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NHS guidance

The NHS provides online guidance on treating the following problems:

Advice on Nail Cutting:

Useful links

College of Podiatry

The Health and Care Profession Council

Diabetes UK

Arthritis Research Campaign

Service Information

What are chilblains?

Chilblains are small areas of inflamed and often, itchy, skin which develop on fingers and toes. They generally affect the young and old and are caused when blood vessels don’t react normally to cold, damp weather.
Chilblains can be uncomfortable and can become infected if the inflamed skins tears. If people with chilblains protect their fingers and toes from the cold, they will heal within a few weeks.

Look after yourself

  • Family history – chilblains are often a family trait
  • Poor circulation or general health.
  • Work-related – people working in cold and damp conditions.
  • Smoking - nicotine narrows blood vessels.
  • Damaged feet - chilblains can appear on a bunion or a toe that’s squeezed by tight shoes.

Prevent

  • Warm your cold feet up slowly, don’t put your feet in hot water, near direct heat from fires or radiators or use very hot water bottles and wheat bags.
  • Improve your circulation through gentle exercise and massage
  • Use thermal insoles in shoes and boots
  • Stop smoking – nicotine narrows your blood vessels
  • Wear warm clothes and protect your hands, feet and legs from the cold.
  • Warm your hands before you go out by soaking them in warm (not hot) water for several minutes and then drying them thoroughly. Wear cotton-lined waterproof gloves if necessary.
  • If you have diabetes, regularly check your feet or ask some-one to do this. You may not be able to feel your feet and could have infected chilblains without noticing it.

When to seek professional advice

You should seek medical advice if you think your chilblain may have become infected. Signs of infection may include swelling or pus forming in the affected area, swollen glands, feeling generally unwell and a high temperature of 38C or above.

Further information: www.scpod.org 

What is a foot ulcer?

An ulcer is a wound that is not healing as expected. Wounds and ulcers can be painful and sometimes ooze clear fluid or pus.

What is a wound?

A wound is any break in the skin.

Common causes:

There are many causes (risk factors) such as:

  • poor footwear
  • complications of diabetes
  • loss of fatty padding on the feet
  • loss of feeling (neuropathy)
  • poor circulation (peripheral arterial disease)
  • self-treatment e.g. medicated corn plasters or use of sharp implements
  • foot structure e.g. hammer toes or bunions

What can you do for yourself?

  • Eat a well-balanced diet, including protein and a variety of fruit and vegetables.
  • Maintain good blood glucose control if you have diabetes.
  • If you smoke, try to reduce the number you smoke or consider giving up.
  • If you drink alcohol regularly, try to reduce your intake.

When to get professional advice:

If you experience any of the following contact your podiatrist, doctor or nurse immediately:

  • An ulcer or wound to the foot
  • Any new pain or throbbing
  • More swelling in the affected area
  • Colour changes surrounding the ulcer e.g. redness or blackness
  • More discharge or smell from the ulcer
  • An increase of heat and warmth in the affected area
  • Generally feeling unwell with a raised temperature (38C or above) or nausea.

Treatment

If you need regular treatment to help your foot ulcer to heal we will work out a plan with you which might include some or all of the things listed here:

  • Removing dead skin- ulcers sometimes hide under hard skin and can gather dead tissue around them, so dead skin needs to be removed regularly. This might cause slight bleeding which is completely normal.
  • Antimicrobial and protective dressings – these might change during your treatment.
  • Regular change of dressings - the podiatrist will show you how to change your dressing if you’re able to do this yourself. We’ll make other arrangements if you can’t do this yourself
  • Referral to other NHS specialists.
  • Wearing special boots or sandals if you can’t wear your own shoes. Some patients may be referred to an orthotist for specialist footwear.

Further information: www.scpod.org 

Footwear advice

Consider having your feet measured. They could have become wider over the years or changed shape. You will get the best measurements standing up because your feet splay out. If you can, have this done during the week when the shops are less busy so you get the shop assistant’s full attention. There should be at least 1cm (1 ½ inch) of room in the shoe beyond the longest toe. Try shoes on with the type of socks, stockings, insoles you normally wear because some insoles may need shoes with more depth. The right shoes for you will be comfortable when you first try them on. Buying shoes to ‘break in’ later is not a good idea. Shop for shoes later in the afternoon, if your feet tend to swell, this will be when they are at their largest. When buying slippers, look for ones that have a cushioned sole, and ideally a fastening to hold them securely on the foot. Avoid mules - they don’t give the foot the support it needs and can lead to falls. You could wear comfortable, well-fitting shoes indoors instead of slippers.

Footwear fitting

  • Footwear which have laces, straps, buckles or velcro are more supportive and stay on your feet better.
  • Footwear which is not held firmly onto your feet can be hazardous and cause falls.
  • Consider having your feet measured, they may have become wider over the years, or changed shape. It is recommended to have your feet measured whilst standing as they tend to splay out when we stand.
  • There should be at least 1cm (½ inch) of room in the shoe beyond the longest toe. Always select the size to fit your larger foot, if there is a difference.
  • Try shoes on with the type of socks, stockings, insoles you normally wear. Some insoles may need shoes with more depth.
  • The right shoes for you will be comfortable when you first try them on. Buying shoes to ‘break in’ later is not a
    good idea.
  • Shop for shoes later in the afternoon if your feet tend to swell - this will be when they are at their
    largest.
  • Avoid having your shoes fitted at the weekend when retailers are often most busy and therefore are unable to
    provide full attention.
  • Avoid wearing your new shoes outdoors until you are certain they are comfortable. If they are uncomfortable, the retailer will be more likely to exchange them for you if they have only been worn indoors on carpeted floors.

Socks and hosiery

Good socks will not only help keep your feet comfortable inside shoes, but will also keep them dry by drawing moisture away from the feet. If you have problems with circulation or swelling, try to avoid socks with tight elastic tops. You can easily find wider, soft-top socks in shops. Regularly check your socks and throw worn out or misshapen ones away Always check toe seams for an uncomfortable, knobbly ‘casting off’ knot – particularly in children’s socks. There are now socks manufactured from one piece of material without a toe seam. Avoid hosiery which is too tight across your toe area.

What to look for in a good shoe

Heel: Flatter shoes are best, particularly if you are on your feet a lot. Heels should no higher than 1 ½” and have a wide base.

Depth: There should be enough width and depth in your shoes to allow room for your toes and prevent pressure areas.

Length: Make sure your shoes fit to your the largest foot (most of us have one foot that is bigger than the other!)

Sole: Look for a thick flexible outer sole as this provides a cushion between you and the ground and acts as a shock absorber.

Insole: Some shoes have an insole that can be removed. This will allow for a specially made corrective or cushioning insole if you need one.

Material: A shoe with a soft leather upper will allow your feet to 'breathe'. Try to avoid shoes with stitching over prominent bones. Check that the leather has been stiffened around the heel for support.

Fastenings: Shoes and sandals with adjustable straps, laces or Velcro fastenings will help hold your foot in a good position. Loose shoes can cause slip and falls.

New shoes: If you have a tendency to have problems with new shoes, you may find it helpful to wear them for short periods at first.

Trainers: Trainers are a good choice if the upper is made of leather

Protect your feet at work

It is not unusual for problems to arise within the foot, lower leg and back as a result of working on hard unyielding surfaces for long periods, especially if you are wearing hard soled footwear with no shock absorption.

In a normal working day, the working foot can easily travel several miles and just standing still can also put a lot of strain on your feet and legs. If you are on your feet a lot, you should wear well-fitting, comfortable footwear with cushioning and flexible soles.

Tips for working feet

  • Wear footwear that is appropriate for your job and suitable for the conditions.
  • Wear safety footwear if your job requires or recommends it. Always have two pairs of footwear on the go alternating on a daily basis so that any perspiration can dry out properly.
  • Wearing different footwear can also prevent pressure areas.
  • If you work on slippery surfaces it is important to wear footwear with slip resistant soles.
  • If there is a danger of nails or sharp objects – wear puncture resistant soles.

The wearing of high heels can:

  • Increase the weight taken by the ball of the foot, which may lead to calluses, painful bunions, corns and deformity.
  • Push the entire mass of the body forwards, causing the spine to bend backwards to compensate. This can lead to back and lower limb problems.
  • Create a higher ankle position, particularly with a narrow heel width which can cause instability and ankle sprains.
  • Wearing high-heels for long periods – more than 6 months – may cause long term shortening / tightening of the calf muscles. The person compensates for this tightness of the calf muscle by lowering the arch of the foot, this can affect the knee, hip or back.

Slippers

Many people wear slippers at home because they are easy to put on, and are soft and comfortable. However, well-worn slippers may not give much support to the foot so may contribute to trips and falls. The soles may also have little cushioning leading to pain in your feet.

  • When buying slippers, look for ones that have a cushioned sole, and ideally a fastening to hold them securely on the foot.
  • Alternatively, try wearing a comfortable, well-fitting shoe reserved for indoor use instead.
  • Avoid mules - they give the foot little support and can lead to falls.

Useful sources of further information

British Footwear Association
01933 229 005 / www.britfoot.com

Hotter Shoes
01695 213 213 / www.hottershoes.com

Ecco
0808 101 7442 / www.ecco.com/uk

Cosyfeet
01458 447 275 / www.cosyfeet.com

Simply Feet
0845 370 0380 / www.simplyfeet.co.uk

Walktall
www.walktall.co.uk

Crispins Orthopaedic /Bespoke shoes
0113 252 8866

Taycare Bespoke footwear
0113 231 1800

Falls

If you have a history of falling within the last six months or any problems with your balance, you should ensure that your footwear is suitable and any that isn’t should be discarded. You should also discuss this with your GP or healthcare professional.

Further information: www.scpod.org

What is Neuropathy?

Neuropathy is the name given to nerve damage – usually from complications associated with diabetes. Diabetes harms the tiny blood vessels which carry oxygen and nutrients to your nerves. The nerves are damaged by this starvation and then struggle to get messages to the brain. In people with diabetes, nerves in the feet are usually first to be affected. There are many symptoms, but they can include numbness, tingling, burning and pins and needles. It is also possible to have no symptoms. Some people may develop severe pain due to the nerve damage.

What you can do for yourself:

  • It is really important to maintain good blood glucose control through diet or medication. Neuropathy is more common in people with poorly controlled diabetes.
  • Maintaining a healthy diet, doing regular exercise and stopping smoking will all help.
  • Get advice from your doctor, practice nurse, podiatrist or diabetes nurse specialist.
  • Follow your prescribed treatment. This can include prescription medication and other therapies if needed 
  • Check your feet every day for colour change, breaks in the skin or discharge or swelling. Use a mirror to help you with this if necessary.
  • Check your feet very regularly after you have bought new shoes. The neuropathy might mean you don’t feel any pinching or rubbing which could cause you further problems.
  • Check for bits of grit or any other foreign objects before you put your shoes on.
  • Don’t treat any foot problems yourself – get advice and help
  • Don’t use corn pads or cures which contain acid – this will damage healthy skin.
  • Don’t remove hard skin with razors or anything sharp
  • Don’t go barefoot; even on carpeted floors
  • Don’t warm your feet directly on a hot water bottle, fire or heater and test the water before you get into the bath to make sure it’s not too hot.

Further information: www.scpod.org 

What is Neuropathy?

Neuropathy is the name given to nerve damage – usually from complications associated with diabetes. Diabetes harms the tiny blood vessels which carry oxygen and nutrients to your nerves. The nerves are damaged by this starvation and then struggle to get messages to the brain. In people with diabetes, nerves in the feet are usually first to be affected. There are many symptoms, but they can include numbness, tingling, burning and pins and needles. It is also possible to have no symptoms. Some people may develop severe pain due to the nerve damage.

Look after yourself

There’s a lot you can do to help look after your feet by:

  • Keeping your glucose levels under control through diet or medication. Neuropathy is more common in people with poorly controlled diabetes.
  • Eating a healthy diet, doing regular exercise and stopping smoking will all help.
  • Getting advice from your doctor, practice nurse, podiatrist or diabetes nurse specialist when you need support.
  • Following your treatment plan carefully. This can include prescription medication and other therapies if needed What is Neuropathy? Neuropathy is the name given to nerve damage – usually from complications associated with diabetes. Diabetes harms the tiny blood vessels which carry oxygen and nutrients to your nerves. The nerves are damaged by this starvation and then struggle to get messages to the brain. In people with diabetes, nerves in the feet are usually first to be affected. There are many symptoms, but they can include numbness, tingling, burning and pins and needles. It is also possible to have no symptoms. Some people may develop severe pain due to the nerve damage.
  • Checking your feet every day for colour change, breaks in the skin or discharge or swelling. You can use a mirror to help you with this.
  • Checking your feet very regularly after you have bought new shoes. The neuropathy might mean you don’t feel any pinching or rubbing which could cause you further problems.

Things you shouldn’t do:

There are some things you shouldn’t do if you have neuropathy:

  • Don’t use corn pads or cures which contain acid – this will damage healthy skin
  • Don’t remove hard skin with razors or anything sharp
  • Don’t go barefoot; even on carpeted floors
  • Don’t warm your feet directly on a hot water bottle, fire or heater and test the water before you get into the bath to make sure it’s not too hot.

Before you start, ask yourself:

  • Is there enough light?
  • Am I sat safely?
  • Do I have everything I need?

1. Nails are generally easier to cut after a bath or shower as they are softer.

2. Sitting safely. Put two chairs together opposite one another. Sit against the back of the supporting chair. Put your heel on the chair in front of you. Keep your knee bent so you can reach your foot easier. It may help you reach if you point your knee outwards whilst it is bent. This also applies when applying moisturiser to your feet. Alternatively you may wish to do this sat on your bed with your feet resting on the bed using a towel to protect your bedding.

3. Use a pair of nail clippers. Do not share these with other people. Try and cut nails straight across, gently follow the contour of the nail. Do not cut too short or down the sides. Clear debris such as soap, cream, sock fluff from the sides of the nails using a soft toothbrush. Gently file any rough or sharp edges.

4. If may be safer for you to file your nails. This will need doing once a week to keep them at a short comfortable length. You can also reduce the thickness of nails by filing across the entire surface of the nail.

5. Use a clean long nail file. File away from yourself across the front edge of the nail. Only use enough pressure to gradually reduce the nail.

6. You can also use a file or pumice stone to reduce hard skin. Only use enough pressure to gradually reduce it. Avoid causing abrasions to the skin.

7. If you do cause a bleed firmly apply pressure to the area with some gauze or similar product for a couple of minutes. Checked the bleeding has stopped. Apply a dry dressing.

Before the procedure

  • In advance of any surgical procedure it is important that an assessment is undertaken. You will be asked questions about your general health and foot condition. Your family doctor may be contacted to make sure you are well enough to have nail surgery.
  • The Podiatrist will discuss with you treatment options which may include having a total or partial section of the nail being removed.
  • On the day of surgery have your normal breakfast or lunch.
  • Remove any nail varnish from the nails before you arrive.
  • Wash your feet and wear clean socks or tights.
  • Arrange for a taxi or a relative or friend to provide a lift home for you afterwards. You must not drive after the procedure until the effects of the anaesthetic have worn off. This may take several hours.
  • Bring any tablets or medication that you normally use throughout the day e.g. inhalers.
  • Bring some roomy footwear such as slippers, flip-flops or open toed sandals as you will have a dressing on your toe/s.
  • We strongly recommend that a parent or legal guardian accompany any patient under the age of 18. Children under 16 must be accompanied by a parent or legal guardian otherwise the procedure will not be undertaken.

During the procedure

  • The procedure will take approximately one hour.
  • Please inform the podiatrist of any changes in your medication or health. A procedure checklist will take place to review your health status has not changed and surgery is still required.
  • A local anaesthetic is used to numb the toe. These injections are very safe but you may experience some discomfort. The local anaesthetic used is not licensed for use in podiatry on children under 14 but is licensed for use by dentists. However this anaesthetic is commonly used by podiatrists on children.
  • Once the toe is numb, the podiatrist will place an elastic ring over the toe. This stops the toe bleeding during the procedure.
  • The podiatrist will then remove part or all of the toenail.
  • Once the nail has been removed, a chemical called phenol is rubbed into the nail bed to prevent the nail from growing back. In rare cases, phenol will not be applied and the nail will be left to grow back.
  • The phenol is washed off and the elastic ring is removed.
  • A sterile dressing is placed around the toe which you will need to keep on and keep dry until your first dressing appointment.

After your procedure

Healing times
This will vary with most toes healing between 4 – 8 weeks. However this depends on a number of factors e.g. infection, age, general health, activity levels and your compliance in following the podiatrist’s instructions.

Driving
Your toe may remain numb for several hours. Do not drive immediately after surgery until the effects of the anaesthetic have worn off.

Pain relief
You must rest your foot as much as possible for the remainder of the day. You might experience some discomfort once the anaesthetic wears off. If you need to take medication to control the discomfort we advise that you take your normal painkiller e.g. paracetamol. Do not take aspirin as pain relief. However, if you take a low dose of aspirin as part of your prescribed daily medication, continue taking as indicated by your GP.

Activities
If you have an office-based job, attend school or college you can return the following day. For other jobs where you stand or walk a lot, your podiatrist will advise. You are strongly recommended not to participate in any sporting activities until advised by your podiatrist.

Dressings
After the surgery you are expected to keep the toe clean and covered. You might notice some discharge or spots of blood on the dressing – this is quite normal. If the initial dressing starts to come loose you can apply some more surgical tape to hold it in place.


The dressing will be changed at your first follow up appointment.

After this your podiatrist or practice nurse will arrange review appointments as required.
Urgent attention

If you experience any unexpected pain in your toe or become concerned please contact your local clinic where you will be attending for your follow up dressings and speak with a podiatrist. If this is not possible please contact Leeds Community Podiatry Service during working hours 8.30am – 4.00pm (3.40pm on Fridays), tel: 0113 843 0730.

 Dressing your toe

  • Keep the dressing clean, dry and intact until your first dressing appointment.
  • Apply the new dressing and using the technique shown by the Podiatrist
  • Keep your dressing as dry as possible when bathing. It is best to change your dressing after bathing in case it has got wet.
  • If your dressing gets wet it is important to change it to a new dry one. This will help reduce the risk of infection and aid the healing process.
  • You will initially be required to change the dressing every 1 – 3 days, ask the podiatrist if you are unsure.

Risks associated with nail surgery

Infection
Every precaution is taken during the procedure to prevent an infection. However, because we are dealing with an open wound, it is inevitable that a small number of cases may develop an infection. Keeping your dressing dry and following the advice of the podiatrist will reduce the risk of infection.

Phenol burn
Occasionally the phenol used to stop the nail regrowing can spread onto the surrounding skin. You may experience some discomfort and this may delay the healing time. Every precaution is taken to prevent this.

Excessive bleeding
There is little or no bleeding during the procedure. However, bleeding may occur afterwards. Appropriate dressings will be used to help this.

Pain following the operation
Once the local anaesthetic has worn off you may feel some pain or discomfort. Your podiatrist will advise you on how to treat this.

Numbness
In a very small number of cases the nerve may be damaged by the needle. This numbness can last up to 3–4 months.

Local anaesthetics
In rare instances the local anaesthetic is not effective and the operation will need to be rescheduled.

Allergies
If you have ever had an allergic reaction or have felt unwell following a local anaesthetic, for example after dental treatment, you may have an allergy (similar to nut allergy). If you have had this type of reaction please inform the podiatrist.

Latex allergy/sensitivity
This can cause a skin reaction or affect your breathing. Please inform the podiatrist if you have a skin sensitivity or are allergic to latex/rubber gloves.

Nail appearance
The cosmetic appearance of the nail will be permanently changed. In a small number of cases the whole or part of the nail may grow back.

Proper foot care is essential to maintain healthy feet and should be as much a part of your daily routine as brushing your teeth.

It is essential that your feet are looked after regularly if they are to stay healthy. This section explains why it is important to care for your own feet and also contains useful advice on what you can do to improve your foot health.

Foot hygiene

  • Feet should be washed on a daily basis with soap and warm water, then dried thoroughly. You should pay particular attention between the toes.
  • Do not soak feet for long periods of time as this can dry the skin by removing the natural oils.
  • Change socks or stockings daily for comfort and to reduce the risk of infection.
  • Check hosiery / socks fit comfortably, and are not too tight.

Nail care

Nails protect the end of the toes. If neglected, they can become uncomfortable or damaged. Good nail care can reduce this risk.

Please follow this simple advice on how to care for your nails.

  • Cut nails after bathing or shower as they will be softer
  • Find a comfortable position. Try sitting on a low seat or with your leg on the bed. Take your time - you may wish to trim a few nails at a time and spread the task out.
  • Cut or file nails following the natural shape of the toe.
  • Most nails could be cut with nail clippers. However, you may wish to purchase nippers and a file.
  • If nails are thick, try filing with an emery board or nail file on a weekly basis.
  • To maintain good healthy nails, do not cut nails too short, do not cut down the sides, pick or pull the nails.
  • Do not use equipment which is not for this purpose i.e. knife or razor blades.
  • If you experience difficulty, ask a friend, relative or carer for help.

Cleaning sides of nails

While bathing or using a foot bath use a soft toothbrush to clean down the sides of nails. Olive oil may help to soften dry skin in this area.

It is advisable to purchase nippers and files from your pharmacist / chemist or mail order companies. See end of this leaflet.

Skin care advice

Dry skin
Can present on your feet as areas of flaking, rough or cracked skin that may become painful if left untreated.

Moisturisers help to keep skin supple and soft. They help to stop callus from becoming painful. It is advisable to apply a moisturiser at least once a day, after bathing if possible. Do not apply between the toes.

Moisturisers should be thoroughly massaged into the skin before putting hosiery on. Creams such as E45 and Aqueous Cream can be used. If your skin is thick and dry a UREA based cream such as Calmurid, Flexitol or Dermatonics can be used. If you have difficulty applying cream, ask a friend, relative or carer to help.

Moist skin
Appears mostly between the toes. It is white and spongy in appearance and can peel off leaving the area raw and red. It is usually caused by inadequate drying in between toes though in some people it may be caused by excess perspiration or infection.

Ensure you wash and dry your feet thoroughly. Applying surgical spirit sparingly to any areas of moist skin, e.g. between toes can help improve the condition of your skin.

Corns and callus

  • Corns and Callus usually form over areas of high pressure on the foot and are usually associated with structural problems.
  • Ill-fitting footwear / hosiery can contribute to its development.
  • It can appear as an area of thick, dry, hard yellow skin.
  • On occasions callus may be caused, or made worse, by a medical condition.

What should I do about my corns and callus?
Choose footwear with a wide / deep toe box to avoid putting pressure on your feet and toes.

Remember not all callus requires treatment. If you have diabetes or have poor circulation you should seek advice.

Use a pumice stone or emery board followed by a moisturiser. This can help reduce the amount of callus formation.

What should I NOT do?

  • Attempt to cut corns or callus with sharp instruments like razors or scissors, as this may lead to bleeding or infection.
  • Use corn or callus preparations especially if you have diabetes or have problems with your circulation.

If you have painful hard skin and corns or problems with the structure of your feet you may wish to consult a podiatrist (chiropodist).

Blisters
Blisters are painful, fluid-filled lesions, often caused by friction and pressure. They can be caused by:

  • Ill-fitting shoes
  • Stiff shoes
  • Wrinkled socks against the skin
  • Excessive moisture
  • Foot deformities

How to prevent blisters

  • Keep your feet dry
  • Always wear socks as they act as a cushion between your feet and shoes
  • Wear properly fitting shoes

If a blister does occur, cover with a protective dressing.

Exercises

Simple exercises to help maintain foot mobility and circulation.

  • Circle your feet ten times in each direction, keeping your legs as still as possible
  • Consciously straighten your toes then wiggle them around
  • Raise, point and curl your toes for five seconds each, repeated ten times – this is particularly good for toe cramps or hammer toes.

Useful tips

Swollen feet / legs
If your feet or legs are swollen, try placing them, for some part of each day, on a footstool. Alternatively you may wish to lay down with your legs slightly raised.

Useful sources of footcare products and further advice

Your local chemist or supermarket will stock a range of foot care products such as specialist creams for dry skin, files for hard skin.

Simply Feet
www.simplyfeet.co.uk
0845 370 0380

Toe and Foot Solutions
Tel / fax: 01484 714 789 (products only)

Scholl
www.scholl.co.uk 

Dreamy Feet
www.dreamyfeet.co.uk
0845 519 8929

Foot Care Supplies
www.footcaresupplies.com
0845 230 0770

Feet for Life
www.feetforlife.org (advice only)

For further advice

Consult a podiatrist. We recommend practitioners who are registered with the Health Professions Council – www.hcpc-uk.org

Contact and Referrals 

Please be aware that we are a referral only service. Contact us and view service locations here

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