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My Excellent Toe Surgery Adventure - Hallux Rigidus, Plate/Screw Fusion, and Osteotomy - Page 53

post #1561 of 1606
I just discovered this site, 3 weeks after my fusion for hallux rigidus of my right foot. Can't drive, and I'm sick of TV so I was surfing the web.
I am struck at the variety of experiences. I chose an orthopedist who does only foot/ankle rather than a podiatrist, mainly because I knew of his work. He said doing this surgery is his favorite as the outcome is generally so good and permanent. That was reassuring.
I had both general anesthesia and a nerve block. Personally, I could have done within the nerve block. I'm sure many will disagree. But I have been amazed at how little pain I have had. I have a full bottle of Percocets I never used. I'm not sure why my experience is different. My untreated rigidus hurt as much so maybe I'm used to it. My nerve block lasted over 2 days. Not only did it anesthetize the foot, but of course paralyzed it and I had no proprioception. That is, I didn't know what position my foot was in unless I was looking at it. This made non-weight bearing crutch use nearly impossible for me, as I almost put full weight on my twisted-inward, paralyzed foot! I had a borrowed wheelchair I used for 2 days until the block wore off.
On Amazon, I spent $7 for a box of 2 cast covers. One lasted me until I could get my foot wet. It is a Curad brand and kept my foot totally dry.
I was sent home with just gauze on the wound and a tight Ace wrap. I had a little velcro shoe as well. I saw the PA 3 weeks later. No XRay, just removed the stinking Ace wrap. A happy day, if you can imagine an unbathed foot for 3 weeks. I never had a cast. Never had any swelling and minimal pain. All my sutures were subcutaneous and resorbable so no stitches to remove. I have steri strips which are now falling off.
My wound is on the side of my foot, not the top. I now have a walking boot which is very comfortable but can be heavy and warm.
Of course my big toe cannot flex or extend, but it really couldn't before as the joint was destroyed by the arthritis.
There are a few posts some people have written that concern me. One poster refers people to her blog on another site. She uses the words nsaids and acetaminophen interchangeably. The max dose of acetaminophen is 4000 mg/day, less if you drink or other medical issues. Above this can cause severe liver damage. Tylenol is a brand of acetaminophen. Acetaminophen is also in Percocet, Vicodin, Ultracet and others, so carefully keep track of how much you are ingesting.
Nsaids are totally different. Ibuprofin is generic for motrin and Advil. Naproxen is generic for Aleve and Naprosyn. Nsaids are actual anti-inflammatories and analgesics. Acetaminophen has no anti-inflammatory action, it is only a mild pain reliever. Anyway, be careful mixing Percocet and Tylenol so you don't exceed a safe dose.
Some doctors prefer you not use nsaids as you need inflammation for your hardware to fuse to your bone. I tried to research this and the data is weak, so ask your doctor. I am using ibuprofen sparingly "just in case."
Many of you are looking forward to running and skiing but right now I can't wait to drive. The PA told me to try wearing a regular shoe for an hour or two a day, and once I'm in a shoe and on no pain killers, I can try driving in a parking lot. Seeing as how I have not even had a follow- up Xray yet, I think that is pushing it.
post #1562 of 1606

@footman : I am going to go back and check my post as I may have gotten ibuprofen and acetaminophen mixed up--not good. I read and was told by my doctor to not take drugs like  Aleve and Advil (which are NSAIDS and contain ibuprofen) because they inhibit bone growth. I was told that acetaminophen (such as Tylenol) are fine.

post #1563 of 1606
Quote:
Originally Posted by Crumpcake View Post
 

I had a cheilectomy 9 months ago.  I am in more pain now than I was before the surgery, espcecially under the ball of my foot which never hurt before the surgery.  I have had a cortizone shot(did nothing) and an MRI a month ago which I guess lit up like a pinball machine.

 

My ortho thought my sesamoids looked fine and so he sent me to another ortho in his office.  He told me arthristis was bone on bone and I needed a fusion, as well as both sesamoids removed.  Yikes!  This is scary to me.  Has anyone else had this done?  Right now I walk in a boot as it is too painful stepping on the ball of my foot.  I am in little to no pain when not walking and it doesn't hurt to bend my toe.

 

Has anyone had a sesamoidectomy with a big toe fusion?

 

Many thanks for this forum!

 

My sesamoids are arthritic and were extremely painful before my fusion, and my doctor told me once I had the fusion, they would feel better since there wouldn't be movement in there anymore. Well, he was right. It was much better. Although ... they have been a little tender while hiking the past few months. I might need new orthotics, it could be a cushioning thing. 

 

I have a friend who had a sesamoidectomy but no fusion, and it was a tough recovery (scar is on bottom of foot rather than top), but she's fine now. Avid tennis player. 

 

Anyway, I would probably ask a lot of doctors about this. In one way, it seems like it would be ok to just get it all when they are in there; on the other hand, my experience was that the sesamoids felt better after the fusion, so why do too much?  

post #1564 of 1606

Another approach is to fuse the sesamoids to the first metatarsal. Movement of an arthritic joint is what produces pain, so the idea is that no movement = no pain. 

post #1565 of 1606
I have a question for anyone who feels "fully recovered " from first toe fusion.
I had mine on the right foot just over a month ago. I am not particularly athletic but I like to be active and spend at least an hour a day on the Lifecycle. Since I can't drive and because of the surgery itself, I have been very inactive. No PT was prescribed for me.
Since I have almost no pain in my forefoot and very little swelling, I switched from the walking boot to a regular shoe yesterday. I am wearing a "Sanuk" which is an ugly but comfortable canvas man's shoe. It has no arch support.
I did maybe 1-2 miles of walking yesterday. Again, no real forefoot pain but I notice my right foot is weaker than the left in terms of lift off while walking, and my right calf is sore, as though I had walked 30 miles. My left leg has been just as inactive and is normal.
I am now doing stretching of my foot to stretch the gastrocnemius. I notice when trying to lift my body up by standing on "tippy-toe" my right foot can barely lift myself up.
The logical explanation to me is that since I no longer have a right first MTP joint, the muscles to that toe are no longer contributing to being able to stand tippy-toe. So I guess with time, my foot and leg will adapt.
One concern I have is the nerve block I had to the right foot. The anesthesiologist injected my in my posterior calf. But even if there was any damage to a peripheral nerve from that, it should eventually regenerate.
I don't see my doctor for another 3 weeks. Maybe I am pushing things by being in a street shoe after only 5 weeks, but I really have no pain around the forefoot and the PA said I could progress based on comfort, and I could even drive if on no pain pills and in a street shoe. I am electing not to drive just yet due to this sense of weakness.
Did other people experience weakness of the calf with normal walking post-surgery? How long until this normalized? What exercises, if any, did you find helpful?
post #1566 of 1606


Hi @footman: I was just released to wear shoes today -- at about 11 weeks. When I got my cast off at 6 weeks, my calf had definitely shrunk, but just walking around on it in my post-op shoe seemed to help strengthen it. I was surprised that my foot would fit in my tennis shoes when I was OK'd to drive about 3 weeks ago (based on other people's experience on this thread), and that's still the only shoe that will fit. I have been doing PT though, and a lot of it has focused on strengthening the core and hips so they bear more of the weight so that the ankles and feet bear less. In the process of recovery, I've had to do a lot of calf stretching, but the strengthening hasn't been focused there -- more on the ankle and the thighs/hips. 

 

Have you had an x-ray yet that shows the bone is solid?

post #1567 of 1606
@segbrown thanks for your reply. I agree, sounds like too much to remove sesamoids, too. I have made apps with two other orthos to get second opinions. Very scared to even have a fusion with the failure of my last surgery(cheilectomy).

But my quality of life is being compromised. In the morning, pain is manageable, but by midday I am limping, hip is hurting. And that is with no major activity, just normal walking.

The weird thing is I have great flexibility of the big toe now. I can flex it, pick things up with it. It only hurts with full weight bearing. And my surgeon said although my joint space was narrow, it wasn't bone on bone. Most pain on ball of foot at push off and some pain in joint then, too.

It is encouraging to see on this forum that there have been numerous positive outcomes for a fusion if I need to go that route, because it totally freaks me out. I am wondering if nerve damage or scar tissue could be my problem as it does start to burn when I walk, up to the tip of my toe.

Thanks!
post #1568 of 1606
Quote:
Originally Posted by footman View Post

I have a question for anyone who feels "fully recovered " from first toe fusion.
I had mine on the right foot just over a month ago. I am not particularly athletic but I like to be active and spend at least an hour a day on the Lifecycle. Since I can't drive and because of the surgery itself, I have been very inactive. No PT was prescribed for me.
Since I have almost no pain in my forefoot and very little swelling, I switched from the walking boot to a regular shoe yesterday. I am wearing a "Sanuk" which is an ugly but comfortable canvas man's shoe. It has no arch support.
I did maybe 1-2 miles of walking yesterday. Again, no real forefoot pain but I notice my right foot is weaker than the left in terms of lift off while walking, and my right calf is sore, as though I had walked 30 miles. My left leg has been just as inactive and is normal.
I am now doing stretching of my foot to stretch the gastrocnemius. I notice when trying to lift my body up by standing on "tippy-toe" my right foot can barely lift myself up.
The logical explanation to me is that since I no longer have a right first MTP joint, the muscles to that toe are no longer contributing to being able to stand tippy-toe. So I guess with time, my foot and leg will adapt.
One concern I have is the nerve block I had to the right foot. The anesthesiologist injected my in my posterior calf. But even if there was any damage to a peripheral nerve from that, it should eventually regenerate.
I don't see my doctor for another 3 weeks. Maybe I am pushing things by being in a street shoe after only 5 weeks, but I really have no pain around the forefoot and the PA said I could progress based on comfort, and I could even drive if on no pain pills and in a street shoe. I am electing not to drive just yet due to this sense of weakness.
Did other people experience weakness of the calf with normal walking post-surgery? How long until this normalized? What exercises, if any, did you find helpful?

Hi Footman - Welcome to this forum. I waited to reply to your inquiry as I wanted to check my journal so my info was accurate. First, I had hallux rigidus in both great toes for years. I am a very active retiree - 60'ish - play golf, long walks daily, cardio and yoga classes, bicycling, etc. When the pain got to be too much I got two medical opinions- both agreed I was bone on bone in both joints. I decided to have the left foot done first as it was a little more painful than the right. Surgery was December 2015 at which time I had a cortisone shot in the right joint. So I'm 9 months post-op almost to the day. My surgical experience was very similar to yours. The incision is on the side, one screw. My foot was bandaged heavily and ace wrapped. I also had an ankle block and was sedated. I walked out of the surgery center in a surgical shoe on the heel. Unfortunately, the nerve block wore off before my husband could get back with pain pills so I was in terrible pain for the first 24 hours. I also bled a lot and had to have a bandage change after a couple of days. The pain improved tremendously by the 4th day. I had a one week checkup, X-rays at 2 weeks, 8 weeks, and 16 weeks. My bones fused very well. I stayed in the surgical shoe for 8 weeks total, heel walking for 6 of those weeks. I had a lot of odd pains in the ankle, calf, hip, low back, and knee. When I overdid it at about week 4, I had shin splints so bad for 3 days I could barely walk!

I did not have PT either. My doctor was very adamant about no standing exercises or anything involving my feet for at least 8 weeks. I found that I could do mat Pilates and seated Yoga poses, also lifted weights while sitting. I was constantly stretching and flexing my legs and ankles. When it was not painful to do so, I did leg work laying on the floor (there are lots of good You Tube videos - look for "non weight bearing exercises").

The recovery process was smooth, and quite rapid in the first few months, then tended to taper off and become more incremental. At my release at 3 months, the doctor cautioned me not to be disappointed if I experience a set back as I increase my activities and that full recovery takes one year.

Fast forward to now ... The repaired toe does not hurt with activity but does swell a little still (I just walked a brisk 3.5 miles and can feel it's a bit swollen). I try to give it a break throughout the day. Shoes are still an issue for me because my screw is protruding. For that reason I wear sandals a lot and put a pad over it when I wear closed toe leather shoes. I'll have it removed when I have the right toe fusion done in November.

Sounds like you're having a very good recovery and experiencing normal aches and pains associated with walking differently. The only remaining problem I notice on the fused toe is walking barefoot or in shoes with minimal support causes a tingling at the tip of the toe - I'm told this sensation is due to the nerves continuing to heal. So be patient- it's very hard but I see now that it's truly a one year process. Best wishes!
post #1569 of 1606
@footman
I would go easy , mostly everyone on here have all been strictly none weight bearing for 6-8 weeks minimum . You may be feeling good but you could be impacting your recovery .....personally I was 6 weeks in a surgical shoe . I would say it took a good 6-8 months for all the swelling to subside. Next week I'll be 2 years post op, still having pain iand discomfort and actually had the hardware removed in June it didn't really help so . You sound like your progressing well and maybe ahead of the game good luck with the rest of your recovery.
post #1570 of 1606

Nevada Sue, here.

 

My fusion was 9 months ago.  I'm pretty much in constant pain if I do any walking at all - it's SO discouraging!  I'd planned to have my hardware removed in December (the only time of year that I have a few free weeks of work) but I'm not sure now.  I'll definitely go back to see the doctor and see what he thinks.  I have a bruise on the top of my toe that never goes away and there is lots of redness on top of the fused joint  (Would take a pic, but I can't figure out how to use Android Transfer to get pics from my phone on the Mac.) 

 

I have a couple of pairs of shoes that are relatively comfortable, but I can't wear flip flops at all - my toes are to close together that it's painful to even try and get them on.  My Crocs are comfortable for my toes, but walking in them seems to cause pain.  Tennis shoes are the go to.  I'll still put my boot on if the pain is bad, and it seems to help.  Not good for my hips, tho.

 

I still try to do some easy hiking - if I'm going to be in pain no matter what, I might as well have some fun! 

post #1571 of 1606
Thanks to all who responded to my post. I am 7 weeks post op. I had my first post op XRay today which is longer than most people on this site. The good news is the orthopedist was very pleased with the healing of the fusion.
@Golfing Queen , @Riki D you are both so right about doing core exercises, stretching. I had specifically asked about starting PT even before the surgery but was told no exercising until cleared post op. But I think proactive core strengthening would be smart, especially for those of us not as athletic as others. This is my advice for anyone reading this site in advance of surgery. I had knee arthroscopic surgery 5 years ago and started exercises day 1 and that relieved pain terrifically.
My ortho is now sending me to PT for leg strengthening. I spoke to my cousin yesterday and he had an ankle fusion 4 years ago. He also had calf pain and weakness that took almost 2 years to resolve but he is now 100% better. So again, I guess calf pain with weakness and tightness, shin splints, and low back pain are normal but will slowly improve.
@Tinman thanks for this site and yes I may be pushing it. Golfing Queen, you are right recommending YouTube for exercises. I found some good ones there. Also for low back exercises. For anyone contemplating surgery, the videos for using crutches were better than what I got in PT, especially for how to go up and down stairs on crutches and getting out of a chair. My most comfortable shoes are canvas Sanuks as they expand if my forefoot swells. I haven't been able to wear flip flops in years as the strap ran right over the rigid joint and caused severe pain. Hope I can wear those to the beach next year.
I also note my right foot is now a full inch shorter than my left foot. But that huge painful swollen joint is now gone.
@Nevada Sue hope you get resolution of your pain soon.
post #1572 of 1606
Just a quick followup after having 2 weeks of PT. I'm very grateful for having an outstanding therapist. She noted on the first visit that I was externally rotating my foot. I never realized I was doing this, but because of the swollen sensation under my first MT area, I was unconsciously rotating my foot outward, bearing weight on my lateral foot, and doing take-off on that side. Soon after she "retrained" me to keep my foot straight while walking, my calf pain greatly subsided. Doing leg strengthening is helping a lot. I am now firmly convinced anyone contemplating surgery should start therapy even before surgery to strengthen your core. Not all surgeons send you to PT automatically so ask for it. If your insurance doesn't cover PT well, YouTube does have some good instructional videos.
post #1573 of 1606

Footman, glad your PT is helping.  Sounds like you've had a rather uneventful journey - nice!  Tinman, still no relief? 

 

I'm 11 months post-op.  I haven't had to wear my boot since my last post, so that's an improvement.  I haven't hiked since then, either - hmmm.  I mostly have pain at night when I'm trying to sleep. The days' activities seem to catch up by then.

 

I'm thinking about making another appointment with my surgeon, but don't know if it will help.  Has anyone had a revision done by the original surgeon?  Good idea?  Bad idea?  I think he'll recommend taking out the hardware as a first step, but I don't really want to waste my time if it won't help.  My toe is completely off the ground from the joint forward.  1/8 of an inch, maybe?  I really like my surgeon and trust him even though things didn't turn out the way I thought they should.

post #1574 of 1606
Is anyone rock climbing after the fusion of the first metatarsal?

I have advanced arthritis there and I'm sure fusion is in the near future.
post #1575 of 1606
Hey Nevada Sue,

Sorry you're still in so much pain. I'm 10 months post op and scheduled to get the other foot done in 2 weeks. Everything was progressing very well - no pain at all. Just the normal swelling and nerve recovery. About 12 weeks ago I began having increased discomfort in the fused toe and could see that the screw was starting to protrude. Surgeon agreed - said it was the source and needed to come out. Having that done in 2 weeks at same time of fusion. That should be interesting! It's much worse so I can't wait to have it removed! My toe actually seems more raised and turned inward than before since the screw issue. I'll let you know if removing it makes the difference I think it will. At least it won't be rubbing on my shoes - I can barely wear any closed toe shoes unless they're very soft. Not looking forward to another surgery and long recovery, but am looking forward to no pain in the right foot!

Rod,

I don't rock climb but am able to do everything I did before - cardio, yoga, aerobics, dance, jump, run, bike, golf. The only thing that is hard is doing lunges. Neither toe likes that move so I avoid.

Footman has it right - get in the best shape you can before surgery. It will help with the recovery immensely. I've been prepping all year for this one and am in better condition than I was last year. Fingers and toes (no pun intended) crossed! 😁

GQ
post #1576 of 1606

Wow, GQ - both feet at once, lol!  I'm sure screw removal is not that big of a deal, but it's still a surgery! 

 

Rod, we're remodeling a house and I spend a lot of time on my haunches and getting up an down.  I haven't really noticed a difference from before surgery til now.  I'm guessing the flex is happening in the end joint of my toe rather than the joint that was fused.  I'm still able to curl my toe to grasp, which I guess is what you need when rock climbing?

post #1577 of 1606
Screw removal is like a paper cut.
post #1578 of 1606
In rock climbing you stand a lot on your big toe.
post #1579 of 1606

Paper cuts hurt, Toecutter! 

 

Rod, the only thing that changes with a fusion is that your big toe doesn't bend.  If you don't need it to bend then you should have no problem rock climbing.

post #1580 of 1606
I don't need to bend it, just concerned that if I put my weight on it, the bone might break.
post #1581 of 1606
Once it's fused it'll be as strong as your first metatarsal bone since it'll essentially be just a longer version of a metatarsal. If you're not breaking your first metatarsal while climbing now you won't after surgery.
post #1582 of 1606
Quote:
Originally Posted by NevadaSue View Post

Paper cuts hurt, Toecutter!

Only for a day or two.
post #1583 of 1606

Hi Golfing Queen, I am so happy to hear that your recovery is going well!  I hope that continues until you are fully recovered.  I was wondering if you could please share the name of the Doctor who did your surgery?  I live in South Florida and I would love to hear the name of a Doctor who someone has had a successful outcome with.

 

Thank you so much for your help!! I am grateful for it.

 

Pearlskier77

post #1584 of 1606

Hi Msdivinedc and the rest of this totally amazing and helpful group,

 

How are you? I hope that you are, by now, fully recovered and back to all your usual activities.  I have read almost all of the threads in the past few weeks, as I also have a problem with my big toe joint and am considering having the fusion surgery.  I have read about the Dr. that you had kindly mentioned in Rochester, NY and have considered going up there to have it done. It is very far to go and I would have to take 2 planes to get there each way.  I don't know how that would work with the follow up consults, or if I have an emergency. I was wondering if you ever had your "hardware" (plate and seven screws taken out)?  I am just so afraid of having the surgery, that I have put it off for years as I have had this condition for over 12 years.  I too love to exercise and I walk, do the elyptical, and bike indoors.  I can do these things all on a limited basis, because, if I overdo the activity, I am in pain.  Sometimes, I can't exercise for a week or two, and I have to baby the foot until it feels better.  I have not worn regular shoes for like 10 years.  I have Morton's Toe extension custom orthotics in almost all of my low hiking Merrill type shoes, which, along with Sanita's (like a Dansko) rocker bottom shoes are the only shoes that I can wear.  I just got a pair of hiking Hoka shoes which I love, although pricey.  Since I have been wearing rigid, stiff bottom shoes and Sanita's, I have no pain except when I overdo it, but I am limited and restricted with the length of time that I can exercise, which is why I am interested in having the surgery.  I am going to get some new opinions by going to doctors in the next few weeks.

 

Mainly, I am so grateful to have found this wonderful resource!  Thank you all for sharing your stories!  I am hoping that I will be able to find a doctor much closer to home to do this surgery for me.  If anyone on this list has any suggestions please...I am waiting and so ready to hear.  Please tell me the names of the doctors that you used. Thank you all for reading this long message.  I appreciate it so much!!

post #1585 of 1606

Hi again all!

 

I was wondering if anyone has heard about the Cartiva implant?  It is a synthetic cartilage device. It has been around for over 5 years, but the first procedure in the US was done by Dr. Judith Baumhauer, in July of 2016.  It is supposed to speed up the healing process for big toe joint surgery by a huge amount!  I am interested in knowing if anyone on this thread has had the procedure or knows of anyone who has had it? I have read that it has been used internationally for a few years and that it just received FDA approval for use in the US in the Spring of this year. I am also interested in learning about local doctors in South Florida, near Boca Raton, who have had success with it.

post #1586 of 1606
Quote:
Originally Posted by Pearlskier77 View Post
 

Hi again all!

 

I was wondering if anyone has heard about the Cartiva implant?  It is a synthetic cartilage device. It has been around for over 5 years, but the first procedure in the US was done by Dr. Judith Baumhauer, in July of 2016.  It is supposed to speed up the healing process for big toe joint surgery by a huge amount!  I am interested in knowing if anyone on this thread has had the procedure or knows of anyone who has had it? I have read that it has been used internationally for a few years and that it just received FDA approval for use in the US in the Spring of this year. I am also interested in learning about local doctors in South Florida, near Boca Raton, who have had success with it.

 

Promises, promises. "Never be the first or last to do anything new surgically."

 

I've had an opportunity to handle a Cartiva plug and it's about the size and shape of a mini-marshmallow. If your cartilage defect is about the same size then I could see the implant making your toe joint feel better at least initially but it doesn't address whatever factors caused the defect to occur in the first place (e.g., faulty biomechanics). If someone is a candidate for a fusion then he or she is likely at stage III-IV hallux rigidus, and chances are his or her joint arthritis involves much more surface area than the size of the Cartiva implant, which means that the rest of the joint would still be arthritic and likely painful upon motion. I've seen numerous "latest/greatest" implants and treatments come and go over the years simply because they didn't stand the test of time, and I suspect this will be another in that long list of ideas that didn't quite work out. I'd wait at least five years (if not more) to see how Cartiva plays out. Let someone else be the test mule.

post #1587 of 1606
Quote:
Originally Posted by Pearlskier77 View Post

I am also interested in learning about local doctors in South Florida, near Boca Raton, who have had success with it.

I got some names of docs near Boca Raton for you. I don't know if they use the Cartiva implant or not but they're supposed to be top notch surgeons:

John Levin, DPM or James Clancy, DPM at The Orthopedic Center. Offices in Boynton Beach, Wellington, Lake Worth
post #1588 of 1606

Saw my surgeon today and he recommends removing the hardware.  He doesn't say it will solve my problems, but he said it should help.  Oddly, the tendon on top of my foot seems to be working well, but the tendon on the bottom is not.  I've had a constant bruise on the top of my foot since surgery.  Doc says my body probably doesn't like having an implant, and there is constant inflammation.  I reminded him that my toe is totally off the ground, and he hopes taking out the hardware will let the tendons relax and do their job.  I'm not holding out high hopes, but I have to do something.  Surgery will be January 12.

post #1589 of 1606
Hopefully removal of the hardware will solve your issues, Nevada Sue! My feet have been great since my 8/15 and 1/16 toe fusions. My big toes seem pretty flat and my scars are almost invisible. PT in August strengthened my knees. I have a final appointment with my podiatrist in two weeks. Good luck!
post #1590 of 1606

In the press: Long-term outcome of first metatarsophalangeal joint fusion in the treatment of severe hallux rigidus

 

http://link.springer.com/article/10.1007/s00264-016-3277-1

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