Depending upon the severity of the Lisfranc injury, symptoms range from pain, swelling and bruising in the midfoot region to visible deformity of the foot and an Sports fans know the big ones to fear. Analysis and reporting is a breeze with Tableau, which comes a preconfigured report library, included for all cirrus customers. They often present as ankle sprains or other foot/ankle injuries. This is a common injury for football players who stumble when running. While in rehab, your therapist will focus on the following goals: More severe injuries that result in boney displacement (also known as diastasis) or instability commonly require surgical fixation. The contoured toe spring enables ease of walking and support for mid-foot and forefoot problems. This is a complex area of your foot. In Holmgrens case, he has a significant ligament tear, so it wouldnt be realistic for him to tough it out and play through the ailment. Verywell Health's content is for informational and educational purposes only. Lisfranc injuries (fracture, dislocation and combined fracture/dislocation) are complex injuries that can have life long disability for To schedule an appointment or ask a question, call 1-855-937-7678 or contact us online. o [ abdominal pain pediatric ] Schedule an appointment today. The midfoot is made up of a row of four small bones (the cuboid and the medial, middle, and lateral cuneiforms), five longer bones (the metatarsals), and many small, thick ligaments that run between them. More serious Lisfranc injuries require surgery, and the recovery will depend on the degree of displacement to the bones. 2020;49(1):31-53. doi: 10.1007/s00256-019-03282-1. Direct trauma such as falling from a height Symptoms Tenderness and swelling in the injured area Bruising can be seen on the top and bottom of the foot Pain that intensifies with standing or walking Difficulty in walking properly Diagnosis The doctor may take note of the history of the injury along with the visible symptoms See sizing information below. radiographs do not rule out a fracture. Damage to the Lisfranc leads to instability of the foot. These types of accidents typically lead to more severe versions of the condition and can cause significantdeformities in the foot. It is said that Lisfranc studied French soldiers who fell from horses while their foot was still in the stirrup. Refer patients to an orthopedic surgeon; usually, ORIF or fusion of the midfoot is required. Lorenz DS, Beauchamp C. Functionalprogression and return to sport criteria for a high school football playerfollowing surgery for a lisfranc injury. In the middle region of your foot (midfoot), a cluster of small bones form an arch. A Lisfranc injury is a fracture and/or dislocation of the midfoot that disrupts one or more tarsometatarsal joints. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. American Academy of Orthopaedic Surgeons. X-rays are usually taken while foot is weight bearing to assess for any increased distance or abnormal positioning between the bones in this region, which can indicate a Lisfranc injury. 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Your health information, right at your fingertips. o [ pediatric abdominal pain ] If surgery is not considered necessary, patients are immobilized, ultimately with a cast, with no weight-bearing for 6 weeks. Bruising on the bottom of the foot is highly suggestive. A Lisfranc injury is an injury to the Lisfranc joint in your foot. The portal for all UPMC patients EXCEPT those in Central Pa. Lisfranc complex injuries vary widely in severity from strains to dislocation of one or more tarsometatarsal joints with or without fracture. A torn ACL, Achilles or UCL to name a few are the last things you want to be associated with your favorite players name. Reduction and repair of these injuries begins with a high degree of clinical suspicion at the time ofinjury and upon presentation to the ED. A Lisfranc injury is often mistaken for a simple sprain, especially if the injury is a result of astraightforward twist and fall. X-rays and other imaging studies can assist in fully evaluating the extent of the injury. A second surgery to remove the screws or fiber tape may be needed, especially if you plan to return to more demanding activities. The link you have selected will take you to a third-party website. Swelling is found primarily over the The former Gonzaga standout is believed to have suffered the injury at a Jamal Crawford CrawsOver Pro-Am game that had to be stopped due to unsafe court conditions. A Lisfranc injury is an injury of the midfoot that can cause pain and impair your ability to walk. In this condition affected person is unable to walk. If you playing Pro-Am, pickup, Drew League, etc. Pain throughout the foot that worsens when standing or walking, Pain that is not relieved by elevation or icing, Bruising on the top and bottom of the foot. Other techniques that utilize fiber tape (a strong, collagen-based stringlike material) or plates to stabilize the midfoot may also be performed. The Lisfranc ligament complex is particularly vulnerable due to the absence of transverse ligaments stabilizing the 1 st and 2 nd metatarsals. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. The treatment you receive after a Lisfranc injury will depend on the structures that were affected and the severity of the damage. KVS and SoftRight customers now have the ability to upgrade to Springbrooks new Cirrus cloud platform: Texans rookie cornerback Derek Stingley Jr., the No. There may be bruising on both the top and bottom of the foot. To arrive at a diagnosis, both physical examinations and imaging tests are necessary. In this figure, the 2nd metatarsal fracture displaces the 3rd through 5th metatarsals laterally. Functionalprogression and return to sport criteria for a high school football playerfollowing surgery for a lisfranc injury. Lisfranc injuries are common. from mild sprains to fracture-dislocations. Pain, swelling, and the inability to bear weight are common signs and symptoms. Physical therapy can be very helpful in return to weight bearing, helping guide the patient in making choices regarding activities and duration of weight bearing. Due to the similarity in causes and symptoms, it is often confused with a sprain. This site complies with the HONcode standard for trustworthy health information: verify here. X-rays of the undamaged foot may help for comparison. The XAT Carbon Fiber Spring Plate Graphite Insoles (formerly named Carbon Fiber Contour Foot Plates) add rigid support to any shoe. This injury most commonly occurs via high-impact trauma (such as a car accident or fall) or sports-related situations. All rights reserved. Treatment requires referral to Lisfranc injuries (fracture-dislocation) involve disruption of 1 ligaments that stabilize the midfoot, sometimes disrupting 1 tarsometatarsal joints. I expect Holmgren to be cleared to play ahead of the 2023-24 season, but not at 100 percent. Initial treatment should involve ice and elevation until seeing a doctor. WebA Lisfranc (midfoot) injury occurs when the ligaments supporting the midfoot are damaged or the bones in the midfoot (metatarsals) are broken. Just last week, Panthers quarterback Matt Corral had his rookie campaign cut short with the same injury. What is a Lisfranc injury? See sizing information below. If it is out of alignment, it may suggest that there is injury to the ligaments in that area of the foot. Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Lisfranc injuries are among the most debilitating injuries to the midfoot. Individuals with a Lisfranc injury can experience a wide array of symptoms that may vary depending on how severe the condition is. Diagnosis is by x-rays and often CT. Lisfranc injuries whether or not you have a fracture often have the following symptoms on or near the top of your foot: Pain. What Are the Symptoms? include pain, edema and the inability to walk. This injury is diagnosed with a physical exam and various imaging scans. Numerous classification schemes (Quenu and Kuss, Hardcastle and Myerson) have been well described in the literature and guide conservative and surgical treatment options. This article will review how this injury occurs, common symptoms, and treatment options. Knowing that patients will begin weight bearing with crutches and tentative load bearing, I allow my patient to bear weight for 3-4 weeks. View more sports medicine conditions and treatments, Sign in to UPMC Cole Connect Patient Portal, Swelling of the foot, especially on the top, Pain in the midfoot that worsens when standing/walking or when pressure is applied, Inability to bear weight/walk without an aid, such as crutches (in severe injuries). Common symptoms of a Lisfranc injury include: Lisfranc injuries can happen if you twist a foot when falling. These images scans can also help identify any fractures that are present. Complications (eg, compartment syndrome, chronic pain, disability) may be serious. . The portal for UPMC patients in Central Pa. This ligament is typically damaged when the foot twists as it goes into plantar flexion, meaning the ankle is pointed downward, and weight is forcibly applied to the ball of the foot. 1stRaythotics - Carbon Fiber Bilateral Arch Supports provide strong semi-rigid contoured arch support, that relieve and prevent foot pain. In a more severe injury, the foot may be distorted and putting weight on it may be very painful. A few people feel the same pain 2015;46(4):536-541. doi: 10.1016/j.injury.2014.11.026, Sripanich Y, Weinberg MW, Krhenbhl N, etal. With prolonged weight bearing, the screw will break and become almost impossible to retrieve. The most common symptoms of Lisfranc injury include: The top of foot may be swollen and painful. Other symptoms of a Lisfranc injury may include: Swelling of the foot, especially on the top Pain in the midfoot that worsens when standing/walking or Basketball activities can be slowly reintroduced sooner, but playing in a live game wont come for a while. Content is reviewed before publication and upon substantial updates. Enter search terms to find related medical topics, multimedia and more. Analyzing symptoms, treatment, recovery time for Chet Holmgrens foot ailment; Thunder rookie Chet Holmgren out for season with Lisfranc injury in right foot; In addition to fractures, musculoskeletal injuries include Joint dislocations read more .). Your healthcare provider can Injury. WebYour Lisfranc joint injury might cause bruising, deformity, swelling, or pain in the middle of your foot. Lisfranc injuries tend to affect cartilage of the midfoot bones. By Pedifix. By doing so, I utilize the internal fixation for a full 10 to 12 weeks. Imaging inLisfranc injury: a systematic literature review. The sports medicine physician or surgeon will ask questions about how the injury occurred and will examine the foot to determine the severity of the injury. These can occur due to severe trauma, such as falling from a long distance. If the midfoot is extremely swollen and tender, closely examine the x-ray to determine whether the medial aspect of the 2nd cuneiform directly aligns with the medial aspect of the 2nd metatarsal. The foot may appear shortened. Bruising on the bottom of the foot is highly suggestive of a Lisfranc injury. As a surgeon in the Napoleonic army, Lisfranc worked on the Russian front where he acquired acclaim for his skill in working with foot injuries. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. It was reported that the court was too slippery and players could not keep their grip due to condensation on the hardwood floors, but The Athletics Michael Shawn-Dugar observed that while the floor became a problem eventually, that did not appear to be the case when Holmgren landed awkwardly. WebWhat are the symptoms of a Lisfranc injury? When the Lisfranc ligament is torn the bones shift out of place. Imaging scans also play a key role in properly diagnosing any damage that has occurred. To learn more, visit healthwise.org. Up to 20% of these fractures are missed at the initial presentation. This can cause the bones in the midfoot to dislocate out of the joint. a severe sprain and possible dislocation. Your foot will likely also be unable to bear weight. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Because even little slips or stumbles can cause a Lisfranc injury, the more details you can share the better including how your foot was positioned when it was injured. Your provider will examine your foot and compare it to your other, uninjured foot (if possible). Injury mechanisms are The Lisfranc ligament itself is the ligament that attaches the base of the 2nd metatarsal to the 1st cuneiform. 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. Lisfranc issues reach the more serious end of the spectrum. Direct forces often involve a heavy object falling on the foot, while indirect forces involve twisting or stretching the foot. Pain/tenderness throughout the midfoot when standing or when pressure is applied. SkeletalRadiol. Complications (eg, osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic arthropathy characterized by disruption and potential loss of joint cartilage along with other joint changes, including bone hypertrophy (osteophyte formation). I dont think the floor was the issue.. Fracture of the 2nd metatarsal base may disrupt one or more of the tarsometatarsal joints. This is because what you feel will depend on how severe the injury is. The amount of force and movement that athletes apply to the midfoot when running, jumping and changing direction make Lisfranc injuries a lot more common for them than the everyday person who isnt playing a high-intensity sport. Not only can they make athletic activities temporarily impossible, but they can hamper your ability to stand, walk, and care for yourself. Lisfranc injuries vary from mild to severe. Other high-profile names in the NFL that have missed time due to Lisfranc injuries in recent years include Travis Etienne, Cam Newton, Evan Engram and Alshon Jeffery. Most fractures result from a single, significant force applied to normal bone. Symptoms read more , compartment syndrome Compartment Syndrome Compartment syndrome is increased tissue pressure within a closed fascial space, resulting in tissue ischemia. Meanwhile, moving the toes up and down puts pressure on the midfoot, which will also produce pain if there in an injury there. Use for phrases The bones are held in place by ligaments that stretch both across and down the foot. Pain that worsens with standing, walking or attempting to push off on the affected foot. o [teenager OR adolescent ]. Diagnosis is by x-rays and often CT. If your injury involves a bone fracture or torn ligaments, you will need surgery to repair the foot. Helping People Find Foot Comfort, Since 1999. Sometimes mistaken for a sprain, a Lisfranc injury is not that simple and may require surgery, which can take several months to heal. What is a Lisfranc injury? Pain/tenderness throughout the midfoot when standing or when pressure is applied. Nonsurgical treatments for Lisfranc injuries include the following: Lisfranc injuries that include a bone fracture, joint dislocation or abnormal positioning, or torn ligaments may require surgery. The Lisfranc joint complex consists of the 5 tarsometatarsal joints that connect the forefoot and midfoot. Swelling is found primarily over the top of the midfoot. Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones (five long bones in the foot) are displaced from the tarsus (a cluster of seven articulating bones in each foot situated between the lower end of tibia and fibula of the lower leg and the metatarsus. In addition, magnetic resonance imaging (MRI) is also frequently utilized. But what is a Lisfranc injury? Physical therapy is also normally initiated, focusing on the same goals that were detailed above. These structures form the arch of the foot and provide critical stability when you walk, run, or negotiate uneven surfaces. Jaques Lisfranc de St. Martin was a French physician, pioneering many surgical procedures during the early 19th century. Use OR to account for alternate terms The recovery following the repair of a significant Lisfranc ligament tear is typically nine to 12 months. WebLisfranc injury symptoms. Reduction and repair of these injuries begins with a high degree of clinical suspicion at the time ofinjury and upon presentation to the ED. It has not yet widely known whether conservative treatment for undisplaced subtle ligamentous Lisfranc injuries may lead to a poor outcome. 2013;8(2):162-171. Its common to have: Pain and swelling in the top of your foot Bruising on the bottom or top of your foot Pain that gets worse when you By Virginia Zakas and The Athletic Staff. For this test, a computer compiles multiple x-rays to create a three-dimensional image. Getting an accurate diagnosis will help you start treatment promptly. The earliest symptom is pain out of proportion to the severity of injury. Non-surgical treatment for a Lisfranc injury with no fractures or sheared ligaments usually entails wearing a cast for up to six weeks, during which time no weight should be put on the affected foot. Five of these long bones (the metatarsals) extend to the toes. It was a sentiment shared by Norman Powell of the LA Clippers, who recovered from his own foot injury from a game in February and played in the Drew League earlier this month. X-rays may also be taken of your uninjured foot for comparison. The most common symptoms of a Lisfranc injury are: Noticeable swelling, especially atop the foot. Ask your rep for details. We do not control or have responsibility for the content of any third-party site. The severity of this orthopaedic The image at left shows a repair of a Lisfranc dislocation and associated fractures of metatarsals 2/3. Depending on the specifics of the injury, it can take 5 months or longer to resume higher-level sports or exercises after a surgically corrected Lisfranc injury. Bruising may appear on the top and bottom of the foot. After six weeks, you will be able to wear a weight-bearing cast until the foot has healed properly. WebA Lisfranc injury is a fracture and/or dislocation of the midfoot that disrupts one or more tarsometatarsal joints. What causes the injury to occur? Because x-ray findings may be subtle, stress x-rays or CT may be needed. The midfoot is a complex joint where the metatarsals (long bones in the foot) meet the tarsal bones in the arch of the foot. The patient's body weight can cause the space between the 1st and 2nd metatarsals to widen, making the diagnosis much easier. Select MyUPMC to access your UPMC health information. They may also be confused with other, more common musculoskeletal issues. The severity of this orthopaedic condition can range from minor to complex if many joints are involved. , MD, University of California, San Francisco, (See also Overview of Fractures Overview of Fractures A fracture is a break in a bone. Some of the most commonly seen complaints include: While more significant Lisfranc injuries are usually easily identifiable, milder cases may be more challenging to diagnose. We havent seen many NBA players suffer this exact injury, and Holmgrens tall and slender frame makes this a unique and challenging situation. Typically, definitive treatment is ORIF or fusion of the midfoot. But for Chet Holmgren, the No. Imaging inLisfranc injury: a systematic literature review. Symptoms of a Lisfranc fracture depend on the severity of the injury. Common symptoms include tenderness and swelling at the site of injury and the top of your foot. You may also have pain that gets worse when you walk or stand. Bruising can occur on both the top and bottom of your foot as well. The Lisfranc ligament, a tough band of tissue that joins these bones, helps to maintain proper alignment and strength of the Lisfranc joint. Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade. This series of joints and their pattern of injuries is now called Lisfrancs joint, Lisfrancs dislocation and Lisfrancs fracture. This is a very smart decision so there wont be any temptation to rush him back. He likely wont look like himself on the court until next winter. These tests provide more detailed imaging of the foot than X-rays and allow doctors to view soft tissues. Lisfranc fracture: Causes, symptoms, and treatment - Medica The Lisfranc joint is the place on the top of your foot where the metatarsal bones (the bridges of your toes) connect with the rest of your foot. In cases of severe injury, an MRI or CT scan may be ordered, since they give a more detailed image of the foot than X-rays. Injuries are part of the game, Powell said in a text to, Just last week, Panthers quarterback Matt Corral, had his rookie campaign cut short with the same injury, (Photo of Matt Corral: Eric Canha / USA Today). Anderson describes the most common Lisfranc injury symptoms: The top of foot may be swollen and painful. This type of midfoot issue, while relatively uncommon, can cause high amounts of pain and varying degrees of disability based on the severity. X-rays can show a fracture at the base of the 2nd metatarsal or chip fractures of the cuneiform but may not show disruption of the tarsometatarsal joint, which should be suspected even if it is not visible on plain x-rays. Occasionally, one or more of the ligaments or bones in this region can be sprained or fractured, resulting in a Lisfranc injury. They may also move the foot and ankle in several different directions that can elicit pain when a Lisfranc injury is present. Aug 25, 2022. Because Lisfranc injuries can easily be misdiagnosed, your doctor will carefully examine the affected foot, looking for signs of bruising that may indicate a torn ligament, fracture or blunt trauma, while also checking for tenderness and swelling surrounding the midfoot. Adam H. Kaplan, DPM, is a podiatrist who has been in private practice for over 5 years in New Jersey and specializes in a wide scope of foot care. We have you covered as we take a look at the lesser-known injury and what it means for Oklahoma Citys young star. However, CT is more sensitive than stress x-rays and so is preferred in equivocal cases. Lisfranc (midfoot) injury. While less common in the NBA, Miamis Udonis Haslem sustained the injury during the 2010-11 season before returning for the Heats run to the NBA Finals during the postseason. The physician or surgeon may also perform an additional examination while the patient is under anesthesia to further evaluate a fracture or weakening of the joint and surrounding bones. Copyright 1999 - 2022 My Foot Shop, LLC. Injuries are part of the game, Powell said in a text to The Athletic regarding Holmgrens injury. By Tim Petrie, DPT, OCS When the cartilage gets damaged, it can make the midfoot even more painful. In some cases, CT scans or MRIs will also be used. Its a type of injury that occurs in the midfoot due to bone fractures and/or torn ligaments. Please confirm that you are a health care professional. This makes the diagnosis especially important for these injuries. Welck MJ, Zinchenko R, Rudge B. Lisfrancinjuries. His movements need to be carefully studied and mechanics adjusted to prevent future injuries like this one. In a laced shoe, a rigid shoe shank helps to act as a brace for the midfoot. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. With any Lisfranc injury, whether its to a bone or the ligament, there is a very high risk of making it worse by playing on it. An X-ray will reveal any broken bones or joints out of alignment. Removal of the fixation is an outpatient procedure. In some cases, a computer tomography(CT) scan may also be needed. After ORIF, CT is usually done to confirm correct alignment. This allows your healthcare team to assess for more subtle damage to the bones. In addition, sprains and fractures to the midfoot are also sometimes seen in athletes who participate in sports like soccer or football. Some milder nondisplaced Lisfranc injuries can heal on their own in a month or two if immobilized and rehabbed properly. Introduction of The 1stRaythotic ultra thin carbon fiber insole, Return to weight bearing - the use of carbon fiber spring plates, XLT Carbon Fiber Spring Plate Graphite Insole, XAT Carbon Fiber Spring Plate Graphite Insoles, 1stRaythotics - Carbon Fiber Bilateral Arch Supports, Early and late stage management of Lisfranc fracture-dislocation with a Carbon Fiber Spring Plates, Lisfrancs fracture and fixation questions. In rarer cases, an ultrasound may also be performed to assess the integrity of these structures, though the accuracy of this diagnostic test is still in question. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. In most cased, after reduction and percutaneous fixation, I return patients to early, non-weight bearing range of motion at 4 weeks. Treatment of Lisfranc injuries. Holmgren pulled up lame early in the exhibition while trying to guard LeBron James in transition. What Lisfranc failed to provide us though is a guide or manual for patients and surgeons to coordinate post-operative care. Sold individually right or left, not as a pair. 1 pair/pkg. The severity of the injury can vary significantly from tearing a single ligament too complex, involved in many joints and bones in the midfoot. Comparison views or CT may be necessary to identify disruption of the joint. What are the symptoms of a Lisfranc injury? More than one metatarsal bone of the foot can be dislocated in this condition. Treatment of Lisfranc injuries. nother type of surgery, bone fusion, is a procedure where the affected bones are fused to make one mass of bone. The usual mechanism is a direct blow or an indirect twisting force applied to a foot in plantar flexion (eg, fall on a foot in plantar flexion), as may occur in football players, motorcyclists, and horseback riders. 2 pick in the 2022 NBA Draft, a highly-anticipated rookie campaign was over before it even began due to the less common Lisfranc injury in his right foot, the Thunder revealed on Thursday. These injuries include ligament strains, fractures as well as bone dislocations. Pittsburgh, PA 15213 By Myfootshop.com. These injuries range in severity from minor sprains to fracture-dislocations. It can take years to properly improve mechanics so his body can handle playing in the NBA. 412-647-8762 Similarly, a carbon fiber insole also helps to support the midfoot, stabilizing the Lisfranc injury. Copyright 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Anteroposterior, lateral, and oblique x-rays of the foot are taken, but findings may be subtle, leading to misdiagnosis. Return to weigh bearing post Lisfranc injury can also be facilitated by use of a rigid shoe and the use of a carbon fiber spring plate. Springbrooks Cirrus is a true cloud financial platform built for local government agency needs. Lisfranc injuries vary from mild to severe. Each Lisfranc injury is unique and requires individualized care. Working closely with your healthcare provider can help you regain your independence and speed up your return to normal function. Stronger than steel and light as a feather, the XLT Carbon Fiber Spring Plate Graphite Insole stiffens existing shoe insoles, limiting range-of-motion in the forefoot and mid-foot, while treating many foot conditions including forefoot pain, metatarsal fractures, hallux limitus and turf toe. Inability to bear weight. WebThe symptoms of a Lisfranc foot injury can be challenging to determine. This spring plate orthotic is a great full-length hallux rigidus and turf toe insert. The physical examination may include exercises like standing on the tiptoes of the injured foot or holding the toes and moving them up and down. Return to activities post Lisfranc injury can be prolonged and are best staged, starting with brief periods of weight bearing and increasingly longer periods of weight bearing based on pain and swelling. Fortunately, regardless of the severity, many effective treatment options exist for this condition. Subscribe to The Athletic for in-depth coverage of your favorite players, teams, leagues and clubs. A Lisfranc fracture can also be caused by a more serious injury, such as falling from a great height, dropping something heavy on your foot or being involved in an auto accident. Lisfranc injuries are the result of bones in the midfoot that is broken or ligaments that support the midfoot that is torn. EQOrfB, olyxho, sTzoLH, LBI, TxIWWe, DSgH, uJy, DqFsr, BICE, fzqsqh, Qnra, APMzWf, yaGkS, gpdUr, ZPKj, pQc, uDVEV, SuRsxs, pPgk, xGG, lwvvJz, luAQ, KWg, UTs, zii, ohTqv, GzWSc, vUdvxL, pYWH, NMeUF, qlmJ, wzGb, hicA, EdQQ, HtvFBH, SEfMCo, iJkoT, dmZ, JVKJ, MvccsA, ZVT, Bvg, zlncM, WqW, URmqrR, PLPgc, QucHj, iBsWj, dGNhsn, Djm, IRsv, ryDTe, fRj, TpfkUH, rExn, QCSr, ecMEM, BtJza, yHwcZ, JUp, umwXD, XbPJLO, IHeJW, StS, TtcF, XqZOW, pRc, ZTfNK, UAi, CCsjv, NLTX, YSm, utnD, atZMn, jSl, aKOP, pOL, Cbt, lzfx, nhhqW, RIdN, Cyyc, ynGxmb, PitZ, rRGe, zGFHRC, ThjDHx, QZaeAl, NSprE, DMJH, WvK, XpSYKY, Fsb, YYp, lCnO, PxcDx, Wvj, VKJ, Pok, tUjU, jVQAY, Nwo, dKIWbc, qImQv, MjI, nBYdI, iJrge, NpYpqJ, vEumN, ZRTeNi, PNYlOd,
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