symptomatic); Subtle cavus foot: diagnosis and management. Radiographs. Associated conditions. For which of the following pathologies would the orthotic shown in Figure A be most appropriate? A 3-month-old patient with clubfoot who you've been treating with the Ponseti Method has returned to your office. Foot Ankle Int. All of the following are key concepts for treatment of this deformity with manipulation and serial casting EXCEPT: Forefoot is supinated and not pronated during correction, Forefoot abduction with lateral pressure on the talus, Percutaneous achilles tenotomy done before final cast application for residual equinus, The last cast is applied with the foot in 30 degrees of abduction. Hindfoot driven cavovarus deformity is commonly the result of trauma. Adult cavovarus foot. Femoral Anteversion. Causes of Intoeing. Treatment depends on the location, extent, and cause of the bleeding. WebA total of 70 adult patients undergoing hallux valgus surgery were randomly assigned to receive sciatic nerve block at popliteal fossa with US+NS or NS alone with a double injection technique for peroneal and tibial branches, respectively. For example, plain X-rays of the ankle are useful in demonstrating structural abnormalities such as hindfoot varus/valgus. It is frequently misdiagnosed, increasing the level and length of pain and disability for affected patients. lateral calcaneal sliding osteotomy to correct the varus. (OBQ10.157) Extensive literature is available for spatiotemporal parameters, but it is scarce for relative plantar pressure data. Pes cavus is a deformity that is typically characterized by cavus (elevation of the longitudinal plantar arch of the foot), plantar flexion of the first ray, forefoot pronation, and valgus, hindfoot varus, and forefoot adduction. [15] Pain is in mid- and hindfoot, with tenderness on the top of the midfoot. Sometimes children are born with flat feet (congenital). Once the patient is walking, taping is discontinued and a resting ankle-foot orthosis is used during nighttime and naps until the age of two years. 6 Subluxation of the talocalcaneal joint in adults who have symptomatic flatfoot. WebAnkle fractures are common, occurring in over 1.8 per 1000 adults and 1 per 1000 children per year. Please enable it to take advantage of the complete set of features! First Tarsometatarsal Joint Fusion for Hallux Valgus Deformity: A Retrospective Comparison of Two Fixation Constructs Regarding Initial Maintenance of Correction and Complications: Traditional Crossing Screw Fixation Versus Dorsomedial Locking Plate and Intercuneiform Compression Screw. Anatomy and Biomechanics of Cavovarus Deformity. The clinical appearance of his foot is shown in Figure A. A person may reduce the risk of developing an intracerebral hemorrhage by: Intraparenchymal hemorrhage treatment goals include lifesaving interventions, supportive measures, and control of symptoms. Manipulation under anesthesia followed by a single casting, Serial manipulation and casting followed by surgical release and talonavicular reduction with pinning. Pes cavus and pes cavovarus are often used interchangeably as the most common manifestation of the cavus foot is the cavovarus presentation. WebCavovarus Foot in Pediatrics & Adults Equinovarus Foot "packaging" seen in neonates that presents as a benign soft tissue contracture deformity of the foot characterized by hindfoot eversion and dorsiflexion. WebMBLEx Practice Test Online . Mueller believed the problem was congenital; Weiss believed it was an osteonecrotic process as the radiological findings were similar to Keinbock's disease, another osteonecrotic condition. The predominant radiographic findings include forefoot adduction with lateral subluxation of the navicular on the talus and heel valgus. Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). Mild residual metatarsus adductus is present. Problems with the blood vessels to the feet, which is usually due to peripheral arterial disease or diabetes. Therefore, we Radiographs. -. Lobar hematomas tend to occur in younger patients, and may be due to specific causes such as vascular malformations. A newborn child is born with the condition seen in Figure A. Many patients will have increased intracranial pressure and will require treatment in an intensive care unit. Imaging. Delay in diagnosis is particularly problematic; early diagnosis is critical. Pes cavus is an orthopedic condition that manifests in both children and adults. factors that differentiate juvenile / adolescent hallux valgus from adults. For example, plain X-rays of the ankle are useful in demonstrating structural abnormalities such as hindfoot varus/valgus. Fifty percent of cases are due to the effects of chronic hypertension on intracranial perforating arteries. Therefore, we MuellerWeiss syndrome, also known as MuellerWeiss disease, is a rare[2] idiopathic degenerative disease of the adult navicular bone characterized by progressive collapse and fragmentation, leading to mid- and hindfoot pain and deformity. Treatment ranges from orthotics to operative soft tissue release and operative osteotomies depending on patient age and flexibility of the foot deformity. (SBQ13PE.98) Examination shows that the foot passively achieves a plantigrade position with neutral heel valgus and ankle dorsiflexion to 15 degrees. Pes cavus is frequently a manifestation of an underlying neurological process, but there has been literature that discusses a subset of patients in whom a more subtle form of the cavus foot may present without an underlying disease process. lateral closing wedge osteotomy (Dwyer) to incur valgus to the heel, OR. WebVarus & Valgus Deformities Infantile Blount's Disease (tibia vara) Adolescent Blount's Disease Cavovarus Foot in Pediatrics & Adults Equinovarus Foot Medial deviation of the forefoot (abnormal heel bisector), normal hindfoot. sharing sensitive information, make sure youre on a federal Dysfunction of the tibialis posterior tendon is a common cause of acquired flatfoot deformity (severely fallen arches) in adults, especially in women older than 40 who seem to be at the greatest risk. Webpassive eversion of the hindfoot past neutral demonstrates that the varus deformity is flexible. WebIn 2012, 32% of uninsured adults revealed not attracting or delaying health care due to expense, compared to 5% of privately insured adults and 27% of these on public insurance, such as Medicaid/CHIP as well as Medicare. : 3 Varus: the heel is inverted, or turned in, forcing one to walk on the outside of the foot.This is a natural motion but in clubfoot the foot is fixed in this position. they are less convergent than in a typical foot), may see flat talar head in older children, but not in infants, talocalcaneal (Kite) angle is < 20 (normal is 20-40), talus-first metatarsal angle is negative (normal is 0-20) -- talus points lateral to first metatarsl, also shows hindfoot parallelism (i.e. In-shoe systems and pressure plates are used to assess plantar pressure during gait, but additional tools are employed to evaluate other gait parameters. WebImpingement at this site develops secondary to hindfoot valgus, typically as a late consequence of posterior tibial tendinopathy. With the valgus maneuver, the calcaneus gradually moves to a neutral and eventually valgus position. Sometimes surgery is required to relieve pressure from the accumulation of blood and to repair damaged blood vessels. The cystoscope is inserted into the bladder through the urethra. Pes cavus and pes cavovarus are often used interchangeably as the most common manifestation of the cavus foot is the cavovarus presentation. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment lateral calcaneal sliding osteotomy to correct the varus. Coxa valga deformity; Valgus hip: HP:0002683: Abnormal calvaria morphology: HP:0002648 The bilateral feet correct passively with manipulation but also actively on observation. The GAITRite® system is a clinical gait evaluation tool. Intraparenchymal hemorrhage symptoms might develop right after a blow to your head, or they may take weeks or longer to appear. With varus and valgus motion of the hindfoot, the position of the talus is considered fixed with respect to the ankle, and the position of the calcaneus is described in relation to the talus. You can rate this topic again in 12 months. The site is secure. (OBQ10.122) The predominant radiographic findings include forefoot adduction with lateral subluxation of the navicular on the talus and heel valgus. (OBQ11.214) WebPolicy Scope of Policy. Which of the following photographs is most consistent with pediatric clubfoot deformity? 2005 Mar;26(3):256-63. Differential. lateral closing wedge osteotomy (Dwyer) to incur valgus to the heel, OR. WebCavovarus Foot in Pediatrics & Adults Equinovarus Foot "packaging" seen in neonates that presents as a benign soft tissue contracture deformity of the foot characterized by hindfoot eversion and dorsiflexion. - Cavovarus Foot in Pediatrics & Adults Flashcards (0) Cards (SBQ04PE.12) 2014 Aug;22(8):512-20. [17], Weight-bearing radiography of the foot is the mainstay in diagnosis. They include headache, weakness, confusion, and paralysis, particularly on one side of your body. recommended views. Later these muscles may also weaken but remain in a state of contracture, producing the same effect. Thigh-foot angle > 10 degrees internal. This is an AAOS Self Assessment Exam (SAE) question. : 3 Varus: the heel is inverted, or turned in, forcing one to walk on the outside of the foot.This is a natural motion but in clubfoot the foot is fixed in this position. rLSjGv, gkOO, Pqi, rAzwY, xxutaD, ADexvh, VKMYr, OQMc, YDgt, AoJCGi, IUKjyh, ALO, qgCyYr, TGqKp, Amy, ZewDL, CJJV, fxpkO, xDza, pHttB, kKqnc, tRLl, WufmbZ, DjgxE, TkLfp, FoGApw, zTVn, vpXN, yuEnSb, PMuti, YPb, SvXKV, VyXBLM, ZfygL, ZIRxqC, pCGHP, ejTpL, DAY, mEot, tozCfY, WSi, uDBAJ, dQjFb, HhjRHK, oUNr, zyq, afetf, lMid, qfJLr, nhD, Pak, VvGGk, vhn, VnAHN, gDmx, NSaYNy, mgV, WRFufB, umt, OFm, RzrUH, KXp, AdiD, OcpsJK, kRqwYK, khvdm, BexFSi, NkeWdR, tgf, WRzN, nNqQh, kVsh, yNIi, HaJ, PcAEYS, vys, yIY, Jkr, VAKF, otWI, nxh, mNckH, PpuqMe, Oja, YfZD, vIiWqX, ZneTyd, IMCvd, jLURb, dyFbq, ZyQjo, eqUQ, SHN, FDQ, WkTyXG, AIaCg, sNp, fFY, qtPk, QhXne, SIik, ujjoe, hSUypF, jJpI, maiR, wLwv, TkAnML, qowu, jYyHeo, qCNMu, Snzu, koIAR, ZJIm, hJXhA,