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Kit Laughlin

Recommended Therapy for "Flat Feet"

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Kit Laughlin

Thanks Coach for the opportunity to offer a suggestion or two. Slizzardman's exercises sound excellent, as well.

We have had many students start our classes (stretching and strengthening) with 'flat feet' and most have had the form and function of the feet improved significantly. One young man had ankles that pronated so much that he had developed bunions (painfully enlarged joints of both big toes), and the big toes had deviated over 45 degrees away from the midline of the body. Now, three years later (using Five Fingers and a lot of kettlebell work), he now has perfect arches, the swelling and enlargement of the joints has diminished, and he has run two 10km fun runs on asphalt and concrete in his Five Fingers. His feet are perfectly aligned; his arches are developed and supple, and all his toes separate voluntarily.

An aside: most people who have been identified (or "diagnosed") with "flat feet" really have pronating ankles, and not the medial displacement of any of the bones of the feet (talus and navicular, usually that the term properly applies to). True flat feet are rare. When most people (and too many experts, IMHO) use the term, they mean pronating ankles: the whole leg has internally rotated in the hip joint; as this happens, the arch of any foot will flatten, and some collapse. Speaking generally, the pronated ankle is a lower energy configuration of the foot, and this is why exercising barefoot (or in FFs) on gravel or similar sharp surfaces has such a strong effect on foot placement: the body is doing all it can to unweight the sole of the foot—and creating the arch is part of what happens when the weight is spread from the inside border of the foot (pronation) to the whole of the foot (good alignment).

What follows is the first drill:

If you stand, and close your eyes, ask yourself 'where do I feel the weight going through my feet?' If you are like most people, most of the weight goes through the big toe side of the foot, and the heel.

Now, lift the toes off the floor, and deliberately put a bit more weight on the outside of the front of the foot, and look down at your feet: notice how the ankle and arch are better aligned? And notice how that realignment takes no muscular effort?

Now stand in front of a mirror and repeat the exercise (adding weight to the outside of the foot, and follow that with letting the foot roll in). If you watch, you will see that this is a whole-leg movement, mediated by the external rotators of the hip joint and the movement does not come from the foot itself. In fact, as you externally rotate your thighs, the weight moves to the outside of the foot, and the arch forms.

If you have pronating ankles, somewhere in the past, the body has made a choice about where to position the foot (on the internally–externally rotated axis); and the foot adapts to this. The main reasons for the body to make this positional choice (alignment of the femur in the hip joint) are two: tight hip flexors and insufficient stimulation of the soles of the feet during childhood and adolescence. All babies have flat feet; most adults have some pronation, especially under load; and if the pronation is controlled well by the body, it is part of the shock-absorbing mechanism we need for walking and running, as well as the critical mechanism for weight distribution.

So: step two is to stretch the hip flexors—not easy to do on your own. We recommend a partner exercise, to begin with:

(this is the Beginner's one)

and



And step three, last for today, is to do a foot-strengthening/hip–leg alignment exercise. All you need is bare feet and a set of stairs: put the ball of one foot on the edge of the step, place the other behind this leg, and hold a rail. Straighten the supporting leg's knee. Slowly let the heel move below the level of the stair tread (so, a soleus and gastrocnemius stretch). If your calf muscles are tight, then do small contractions with the calf muscles, and then press the heel lower as you relax and breathe. This is part one.

Part two is the strengthening–realigning part: this time as you lower, deliberately let the ankle pronate. Feel where the weight is going through your foot: all on the inside, and under the joint of the big toe. Now, as you press the ball of the foot into the tread to lift the body, transfer some weight to the the outside of the foot so that as you pass the neutral point (normal standing position for the foot and leg): now the ankle will be perfectly aligned, with weight evenly spread across the front of the foot. Pause. Then, as you rise, transfer slightly more weight to the outside (this activated the peroneal muscles strongly, in addition to the two calf muscles). At the top, plantar flexed, position, hold, and feel where the weight is: more will be on the outside than the inside (but don't exaggerate this); and press harder until the muscles spasm momentarily, then lower the heel to stretch that cramp out.

The suggestion to let the muscles cramp might sound a bit intense, but an involuntary cramp activates the largest numbers of the involved fibres in the activity, and the strengthening/realigning effect is maximised. You only need a few repetitions. Once you have done both legs, walk around on a surface that gives you feedback (I like gravel!); you will immediately feel that the feet are contacting the floor differently.

This is enough to go on with, and if there's interest, I will add some intrinsic foot muscle–toe spreading drills, too.

Regards

KL
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Cole Dano

First off Kit great post!

I totally agree with everything you put there. One thought i would add is the idea of simply lifting the inner ankle. In my early days as a yoga teacher i was told to externally rotate to correct the pronation and of course this does bring arch up. However in my case, as is the want of many young yoga students, i took this advice too far. I never engaged from the ankle itself, and this over time created a sort of 'stifled' overly linear gait where i didn't allow the natural rhythm of the hips to flow from internal to external rotation.

Bringing the ankle, toes, and foot pad sensitivity into the equation, while promoting a fluid range of hip movement will help avoid the condition i fell into.

I'm also a big believer in being barefoot and toe spreading and this is part of my classes from the beginner level up. I'd be most interested in your routine for the forefoot!

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heinrich

Great posts guys!

I thought I have to walk the earth on flat feet forever..

So exercising with Kettlebells while wearing Fife Fingers and the Drills you recommended will help? Any specific Kettlebell exercises?

Best,

Heinrich

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Cole Dano

Kettlebell wise the swing is very good, as having a good hip hinge goes along with getting the arch to rise.

One cue i like to use is as the hips hinge lift from inner ankle to inner knee, the arch should come as a result of that. Your big toe will feel rooted but just behind it light if any of that makes sense.

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heinrich

I'm sorry, but I don't get it :cry:

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Joshua Naterman

Spot on Kit! You may find that the loaded ankle inversion with dorsiflexion also helps a bit, because tibialis posterior attaches to the navicular and directly contributes to the support of the medial tarsal arch. This, in combination with the realignment work you describe, should dramatically increase the rate of correction.

The first drill you describe activates the tibialis posterior and direct strengthening work alongside the neuromuscular re-education should really help a lot!

Resisted toe curls should also help, as they should strengthen the intrinsic muscles of the foot (especially the big toe flexors) that are responsible for supporting much of the medial arch.

If I may offer one piece of criticism:

The strength and alignment exercise you mention is another great inversion exercise which is part of why it is helping directly with the feet, but the peroneals are not being significantly loaded. There is some eccentric loading to resist excess inversion, but the ankle inverters are doing the bulk of the work. If the peroneals were what was being strengthened here you would be training the body to move into a pronated position, as pronation and eversion happen together as do supination and inversion, particularly under load.

Sorry if I'm being nit-picky, but you know what you are doing and I would hate for someone to write it off as worthless simply because the muscles being worked were mis-labeled.

I would LOVE to know the foot spreading drills, I don't know how to train that at all and it is driving me CRAZY! One foot can do it and the other is just not getting it. I can pick stuff up and drop it no problem, but I can't make my toes spread out with my right foot at all and it's a huge struggle with my left.

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Kit Laughlin

Slizzardman, thanks for that correction; my anatomy's a bit hazy in that area.

Re. other drills: We have a whole sequence of toe spreading (using the opposite shoulder's hand to interlace with the foot in question, from underneath). Start with the little toe, and interlace the little finger, then repeat for the fourth toe, and so on. Once interlaced, push the hand as deeply in between the toes as you can, so that the thickest part of the fingers are spreading the toes apart (the calluses of the hands abut the ball of the foot). If you can't separate your toes at will, this drill with get them going!

I will try to find if we have video of this sequence, and if we do, I will upload to YT and post here. If not, I will copy the relevant section from Stretching & Flexibility, the book that describes 16 class plans in our system.

Awakening awareness in the soles of the feet, and becoming aware of how one uses one's feet is the key. Even when standing around, ask yourself: "where's the weight on my feet right now?". This sounds absurdly simple, but the fact is that for most people these days their awareness resides mostly in the head, and they are suffering a kind of 'sensory motor amnesia' in the feet, and excessively pronating ankles is one effect. This can be changed quite quickly by bringing awareness to the feet—the drills described do this very efficiently.

Re. kettlebells: for this purpose, the swing is the only movement you need to master, IMHO. As well, the young man I described in the first post is now our KB teacher in the group. It is essential, if you want the effects he experienced, to do your KB work in bare feet, and pay attention to how the body is using the feet, and to the alignment of the knees throughout the movement—do not let the knees come inwards (because pronation follows this like night follows day!). Cole's suggestion is an excellent one to help correct this tendency.

More later

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Kit Laughlin

slizzardman, can you advise which muscles I should have named, and I will do a bit of study and correct the post!

Cheers and thanks, KL

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Joshua Naterman
slizzardman, can you advise which muscles I should have named, and I will do a bit of study and correct the post!

Cheers and thanks, KL

I don't think there was anything besides mentioning the peroneals. That should be tibialis posterior. It originates from the posterior aspect of the medial tibia and inserts on the navicular and directly supports the arch, and the way you describe performing the calf raise moving from pronation to supination (slightly) will definitely be activating and strengthening that muscle. I hate describing things with such clinical language but I suppose right now that's the best way to do it. If you read about the functions of the peroneals and tibialis posterior I think you will see what I mean.

Of course the intrinsic foot muscles will also be activated but I'm pretty sure you already mentioned that. I have been doing something similar when I stand and when I run, I sort of imagine the attachment on the navicular running up to my shin and tightening and have noticed an improvement with that. Sort of the same idea as what you describe when you talk about being aware of where the weight is on your feet throughout the day, that's how I started. Over time I started doing it while I was running as well, and it works. That drill of yours is really smart, I like it a lot.

Thank you so much for sharing! I am going to start playing with the toe-spreading drill you describe. Again, very smart. Should have been obvious but it was not! I was thinking of using the toe spreaders from salons but I like the idea of using my own hands. Well, as long as I wash my feet first :)

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Kit Laughlin

tibialis posterior; of course.

Now: adding to the foot drill: before you begin, stand and look down at your feet—and try to spread your toes. You want both feet to be able to spread all toes, especially the little one. Sometimes parts of the body do not follow orders... so you might have to use a little persuasion.

Assume you are sitting cross-legged, with the foot being worked on sitting on the thigh of the other leg (this exercise can be done on a chair, too). Once you do the toe separation using the fingers from underneath, squeeze the finger together to trap the toes, and gently drive the heel of the palm into the ball of the foot: in addition to stretching the instep, this will traction the toes, too. Then, using the non-involved hand to hold the heel, twist the forefoot in one direction (so that the sole is facing the ceiling; then the other direction (so the top of the forefoot is facing the ceiling); this gently "wrings' the forefoot and toes.

Now remove your fingers and place the heel of the same foot on the floor in front of you. Start with the little and fourth toes. Push the little toe away while pulling the fourth toe to you—feel the fascia stretch (like a tiny burning sensation)? Now do the opposite: pull the little toe towards you and press the fourth toe away. There is no way the brain can spread the toes if the proprioceptors in the fascia and skin of the foot are telling it the end point of all known movement has been reached—this mis-mapping is what we are changing in this exercise, as you will see. Continue with the rest of the toes.

Without images, this next part might be a bit hard to visualize. Put the working foot back on the thigh of the other leg, and (describing the left foot here), grasp the ball of the left foot with a pinch grip, so that the L thumb is under the ball (the main joint of the big toe). Fingers will be on the forefoot; thumb under the joint. Now reach the right hand under the L foot, so that its fingers go on top of the fingers of the L hand, and its thumb on top of the L hand's thumb. Grasp the foot firmly in both hands, and slowly turn the forefoot up to the ceiling: if you have ever sprained your ankle, you will feel this stretch on the outside of the forefoot and the ankle. If movement is reduced, hold the end position very firmly, and try to twist the foot back against the resistance of your grip (but do not let the foot move) for a few seconds; relax (again, don't move) then take a breath in. On a breath out, slowly turn the foot further in the ceiling-facing direction. See how it goes further? Finish this part of the sequence by letting go of the foot and wriggling the toes, and re-grasp it, and turn the opposite direction this time, and repeat all directions.

That's enough for today; cheers to all, KL

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Larry Roseman

Although I dont have chronic flat feet, my left foot does partially flatten when I squat

due to ankle pronation.

This appears also to be an approach that addresses that type of flattening as well as

possibly more chronic flat feet, and I'm wondering your opinions on it.

http://www.easyvigour.net.nz/casestudy/ ... onitis.htm

I do experience the post-tib pain in the left lower-leg referred to, after running half an hour.

Would the above treatments described by kit and slizzardman address the post tib issues

that this targtes, or is this more specific?

Thanks much,

FIN

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Kit Laughlin

@ Futureisow: that's a decent analysis, IMHO.

For squatting, though, we recommend a band or a strap around the knees, and set at a length that is consistent with your foot placement and foot angle (we want the knees to move forwards over the forefoot), and squatting in front of a mirror. You then deliberately lightly press the outside of your L knee against the band/strap, and keep it lightly pressed there—like magic, the foot will not pronate.

Take care to maintain this light pressure when you ascend from the bottom position: this medial knee movement happens because of insufficient external hip rotation (to counteract the medial knee movement caused by the adductors); pressing the knee against the strap and watching the knee and not letting it move medially will re-pattern this quickly. Not everyone realises this, but the adductors are recruited by the brain as hip extensors in the full squat (their action includes extension after 90 degrees flexion at the hip joint).

One more thing (getting back to drills for the feet): pointing the toes hard in all the prep. exercises (scoop, arch, rocks, fish, etc.) all will help the foot to attain a beautiful arch. In dance studios it is a common saying that many dancers begin their careers with flat feet, but none end them that way. It's all about paying attention to what the feet are doing, at all times. Pliés, for example, provide that opportunity on a daily basis for dancers.

I will be videoing some of these drills over the next two weeks, including one on how to improve foot point.

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Joshua Naterman
Although I dont have chronic flat feet, my left foot does partially flatten when I squat

due to ankle pronation.

This appears also to be an approach that addresses that type of flattening as well as

possibly more chronic flat feet, and I'm wondering your opinions on it.

http://www.easyvigour.net.nz/casestudy/ ... onitis.htm

I do experience the post-tib pain in the left lower-leg referred to, after running half an hour.

Would the above treatments described by kit and slizzardman address the post tib issues

that this targtes, or is this more specific?

Thanks much,

FIN

Yes. Kit's drill on the step and my suggestion of loaded inversion + dorsiflexion will fix that in a hurry. Training the posterior tibialis is actually the only 100% sure way to fix that, and it happens fairly quickly.

Kit is totally on point with what he is saying about the bands at the knee, that is such a fantastic drill for re-patterning that I don't know why it isn't recommended on every fitness website.

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Adam Bodestyne

This thread is gold; thanks for all the information here, Kit, slizzardman, Cole.

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Larry Roseman
This thread is gold; thanks for all the information here, Kit, slizzardman, Cole.

Likewise, thanks much for the additional information. Much appreciated :)

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Kit Laughlin

@ Cole, who wrote:

Bringing the ankle, toes, and foot pad sensitivity into the equation, while promoting a fluid range of hip movement will help avoid the condition i fell into.

I only read your post now, for some reason; this is excellent. What you call foot pad sensitivity is the key to all this. There has been an explosion in the research into fascia—you know, that stuff that (until about 15 years ago) medicine regarded as "inert ground substance". Well, nothing could be further form the truth—in fact, fascia is more innervated with proprioceptors and mechanoreceptors than any other tissue in the body AND it is innervated with 'type-C nociceptive' structures, as well. What a major revision!

The point is the latest research (personal communication from Dr Robert Schleip) is that the superficial fascial sleeve is the 'fine tuner' of the body's sense of mechanical force application, in addition to all the other neural structures involved. I mention all this because its degree of activity in the body depends crucially on the extent of its exposure: if you wear shoes most of the time, this hugely important sense organ is literally insulated from the environment that 'feeds' it.

So the toe spreading drills you do in bare feet in your yoga classes are essential—as much from an awareness-direction sense as the actions themselves. As I mentioned in the first post, it's the combination of the 'insulation' and tight hip flexors that is the deep cause of pronating ankles in our culture. More later.

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Joshua Naterman

You know, I think the single best aspect of this forum is that we have so many people from different areas of expertise coming together to collaborate on threads like this instead of just arguing our personal viewpoints. What a great community!

This is truly an excellent thread, thank you Kit and Cole for sharing what you have discovered and put together!

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Cole Dano

Slizz i think the same.

-----------

Shoes are at least part of the problem, i think more than the padding and the heel lift is the fact that there are very few shoes out there that allow the forefoot room to fully widen.

Having gotten used to 'listening' to my feet from being barefoot most of the day and wearing thin soled shoes in summer going back to some more padded shoes as the seasons change is not a big deal. Sure i can't feel the ground but i can still feel how i'm standing. The problem is that the soles of the feet have forgotten how to listen, to use somewhat poetic language.

The whole issue that Kitt brought up is really a fascinating one as it relates to not just the feet but the entire chain from pelvis, hips, knees, ankles, feet. The whole system has to work as a team in order to function properly. This requires quite a lot of brain work in fact, as Coach brought out in a recent post of his.

The brain get it's feedback from the proprioception, tuning into the sensations that movement produces, the feeling in the skin, is far more important than many realize. It's not just about muscles and bones, but the control center we want to work on.

-------------

Yesterday i had a group where not a single person was able to spread their toes, we spent a good deal of time doing some simple footwork and then integrating that into the rest of the class.

The result was someone came up to me after class and said 'i like the exercises you did but what other class at your studio can i go to?' (Followed by me making a mental facepalm) People don't really get this stuff at least not before they are having problems.

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Joshua Naterman

:shock: :? :cry: ... Yea, what can you do... :roll:

:mrgreen:

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David Beckerman

I am looking forward to trying these exercises as I too have the "flat feet" problem. This problem seems to give me very tired and sore calves as well as cause me to have medial knee issues. I can already feel the difference when just using the proper position under tension!!!!

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Matt R

Is there anyway that someone can put these exercises up on YouTube? Some of the anatomical terms are really throwing me off and dictionary.com is not helping.

My right foot is always overly extended to the outside. I used to suffer from a lot of knee joint pain but I thought that it was normal for the high frequency of squatting that I was doing. I saw a sports doctor not long ago and he told me that it is because my knees are uneven--they cave in and are diagonal. He said that it was due to a muscle imbalance and recommended that I do some tubing exercises; its been over a month now and instead of getting better I recently got tendonitis in my right ankle which I believe is related to this imbalance.

Edit: Whoa, the fingers in between the toes stretch is highly therapeutic!

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Cole Dano

If you tend to walk to the outside of the foot, over supinated, it's the opposite end of the same problem, but i find that some of exercises work for both problems. As these problems often involve a hip that doesn't properly rotate in joint with each step or squat. The hip joint will slightly internally and externally rotate, along with the lower leg and ankle, sometimes this gets 'stuck' on externally rotated all the time which can lead to problems.

Of course at least for me, it's the kind of thing i need to work with in person to make sure the idea is coming across. So with that risk in mind here is a simple exercise to help train the correct movement pattern.

You will need a yoga block or folded towel, and support you can hold onto while you squat, door jam or handle squat cage, etc, i use a pair of yoga straps.

Pt. 1

First stand a place the block between your legs all the way up at the groin. As you stand lightly squeeze the block and just using your legs, try to move it somewhat backwards and forwards. Notice what happens at the ankles and feet and try to keep the feet flat on the floor at all times.

Pt. 2

Holding the straps, squat down and feel as if you are moving the block backwards from your groin, it will make it feel as if you are stretching your buttocks. At the same time be very conscious of keeping your feet flat on the floor.

At first do a few slow single reps to work on the movement pattern then sets of 10 or so. Eventually you will do this without any external support and even loaded, but to develop the the hip to ankle movement pattern the support is very helpful.

If this doesn't make any sense i can try to make a quick video if you think it will help. There is no doubt that good full depth squatting is one of the best things of the ankles, knees and hips.

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Joshua Naterman
Is there anyway that someone can put these exercises up on YouTube? Some of the anatomical terms are really throwing me off and dictionary.com is not helping.

My right foot is always overly extended to the outside. I used to suffer from a lot of knee joint pain but I thought that it was normal for the high frequency of squatting that I was doing. I saw a sports doctor not long ago and he told me that it is because my knees are uneven--they cave in and are diagonal. He said that it was due to a muscle imbalance and recommended that I do some tubing exercises; its been over a month now and instead of getting better I recently got tendonitis in my right ankle which I believe is related to this imbalance.

Edit: Whoa, the fingers in between the toes stretch is highly therapeutic!

There should be no pain from squatting at all unless it is DOMS, regardless of frequency.

Did you try the exercises he said?

If you have had knock knees for a while, the MCL and capsular ligament are definitely stretched out and may take quite a while to shorten. Like more than a year, if at all. That will require getting the muscles to pull the knee into the correct position.

Have you been scanned for signs of osteoarthritis?

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TobiasValbjoern

This may seem like a silly question, but I do not really know how to walk properly. What is the correct sequence from when your foot first touch the ground to you lift it again? Where are you ought to feel the pressure?

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Beldor

I have "flat feet" the pronated arch type. These recommendations are great all around. I fully intend on doing this training and documenting my discoveries. Thanks Kit!

WARNING

If you have Morton's Foot Syndrome or have pronated arch "flat feet" and have not been diagnosed by a podiatrist. Minimize weight bearing bare foot work and listen to your body! You can easily end up with Cuboid syndrome, peroneal tendinitis, and stress fractures among other injuries if you go too far too fast with barefoot / five finger work. Especially avoid bare foot running until you have developed the proper supporting strength in the tibialis posterior and peroneal muscles!

Morton's Foot Syndrome:

If caused in early stages of life you could end up with what is called Morton's Foot Syndrome which is a development issue where in the 1st Metatarcel shortens to offer more weight bearing support on the 2nd and sometimes 3rd metatarcel. In some cases the bones can begin to calcify and form bunions and bone spurs. The entire development affects the entire kinetic chain including the hip flexors as Kit described, and can affect spinal alignment (scoliosis) as well as forward head placement. It can be very tricky to correct. Currently podiatrists that I have been to (3-4 in the North East) recommend doing a variety of exercises and suggest having prescription orthotics for correction. And even then- they suggest the problem will only heal 25% in my lifetime. (Thus my interest in utilizing Kit's methods).

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