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Canadian Medical Alliance for the Preservation of the Lower Extremity

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Diabetic Foot Statistics

What percentage of people in Canada have diabetes?


About 10% of Canadians have diabetes.

How do we get this number? 


According to Diabetes Canada, as of 2015, it was estimated that

9.3% of Canadians (3.4 million people) had diabetes. 


And Diabetes Canada projects that 12.1% of the Canadian population,
or 5 million people will have diabetes by 2025.

Based on these numbers, and assuming a steady rate of increase, this means 10.14% of Canadians currently had diabetes as of 2018, and 10.42% of Canadians have diabetes in 2019.  

Working forward, and assuming a steady increase in the rate of incidence, approximately 

      ...10.70% of Canadians will have diabetes in 2020.
      ...10.98% of Canadians will have diabetes in 2021.
      ...11.26% of Canadians will have diabetes in 2022.
      ...11.54% of Canadians will have diabetes in 2023.
      ...11.82% of Canadians will have diabetes in 2024.

              And 12.10% of Canadians will have diabetes in 2025.


How many actual people does this mean we have in Canada with diabetes?


About 3,880,000.  


How do we get that number?


The World Population Review estimates Canada's 2019 population at 37,254,723


If 10.42% of Canadians have diabetes as of 2019, per the statistic above, this means there are approximately 3,881,942 diabetics in Canada.



For a Canadian perspective on what 3,880,000 means, you could combine the populations of Saskatchewan, Manitoba, Nova Scotia and PEI, and you'd still come up short of this number.  

If you're from western Canada, you could add the metropolitan areas of Calgary and Edmonton, throw in Red Deer, and you'd still be a million short. 

Or, you could take the population of the entire Lower Mainland of British Columbia, from Vancouver through the Fraser Valley out to Hope, then add the entire population of Vancouver Island, and you'd still be 225,000 people short of the number of diabetics in Canada.

How many diabetic patients will develop a sensory neuropathy that can lead to an ulcer?


Between 60% and 70%.  



Dyck PJ, Davies JL, Wilson DM, Service FJ, Melton LJ 3rd, O'Brien PC. Risk factors for severity of diabetic

polyneuropathy: intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort.

Diabetes Care. 1999



But 90% don't know they have sensory neuropathy.


Bongaerts BW, Rathmann W, Heier M, Kowall B, Herder C, Stöckl D, Meisinger C, Ziegler D.

Older subjects with diabetes and prediabetes are frequently unaware of having distal sensorimotor

polyneuropathy: the KORA F4 study. Diabetes Care. 2013May;36(5):1141-6. doi: 10.2337/dc12-0744.

Epub 2012 Dec 28. PubMed PMID: 23275355; PubMed Central PMCID: PMC3631873.


What percentage of diabetics have a foot ulcer at any given point in time?


In the US, the odds of a patient having an ulcer any point in time, is conservatively estimated at 2 and 4%. 
And the odds of a diabetic patient developing a foot ulcer in a given year is between 3 and 10%.  




Reiber, G.E., Boyko, E.J., Smith, D.G. Lower extremity foot ulcers and amputations in diabetes. In:

National Diabetes Data Group, National Institutes of Health. Diabetes in America (2nd edn).

US Government Printing Office (NIH pub. no. 95-1468), 1995.  

Abbott CA, Carrington AL, Ashe H, et al. The North-West Diabetes Foot Care Study: incidence of,

and risk factors for, new diabetic foot ulceration in a community-based patient cohort.

Diabet Med 2002; 19: 377-84.

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes.

JAMA. 2005;293:217–28

However, other estimates for the number of ulcers present at any given moment in some populations have been higher, ranging from 5% in US veteran populations with diabetes and 6% of US Medicare patients with diabetes. 


Worldwide, it's been estimated that 6.3% of the world diabetic population has an ulcer.



Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration:

a systematic review and meta-analysis. Ann Med 2017; 49: 106-16.


Margolis DJ, Malay DS, Hoffstad OJ, et al. Prevalence of diabetic foot ulcer and lower extremity

amputation among Medicare beneficiaries, 2006 to 2008 — diabetic foot ulcers: 

Data points #2. Rockville, MD:  Agency for Healthcare Research and Quality, 2011.


Boyko EJ, Ahroni JH, Cohen V, Nelson KM, Heagerty PJ. Prediction of diabetic foot ulcer

occurrence using commonly available clinical information: the Seattle Diabetic Foot Study.

Diabetes Care 2006; 29: 1202-7.


With this said, the prevalence of diabetic foot ulcers can vary by ethnicity. In US Medicare patients diabetic foot ulcers had a prevalence of:

4.2% in Asians
8.0% in the Caucasians
8.6% in Hispanics
8.7% in African Americans
9.6% in Native Americans





Margolis DJ, Malay DS, Hoffstad OJ, et al. Prevalence of diabetic foot ulcer and lower extremity

amputation among Medicare beneficiaries, 2006 to 2008 — diabetic foot ulcers:  Data points #2.

Rockville, MD:  Agency for Healthcare Research and Quality, 2011.



And the prevalence of diabetic foot ulcers also varies by country.  For instance, here is the reported prevalence of foot ulcers in the diabetic populations of a small selection of foreign countries:


Saudi Arabia     11.85%.
Indonesia          12     %

Ethiopia            13.6  %
India                 14.3   %
Sudan               18.1   %




M. Mairghani, K. Elmusharaf, D. Patton, J. Burns, O. Eltahir, G. Jassim, Z. Moore.  The prevalence and incidence

of diabetic foot ulcers among five countries in the Arab world: a systematic review  Journal of Wound Care

September 7, 2017

Saldy Yusuf, Mayumi Okuwa, Muhammad Irwan, Saipullah Rassa, Baharia Laitung, Abdul Thalib, Sukmawati Kasim,

Hiromi Sanada, Toshio Nakatani, Junko Sugama  Prevalence and Risk Factor of Diabetic Foot Ulcers in a Regional

Hospital, Eastern  Indonesia  Open Journal of Nursing, 2016, 6, 1-10 Published Online January 2016 in SciRes. 


Tesfamichael G. Mariam, Abebaw Alemayehu, Eleni Tesfaye, Worku Mequannt, Kiber Temesgen, Fisseha Yetwale,

Miteku Andualem Limenih  Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic

Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia,

2016: Institutional-Based Cross-Sectional Study J Diabetes Res. 2017; 2017: 287924 Published online 2017 Jul 16.

doi:  10.1155/2017/2879249  

Shailesh K. Shahi, Ashok Kumar, Sushil Kumar, et al Prevalence of Diabetic Foot Ulcer and Associated Risk Factors

in Diabetic Patients From North India.  The Journal of Diabetic Foot Complications, 2012; Volume 4, Issue 3, No. 4,

Pages 83-91

Almobarak, Ahmed & Awadalla, Heitham & Osman, Mugtaba & Ahmed, Mohamed. (2017). Prevalence of diabetic

foot ulceration and associated risk factors: An old and still major public health problem in Khartoum, Sudan?.

Annals of Translational Medicine. 5. 340. 10.21037/atm.2017.07.01.

So how many actual people in Canada have a diabetic foot ulcer at any given point in time?

Going by the conservative estimate of a 2-3% prevalence rate, there are between 77,600 and 116,400 diabetic foot ulcers in Canada at any given time.  Splitting the difference, we could estimate that there are likely about 100,000 diabetic foot ulcers in Canada at any given time.  

How do we get that number?


3,880,000 x .02 = 77,600, and 3,880,000 x .03 = 116,400.

What are the odds a diabetic will develop a foot ulcer at some point in a patient's life?


Estimates range from as low as 15%* to 25%** are most commonly cited, with at least one estimate as high as 34%.


* Brem, H.; Tomic-Canic, M. (2007). "Cellular and molecular basis of wound healing in diabetes".

  Journal of Clinical Investigation. 117 (5): 1219  –1222.  doi:10.1172/JCI32169. PMC 1857239 .

  PMID 17476353.

**Singh N, Armstrong DG, Lipsky BA  "Preventing Foot Ulcers in Patients with Diabetes". 

    Journal of the American Medical Association (JAMA) 2005: 293: 217-28

***Armstrong, DG; Boulton AJM; Bus, SA “Diabetic foot ulcers and their recurrence,”

     The New England Journal of Medicine, vol. 376, no. 24, pp. 2367–2375, 2017.

If I have a diabetic foot ulcer, what are the odds I'll end up with an infection?


At the time a wound appears, the odds of an infection developing within the first 12 weeks (three months)

of standard care appears to be about one in three (33.3%).


How do we get this number?


This estimate was derived by examining three studies that examined the efficacy of three different bioengineered tissue dressings.

We used the control group from each study--those receiving standard of care treatment, and no specialized dressings.

The three studies combined had 550 patients enrolled in total (N=97, 245, and 208, respectively), and the control arms receiving standard of care treatments had infectious rates of 36%, 32%, and 32%, respectively over 12 weeks.  This averages out to be 33.3%.

Lavery LA, Fulmer J, Shebetka KA, Regulski M, Vayser D, Fried D, Kashefsky H,

Owings TM, Nadarajah J; Grafix Diabetic Foot Ulcer Study Group. The efficacy and

safety of Grafix(®) for the treatment of chronic diabetic foot ulcers: results of

a multi-centre, controlled, randomised, blinded, clinical trial. Int Wound J.

2014 Oct;11(5):554-60. doi: 10.1111/iwj.12329. Epub 2014 Jul 21. PubMed PMID:



Marston WA, Hanft J, Norwood P, Pollak R; Dermagraft Diabetic Foot Ulcer Study

Group. The efficacy and safety of Dermagraft in improving the healing of chronic

diabetic foot ulcers: results of a prospective randomized trial. Diabetes Care.

2003 Jun;26(6):1701-5. PubMed PMID: 12766097.

Veves A, Falanga V, Armstrong DG, Sabolinski ML; Apligraf Diabetic Foot Ulcer

Study. Graftskin, a human skin equivalent, is effective in the management of

noninfected neuropathic diabetic foot ulcers: a prospective randomized

multicenter clinical trial. Diabetes Care. 2001 Feb;24(2):290-5. PubMed PMID:



Over greater time periods, the rate would be expected to be higher.  According to a European study of 1,232 patients seen in 14 wound care centres across ten European countries, the baseline infection rate in those patients without peripheral artery disease was 53.4%.   



Prompers L, Huijberts M, Apelqvist J, et al. Optimal organization of health care in diabetic
foot disease: introduction to the Eurodiale study. Int J Low Extrem Wounds 2007;6:11-7.

How will an infection change things?


An infection means antibiotics.  If not severe, it may be delivered orally.  If it's a more serious infection, the antibiotics may need to be delivered through IV, either on an outpatient (not hospitalized) or inpatient (hospitalized) basis. If the infection goes to bone, it could mean many weeks of IV antibiotics.  It could mean surgery to resolve the infection.

Infection puts the patient at risk of amputation and even death. 


So we wounds need to be closed as quickly as possible to avoid infection.  And when infections occur, we have to treat them aggressively.


How is longevity affected by a diabetic foot ulcer?


The 5-year survival rate of a diabetic foot ulcer patient is just 55%.  (There are things we can do to improve this number though.)  For a dialysis patient, the 5-year survival rate is just 23%. 


To put these survival rates into perspective, these survival rates are worse than most cancers.  

























Orimoto Y, Ohta T, Ishibashi H, Sugimoto I, Iwata H, Yamada T, Tadakoshi M, Hida N. 

The prognosis of patients on hemodialyis with foot lesions. J Vasc Surg. 2013  Nov;58(5):1291-9.

doi: 10.1016/j.jvs.2013.05.027. Epub 2013 Jun 27.

Moulik, Probal et al.  Amputation and Mortality in New-Onset Diabetic Foot  Ulcers  Stratified

by Etiology Diabetes Care February 2003 vol. 26 no. 2 491-494

Ulcers are serious business.  Our provincial health plans need to be treat diabetic ulcerations as seriously as we do cancers, and invest in proper treatment. 

If I have a diabetic foot ulcer, what are the odds that I'll heal?

It depends on how the patient is treated and the specifics of the patient (such as the overall health of the patient, the patient's circulation status, whether the patient is on dialysis, the patient's blood sugar level, the degree of neuropathy present, the patient's diet, whether the patient smokes, whether the patient uses steroids or immunosuppressants, and the patient's compliance with care).

With that said, if we look at a large study in Europe of 1,088 patients treated in 14 treatment centres in 10 countries, the healing rate was 77% within a year. 


Prompers L, Huijberts M, Apelqvist J, et al. Optimal organization of health care in diabetic
foot disease: introduction to the Eurodiale study. Int J Low Extrem Wounds 2007;6:11-7.

However, rates can be better with proper treatment, and that is the purpose of this website!  We can change results with good education and effective treatment protocols.


If I have a diabetic foot ulcer, what are the odds I'll end up with an amputation?


Approximately 20% of diabetic foot ulcers will eventually, at some point in time, result in amputation.



Lavery, LA, Armstrong DG, Wunderlich RP, et al. Risk factors for foot infections in individuals with diabetes.
Diabetes Care 2006: 29-1288-93


And 85% of all lower extremity amputations in patients with diabetes are preceded by an ulcer.


Lipsky BA, Berendt AR, Cornia PB, et al.; Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132–e173.


Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366(9498):1719–1724.


But much of this--perhaps 70%* to 85%** of these complication--is preventable if we invest in patient and physician education and treatments that have been shown to work.  


*Krishnan S, Nash F, Baker N, Fowler D, Rayman G. Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care. 2008;31: 99–101. pmid:17934144

**Saraogi RK  Diabetic Foot Ulcer:  Assessment and management.  J. Ind. Med. Assoc.  2008 Feb: 106(2):112, 114, 116 passim. 

What would an amputation mean to me?

After one limb amputation, half of patients will have their other limb amputated within 2 years.



Goldner, M  The fate of the second leg in the diabetic amputee 

Diabetes 1960 Mar; 9(2): 100-103.


The 5-year survival rate after amputation of a limb is 32%. 



Icks A, Scheer M, Morbach S, Genz J, Haastert B, Giani G, Glaeske G, Hoffmann F. Time-dependent

impact of diabetes on mortality in patients after major lower extremity amputation: survival in a

population-based 5-year cohort in Germany.  Diabetes Care. 2011 Jun;34(6):1350-4.

doi: 10.2337/dc10-2341. Epub 2011 May 3.  PubMed PMID: 21540432; PubMed Central PMCID: PMC3114367.


This is why we should make all efforts to avoid amputations.



How do I treat my diabetic foot ulcer?

For most people--those with reasonable circulation, reasonable control of blood sugar, and

no wound infection--the single biggest factor in getting a wound to close is getting the body
weight off the ulcer.  This is known as offloading, and it is simply vital in treating diabetic and
other neuropathic wounds.  For more information, please visit our page on offloading.

However, at present, our provincial plans don't typically pay for offloading, even though this is
the most effective treatment for ulcers available.  And long-term offloading is the most effective
way of keeping ulcers closed. 


For most people--again, those with reasonable circulation, reasonable control of blood sugar, and
no wound infection--the second most important factor in wound healing is removing the dead tissue
that often surrounds and covers a wound.  The removal of thickened, dead tissue is known as debridement,
and statistics from over 300,000 wounds in 525 wound care clinics conducted over five years found that healing
is improved significantly if debridement is performed weekly. 



Wilcox JR, Carter MJ, Covington S Frequency of debridements and time to heal: a retrospective cohort study of 312,744 wounds JAMA Dermatol. 2013; 149(12):1441

For more information, please visit our page on debridement.

When debridement and offloading are combined, studies have shown as many as 90% of ulcers will heal within 6-8 weeks. 

Unfortunately, as with offloading, debridement is not performed as much as it should be--mostly because there are few physicians covered by provincial health plans that are trained, or even interested, in doing debridement. 


The medical specialist that has biomechanical, medical and surgical training to debride and offload are podiatric surgeons.  And while study after study around the world shows podiatrists save limbs, save lives, and save money, for the most part, most Canadian provinces don't fund the majority of podiatric services.    Patients may have to pay out of pocket or rely on a third party insurer to cover podiatric services.  The Canadian Medical Alliance for the Preservation of the Lower Extremity (Canadian MAPLE) is trying to change this.  For more information, visit out page on podiatrists. 

For most people--those with reasonable circulation, reasonable control of blood sugar, and no infection--the third factor in wound healing is the wound dressing.   Dressings serve an important role.  They help protect the wound from contamination and mechanical injury.  When appropriately chosen, they can provide moisture for dry wounds.  And they can remove moisture from wet, macerated wounds.  And they may play a role in inhibiting bacterial growth.

So dressings are important. 


But in truth, they are probably over emphasized in Canada.  The government pays for dressing changes, so the emphasis in wound healing in Canada has been on frequent dressing changes.  However, without debridement and offloading, dressings alone will rarely heal a wound.  


Keep in mind the mantra in the wound care world:  It's not so important what you put on a wound (like the bandage or medicines)--it's what you take off--(like the body weight and the dead tissue).

Our group, the Canadian Medical Alliance for the Preservation of the Lower Extremity (Canadian MAPLE), is advocating for the government to insure what has been demonstrated to actually help wound heal.

While Offloading, Debridement and Dressings are all important in wound care, when
infection is present, treating the infection becomes the single most important factor
in healing a wound.  In this case, antibiotics can be the difference between losing a
limb and keeping a limb, or losing a life and keeping a life. 

However, when there is no infection present, antibiotics are useless.  Antibiotics do
not heal uninfected wounds.

When circulation is insufficient, improving blood supply through a vascular surgeon
becomes the most important factor.  Nothing heals without enough blood.

When the sugar is too high, wounds will often not heal, even with debridement,
offloading and a proper dressings.  Keeping sugar under control is very important.


How long should it take to heal my diabetic foot ulcer?


Several studies show that up to 90% of ulcers that receive proper offloading and debridement will heal within 6-8 weeks. 


Mueller MJ, Diamond JE, Sinacore DR, Delitto A, Blair VP III, Drury DA, Rose SJ: Total contact casting in treatment of diabetic plantar ulcers: controlled clinical trial. Diabetes Care 12:384–388, 1989

Caravaggi C, Faglia E, De Giglio R, Mantero M, Quarantiello A, Sommariva E, Gino M, Pritelli C, Morabito A: Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study. Diabetes Care 23:1746–1751, 2000

Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB: Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care 24:1019–1022, 2001

However, many ulcers take longer to heal.  Sometimes many months.  This is particularly so if the patient smokes or has poor circulation, if the sugar is not well controlled, if the patient does not have adequate nutrition, or if the patient does not have enough off-loading or debridement performed.  


What we know is that time is of the essence in treating wounds.  If we see 50% or more healing in the first four weeks of treatment, more than 80% of wounds will be closed by week 12.  If there is less than 50% improvement at 4 weeks, just 9% of ulcers will heal by week 12.  


Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of
complete healing in a 12-week prospective trial. Diabetes Care. 2003  Jun;26(6):1879-82. PubMed PMID: 12766127.



So we need to treat wounds when they're still in the fresh, acute stage.  We cannot afford ineffective treatments that waste time and allow wounds to become chronic.


What if I'm not healing?

If patients do not demonstrate at least 40-50% of closure within the month, it is unlikely they will heal at three months.  So the situation needs to be reassessed. 


The most likely reason a wound won't heal are these: 


1.  There may not be enough offloading.  Patient compliance is notoriously poor.  A more aggressive offloading
     option, one the patient cannot remove, like a total contact cast, may need to be considered.

2.  There is an issue with the level of bacteria present in the wound.  This may be true even when there are none of
     the outward signs of infection.  Imaging may be performed.  More frequent debridement, which removes both
     bacteria and the dead tissue the bacteria eat may be indicated.  And an antibacterial agent may need to be

3.  There is inadequate circulation present to heal.  An Ankle-Brachial Index (ABI) or vascular imaging may be
     ordered.  And a referral to a vascular surgeon may be required.

4.  The blood glucose level is not well enough controlled.  To see a visual example of how high sugar can adversely
     affect wound healing, click here.
5.  There is inadequate nutrition--most commonly, not enough protein in the diet.  

6.  Other medical issues (co-morbidities) are complicating the patient's ability to heal.

Once my ulcer is healed, what are the odds it will return?


In one recent study it was estimated that 40% of patients have a recurrence within 1 year after ulcer healing, almost 60% within 3 years, and about two-thirds will return within 5 years.





Armstrong D, Boulton A, Bus S  Diabetic Foot Ulcers and Their Recurrence 

New England Journal of Medicine 2017;376:2367-75. DOI: 10.1056/NEJMra1615439


Another study found that the most likely ulcers to return were those on the great toe, with 83% of ulcers recurring within 31.5 months of the study.

Peters, Edgar JG, Armstrong David G, Lavery, Lawrence A, Risk Factors for Recurrent

Diabetic Foot Ulcers: Site matters  Diabetes Care, Volume 30, No. 8,   August 2007, p 2077-2079

The most common reason for this is inadequate offloading, so the mechanical cause of the ulcer was not addressed sufficiently, or if the patient is non-compliant in using offloading footwear..

Because of the high recurrence rate, neuropathic wounds should be considered like

cancer.  Foot ulcers are never permanently healed, they are just in remission.

Is there anything I can do to lower the odds of my ulcer returning?





It begins with vigilance.  If you've had an ulcer, you should examine your feet daily,
and see your podiatrist, family physician, specialist nurse, or other foot health

professional regularly.  We'd recommend a guideline of every two months, but you
may need to be seen more or less frequently. 

The second key to lasting closure is addressing the mechanical cause of the ulcer. This might mean an orthotic or a special shoe to remove pressure from a susceptible location.  This is absolutely vital to long-term wound healing.  Unfortunately, the decision makers in government do not understand this, and our provincial plans don't typically cover this.  It may have to be covered by an extended plan, social services, or paid out of pocket.


Addressing the mechanical cause of an ulcer could also mean a surgery.  This could include remodeling a prominent bone that creates the ulcer, lengthening a tendon that's pulling a normal bone into abnormal pressure spot, or some other measure.


Podiatric surgeons specialize in both the biomechanics and surgical care of the foot, and expend a lot of effort preventing

amputations.  However, most provinces don't cover this care either.  

Can diabetic foot ulcers be prevented?


Yes.  One estimate suggests 85% of these ulcers are preventable through a combination of good foot care and        appropriate education for patients and healthcare providers.  



Saraogi RK  "Diabetic Foot Ulcer:  Assessment and management".

J. Ind. Med. Assoc.  2008 Feb: 106(2):112, 114, 116 passim. 



        We hope this website provides some of the information patients can use to prevent ulcers. 

But there is no substitute for seeing your diabetic foot specialist regularly.


How much do we spend on wound care in Canada?


We've devoted a separate page to this topic.  Please visit it here.

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5-year survival rate of cancers of diabe

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                                                             --Marty Rubin

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All clinical photographs are owned and provided
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Podiatric Surgeon, Surrey, BC  Canada

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