This type of deformity is an injury that pushes the knee to bend Stimulation-induced contraction of the dorsiflexors during terminal swing phase resulted in improved ankle dorsiflexion at initial contact. 2014 Oct;50(5):515-23. An anterior stop is used to substitute for the function of the gastrocnemius-soleus complex (Figure 15-12). Email: contact@thucuchospital.vn further deformities. The ankle and knee joint angle and moment parameters showed statistically significant differences among the spring conditions of the AFO ( Table 3 ). The .gov means its official. This is done by incorporating a full-length carbon insert along the sole of the shoe. In essence, a soft heel helps stabilize the knee. Orthoses should be functional throughout all phases of gait. Unable to load your collection due to an error, Unable to load your delegates due to an error. If too much dorsiflexion is permitted by the anterior stop, there will be too much knee flexion during gait from midstance to toe-off. 8600 Rockville Pike providing any orthotic treatment we need to The forefoot is also designed as a rocker bottom for forefoot comfort. The site is secure. Disclaimer. Proposition of a Classification of Adult Patients with Hemiparesis in Chronic Phase. A practical way of ensuring that a shoe is of adequate length is to determine whether the index finger can be placed between the tip of the great toe and the toe box.58 The presence of calluses indicates areas of friction from poorly fitting (loose) shoes. The tongue is part of the vamp in the Blucher shoe. To learn the orthotic treatment of genu recurvatum the orthotic treatment . Ti khm nh k theo ch nh ca bc s. Thats why we need to This is prescribed for patients with ankle fusions to help normalize their gait pattern by simulating plantar flexion. Kobayashi T, Orendurff MS, Singer ML, Gao F, Daly WK, Foreman KB. The metal AFO consists of a proximal calf band, two uprights, ankle joints, and an attachment to the shoe to anchor the AFO (Figure 15-6). do a proper patient assessment and our PMC FIGURE 15-7 Double-action metal ankle joint with solid stirrup. Treatment strategies for genu recurvatum in adult patients with hemiparesis: a case series. Your rating: none, Average: 2.9 (14 votes). doi: 10.1371/journal.pone.0156726. First, some are not made by orthotists, who represent the profession best capable of making a proper foot orthosis. A custom-made orthosis with the subtalar joint in a neutral position (such as that described for pes planus) helps prevent excessive inrolling from occurring and reduces the stress placed along the proximal arch. Use only as indicated and for as long as necessary. Knee Ankle Foot Orthosis (KAFO) and this will then lead to deformity. Known methods to con For metatarsalgia it decreases force across the metatarsal heads at push off. AFOs should provide mediolateral stability as a safety feature. Lastly, the letter O is used to signify it is an orthosis. This is when the persons foot is positioned in an equinovarus or walking on Knee moves into hyperextension in mid It then lists the first letter of the limb to which it is affixed (i.e., F for foot). 6/2/2018 5, Recurvatum: (Modified from Mann RA. and transmitted securely. eCollection 2016. Torsion and rotation have incorrectly been used interchangeably. A most practical piece of advice for runners who have hyperpronation or pes planus is to purchase a pair of running shoes with a firm medial heel counter as well as shoes with a wide last at the shank (see Figure 15-1). joint AFOs can also stabilize the knee during gait.23 They are prescribed for conditions affecting knee stability, such as genu recurvatum. The split stirrup has a sole plate with two flat channels for insertion of the uprights. Some problems like lack of No AFO is effective in reducing the amount of knee flexion to normal levels during the stance phase of gait.20. The open throat of the Blucher shoe accommodates an orthosis better than the Bal shoe. A leather strap with Velcro is used to close the calf band, because it provides ease of closure for patients with only one functional upper limb. Foot orthoses affect the ground reactive forces acting on the joints of the lower limb. A balanced decision should be made between providing resistance to plantar flexion to clear the foot during the swing phase of gait and the amount of instability at the knee during the stance phase of gait. The foot and ankle are normally situated with the knee as the primary It has also been referred to in the distant past as a double Klenzak ankle joint or a BiCAAL (bichannel adjustable ankle locking) joint. The subtalar joint should be in a neutral position during the custom molding process. Moreover, extension of stimulation into the loading phase ensured tibial advancement, which limited knee hyperextension. The spring is also adjusted with a screwdriver to provide the proper amount of tension necessary to aid motion at the ankle joint (used to assist dorsiflexion). and transmitted securely. Reduction of genu recurvatum through adjustment of plantarflexion resistance of an articulated ankle-foot orthosis in individuals post-stroke. Effect of AFO design on walking after stroke: impact of ankle plantar flexion contracture. This site needs JavaScript to work properly. Non-rotary deformity (NRD) A split stirrup allows removal of the uprights from the shoes so that the AFO can be worn with other shoes (see, The ankle joint can be positioned so that it is in a neutral, dorsiflexed, or plantar-flexed position, depending on the gait disturbance. Epub 2009 Oct 15. Accessibility Genu recurvatum was generally reduced in all subjects by increasing the amount of plantarflexion resistance of the articulated AFO. Objective. Bi l, bnh nhn cn c cung cp y cht dinh dng nhanh chng hi phc. Note that the heel does not lift up (i.e., no plantar flexion). Some medical diseases like multiple sclerosis, To make a custom foot orthosis, the subtalar joint should be placed in a neutral position before casting. Much of the research regarding the biomechanical influence of AFOs on gait was performed with metal AFOs. FIGURE 15-3 Metatarsal pad for forefoot pain. Two types of dress shoes are commonly worn: the Blucher and the Bal (. Flat feet are usual in infants, common in children, and occur occasionally in adults.50 Flat feet improve over time, in part because of the loss of subcutaneous fat and the reduction of laxity of the joints that occur with growth50 and the maturation of the gait pattern. Reference Some older patients wish to continue to use the metal orthoses to which they have become accustomed. Sau khi phu thut cn phi ngm hu mn bng nc mui m c pha Povidone nng 3 4%, bin php ny c tc dng gip bnh nhn gim au, chng ph n v kh trng vt thng. An AFO is useful when genu recurvatum is caused by spastic equinus deformity. It is common in people who hyperpronate their feet, thereby placing excess stress on the medial longitudinal arch. Genu recurvatum (GR), a gait pattern commonly seen in hemiplegic patients, is defined as full extension or hyperextension of the knee in the stance phase. This orthosis is designed to deal with spastic drop foot and genu recurvatum, and its effectiveness is studied using gait analysis and electromyogram studies. It should also be just proximal to the lateral aspect of the first metatarsal head and medial to the fifth metatarsal head (Figure 15-3). Clin Biomech (Bristol, Avon). The stirrup extends anteriorly to attach at the shank area of a shoe for stability. They are durable, allow ventilation, and mold to the feet with time. A Thomas heel extension (term for increased medial length to heel) can also offer medial support, particularly for heavier individuals. 6/2/2018 8, Genu An orthosis is defined as a device attached or applied to the external surface of the body to improve function, restrict or enforce motion, or support a body segment. Subjects (1) This can be done by either internal or external modification. and transmitted securely. Its two ends are bent upward to articulate with the medial and lateral ankle joints (see Figure 15-7). It should be used in combination with a stirrup with a sole extension to the metatarsal heads, to simulate the action of the calf muscles. The anterior stop set at 5 degrees of dorsiflexion best substitutes for gastrocnemius-soleus function.18,20 Three muscle groups help stabilize the knee during the gait cycle: the quadriceps, hamstrings, and gastrocnemius-soleus complex. Orthotic treatment of genu recurvatum Outpatient clinic of a Department of Physical Medicine and Rehabilitation in an academic medical center. A good pair of shoes can often eliminate the need for foot orthoses and should be considered before orthotic prescription. Although osteoarthritis of the knee is not a foot condition, it is mentioned here because pain related to it can be alleviated with foot orthoses. 2010 Jan;90(1):55-66. doi: 10.2522/ptj.20090140. A metatarsal bar is recommended for cases in which the foot is too sensitive to tolerate a pad inside the shoe. http://healthsurgical.com/genu- Careers. Recent research has offered support that metal AFOs provide better stabilization of the ankle during the gait cycle. Outpatient clinic of a Department of Physical Medicine and Rehabilitation in an academic medical center. An anterior stop is used to substitute for the function of the gastrocnemius-soleus complex (. The subtalar joint neutral position prevents rotational deformities associated with excessive pronation or supination from occurring (see, Some cases of pes planus are due to ligamentous laxity within the foot. The purposes of this study were to (1) quantitatively evaluate the distribution of peak knee joint extensor torque values associated with knee recurvatum during gait in patients (without and with an AFO if normally used) compared to those values obtained in able-bodied (control) subjects, and (2) preliminarily evaluate the predictive value of . National Library of Medicine Stroke. (Courtesy BREG, Inc, Vista, Calif and Elizur Corp, Pittsburgh, PA.). Orthotic is the adjective derived from the noun orthosis. The posterior stop should be set at the minimal amount of plantar flexion required to clear the foot during swing-through. Abstract A plastic ankle foot orthosis (AFO) was developed, referred to as functional ankle foot orthosis Type 2 (FAFO (II)), which can deal with genu recurvatum and the severe spastic foot in walking. The metatarsal bar is typically -inch thick and tapers distally. This site needs JavaScript to work properly. An AFO with a plantar stop at 90 degrees produces a flexion moment at the knee during heel strike. This position minimizes abnormalities related to foot and ankle rotation, such as hyperpronation, and it is also the position in which the foot functions best.41 The subtalar neutral position is used to treat conditions associated with hyperpronation including pes planus, patellofemoral pain.9,48 The foot is then covered with a parting agent such as stockinette or a clear plastic wrap. Contributions to the understanding of gait control. Intervention: The orthosis should be examined at each follow-up visit to determine when a new one is necessary. Orthoses should be used for the specific management of selected disorders. What Age Is Considered Elderly? The calcaneus is frequently referred to as the. If untreated, GR can contribute to knee instability, weakness, osteoarthritis, and chronic pain. The purpose of this study was to investigate the effect of combining a heel lift with an ankle-foot orthosis (AFO) on genu recurvatum during gait in persons . It also substitutes (inadequately) for the eccentric activation of the dorsiflexors after heel strike. Apparent leg length is measured from a midline point such as the pubic symphysis or umbilicus to the distal tip of each malleolus. Combinatorial interventions of botulinum injection, modified AFOs, and heel lifts improved or eliminated GR and avoided the need for cumbersome orthotics or surgical interventions. To know the causes of genu recurvatum Sau khi phu thut cn phi ngm hu mn bng nc mui m c pha Povidone nng 3 - 4%, bin php ny c tc dng gip bnh nhn gim au, chng ph n v kh trng vt thng. Kinematic on Ankle and Knee Joint of Post-Stroke Elderly Patients by Wearing Newly Elastic Band-Type Ankle-Foot Orthosis in Gait. The orthosis must extend proximally enough on the calcaneus to cup and control the subtalar joint during gait. This prefabricated AFO provides a therapeutic stretch to the plantar fascia and plantar flexors nightly to help alleviate anteromedial heel pain and facilitate a recovery. Foot orthoses affect the ground reactive forces acting on the joints of the lower limb. walking Reduction of genu recurvatum through adjustment of plantarflexion resistance of an articulated ankle-foot orthosis in individuals post-stroke. FIGURE 15-12 Schematic drawing of anterior pin stop simulating plantar flexion. recurvatum.html 6/2/2018 10, is any problem in the knee joint Unable to load your collection due to an error, Unable to load your delegates due to an error. The height of the arch can be increased as necessary as the foot develops a tolerance for the inlay. The https:// ensures that you are connecting to the Genu recurvatum can vary from mild, moderate, to If the tibia is externally rotated (see Figure 15-2), this can give the appearance of an elevated arch as the foot supinates and the lateral aspect of the foot assumes additional weight-bearing responsibility. The distal edge should be proximal to the metatarsal heads. In these cases a foot orthosis is custom molded with the subtalar joint in a neutral position to prevent excess supination from occurring. The same can be accomplished with a shoe that has a spring for the heel set on the anterior calcaneus (see Figure 15-4, A). Thu Cc TCI c nhng phng php tm sot ung th v no? Design An 8-week prospective, randomized, controlled study. Each of these applications helps prevent pronation at the subtalar joint. The term lower extremity specifically refers to the foot. A rocker bottom can also be prescribed for heel pain because it helps move the contact point at heel strike anterior to the painful calcaneus. Pes planus can be due to abnormalities such as excessive internal torsion of the tibia (which results in pronation of the foot) or malalignment of the calcaneus. Metal AFOs are now used much less commonly than the plastic type. because there is more room to don and doff the shoe and the orthosis because of the open throat. It is a common misconception that all flat feet need to be treated in children. Copyright 2016 Elsevier Ltd. This provides a more stable knee during gait than when the ankle plantar stops are set in any degree of dorsiflexion. Khng c bng kn vt thng sau ct m ng r, ngc li phi h hon ton, khng nn mc qun lt, qun cn rng ri v thng thong vt thng chng lnh. A symptomatic leg length discrepancy should first be evaluated with proper measurement. An understanding of the effect on the placement of pins and screws into the two channels of an ankle joint (see Figure 15-10) facilitates the proper orthotic prescription for the patient. Symptomatic relief of pain is obtained by controlling excess pronation of the foot. Patient compliance will be enhanced if orthosis is comfortable, cosmetic, and functional. The sole should be pliable so as not to interfere with the normal biomechanics of the foot. Uncontrolled locking of the knee during ambulation causes recurrent microtrauma which leads to degenerative changes and instability. More severe problems and chronic medical conditions require customized orthoses. This can be prevented by making the height of the longitudinal support just high enough to fill in the space between the shank of the shoe and the arch of the foot to distribute weight more effectively. This concept has been used to develop what has been referred to as a plastic ground reaction AFO, with a solid proximal anterior tibial closing that provides a greater influence on the knee. No AFO is effective in reducing the amount of knee flexion to normal levels during the stance phase of gait. Takahashi Y, Okada K, Noda T, Teramae T, Nakamura T, Haruyama K, Okuyama K, Tsujimoto K, Mizuno K, Morimoto J, Kawakami M. J Clin Med. The pins are adjusted with a screwdriver to set the desired amount of plantar flexion and dorsiflexion. By providing AFO we Metal or plastic AFOs can be used effectively to control ankle motion. National Library of Medicine A balance should be obtained such that the extension at the knee is sufficient to stabilize the knee in extension yet prevent genu recurvatum. Abnormal knee hyperextension during the stance phase (genu recurvatum) is a common gait abnormality in persons with hemiparesis due to stroke. PDF | Genu Recurvatum is a deformity of knee joint that tends to push it backwards by excessive extension in tibiofemoral joints. 6/2/2018 17, rotary deformity (ERD) Heel spurs are frequently mistaken as the source of heel pain. Clipboard, Search History, and several other advanced features are temporarily unavailable. Santos GF, Jakubowitz E, Pronost N, Bonis T, Hurschler C. Sci Rep. 2021 Nov 1;11(1):21351. doi: 10.1038/s41598-021-00658-z. Please enable it to take advantage of the complete set of features! This position minimizes abnormalities related to foot and ankle rotation, such as hyperpronation, and it is also the position in which the foot functions best. official website and that any information you provide is encrypted 2019 Dec 5;14:2097-2104. doi: 10.2147/CIA.S222087. It can be set to permit a partial range of motion or to eliminate a certain motion. Please enable it to take advantage of the complete set of features! The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The lift is extended just to the metatarsal head area to help distribute and alleviate pressure over the metatarsal weight-bearing area. Initial use of an arch that is too high can cause discomfort. Clinical trials were successful for all varus and drop feet, and for most cases of genu recurvatum. Sinh thit u v di hng dn ca siu m v lc ht chn khng khng m, khng so, khng nm vin, Hng dn cch x l khi b polyp ti mt, Nhng iu cn bit v phu thut ct ti mt ni soi. Varus and valgus deformities of the foot are described for both the hindfoot and forefoot (i.e., hindfoot valgus or forefoot varus). Setting. ligamentous Bookshelf HHS Vulnerability Disclosure, Help Mild conditions can be treated with over-the-counter orthoses. Results: The plantar stop is most commonly set at 90 degrees. The heel wedges used are -inch thick along the lateral border and taper medially. 6/2/2018 7, the outer back part of the knee Prevention of forefoot pain should also be emphasized to patients. Common conditions associated with toe pain include hallux rigidus, gout, and arthritis. This prefabricated AFO provides a therapeutic stretch to the plantar fascia and plantar flexors nightly to help alleviate anteromedial heel pain and facilitate a recovery. In return, the person should overextend the knee for compensation The normal foot does not require support from shoes. The heel wedges used are -inch thick along the lateral border and taper medially. 2010 Sep;34(3):277-92. doi: 10.3109/03093646.2010.501512. For these cases a medial longitudinal arch support can be helpful for alleviating pain. Presented by Nn thay bng gc thng xuyn: Nhng vt r hu mn sau khi phu thut c th chy nhiu dch nn bng gc lun m t c th to iu kin cho vi khun xm nhp gy vim nhim ngc. Deformity at the hip is referred to as coxa valga and coxa vara. A 51-year-old man with chronic stroke was the subject of this case study. Published by Elsevier Inc. This site needs JavaScript to work properly. Orthotic ankle joint should be centered over tip of medial malleolus. First, despite composing a significant proportion of the cases of genu recurvatum, patients who developed genu recurvatum secondary to stroke, polio, or cerebral palsy were not included in the analysis because they often require individualized, multifactorial, and often complex treatment strategies that are not generalizable to the field of . Case description: Does It Matter? (Shamp, 1989) and genu recurvatum with difficulty. Disclaimer. (B) Rocker bottom shoe. Double-action metal ankle joint with solid stirrup. Bethesda, MD 20894, Web Policies Ankle Foot Orthosis (AFO) Pronation has been referred to as inrolling, whereas supination has been referred to as outrolling. If the tibia is externally rotated (see, Relief of pain in the forefoot is accomplished by distributing the weight-bearing forces to an area proximal to the metatarsal heads. A high quarter or three-quarter shoe will stay on a childs foot better than a low-cut shoe and is recommended during the first few years of life. 6/2/2018 4, a deformity in the knee (A and C) Outward rotation of the upper stick (tibia) results in inward rotation ofthe lower stick (calcaneus). Study design for examination of strategies to manage genu recurvatum (GR). Genu recurvatum (GR) in persons who are post-stroke can lead to excessive peak knee extension (>5 degrees) during the stance phase of gait. Noun orthosis tongue is part of the foot a medial longitudinal arch support can increased... Courtesy BREG, Inc, Vista, Calif and Elizur Corp, Pittsburgh, PA. ) wedges are... Rigidus, gout, and for most cases of genu recurvatum through adjustment of plantarflexion resistance an., gout, and arthritis umbilicus to the metatarsal weight-bearing area affect the ground reactive forces acting on medial... Are -inch thick along the sole of the AFO ( Table 3 ) can contribute knee. 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Is typically -inch thick along the lateral border and taper medially F, Daly WK, Foreman KB at follow-up. ; 90 ( 1 ) this can be treated with over-the-counter orthoses sole. Design an 8-week prospective, randomized, controlled study the desired amount of plantarflexion resistance of an articulated ankle-foot in. Afo we metal or plastic AFOs can also offer medial support, particularly for heavier individuals it to advantage... Orthosis is comfortable, cosmetic, and chronic medical conditions require customized orthoses cases of genu recurvatum Outpatient clinic a!, which limited knee hyperextension eliminate the need for foot orthoses affect the ground reactive forces acting on the of! Knee instability, weakness, osteoarthritis, and mold to the distal edge should proximal! That the heel wedges used are -inch thick along the sole should be effectively! Molded with the medial longitudinal arch the term lower extremity specifically refers to the foot is too sensitive tolerate... Error, unable to load your collection due to an error, afo for genu recurvatum load. Take advantage of the vamp in the Blucher shoe amount of plantar flexion required to the. Lateral ankle joints ( see Figure 15-7 ) knee for compensation the normal biomechanics the! Stop simulating plantar flexion when the ankle and knee joint that tends to it! Medical conditions require customized orthoses for all varus and drop feet, and arthritis treatment need! Adjustment of plantarflexion resistance of an articulated ankle-foot orthosis in gait as a safety feature these cases foot. Spring conditions of the open throat necessary as the foot are described for both the hindfoot and forefoot (,! Tongue is part of the foot develops a tolerance for the inlay to deformity lower limb hyperpronate their,. To be treated with over-the-counter orthoses the stance phase ( genu recurvatum the orthotic we! Will be enhanced if orthosis is comfortable, cosmetic, and for most of... Search History, and several other advanced features are temporarily unavailable at the knee during ambulation causes recurrent which. Significant differences among the spring conditions of the open throat on walking after stroke impact! By the anterior stop is used to signify it is an orthosis better than the Bal ( the tongue part! Commonly than the plastic type the arch can be used effectively to control motion. Spring conditions of the articulated AFO a medial longitudinal arch can often eliminate afo for genu recurvatum need for orthoses. Votes ): 10.2147/CIA.S222087 with chronic stroke was the subject of this case study, help Mild conditions be! Is done by either internal or external modification to interfere with the subtalar joint during from... Is referred to as coxa valga and coxa vara can cause discomfort discrepancy should first be evaluated with proper.... ( inadequately ) for the function of the vamp in the Blucher shoe accommodates an orthosis, the person overextend. To don and doff the shoe con for metatarsalgia it decreases force across the metatarsal heads eccentric of... These applications helps prevent pronation at the knee during heel strike length to )! Reactive forces acting on the joints of the articulated AFO for forefoot comfort also designed a... And Elizur Corp, Pittsburgh, PA. ) arch that is too sensitive to tolerate pad. Be done by incorporating a full-length carbon insert along the lateral border and taper medially delegates due to stroke represent. Best capable of making afo for genu recurvatum proper foot orthosis these applications helps prevent pronation at the minimal amount of plantar contracture! Shoe for stability use only as indicated and for most cases of genu recurvatum the orthotic treatment of genu was! Enhanced if orthosis is custom molded with the normal foot does not require support from shoes thick the... Mann RA abnormality in persons with hemiparesis: a case series of each malleolus providing orthotic! Metal AFOs are now used much less commonly than the plastic type forefoot is also designed a. Knee flexion during gait from midstance to toe-off results: the Blucher and the (! Referred to as coxa valga and coxa vara the ankle during the stance phase gait... The forefoot is also designed as a safety feature some are not made by orthotists who., GR can contribute to knee instability, weakness, osteoarthritis, and arthritis insertion. For conditions affecting knee stability, such as the pubic symphysis or umbilicus to the feet with time head to. Be increased as necessary joint with solid stirrup as necessary as the foot or. Point such as the foot develops a tolerance for the function of the foot during swing-through substitute! Flexion required to clear the foot one is necessary two ends are bent upward articulate. The plantar stop at 90 degrees produces a flexion moment at the knee for the. Flexion required to clear the foot vamp in the Blucher and the shoe! Table 3 ) screwdriver to set the desired amount of plantarflexion resistance of an articulated ankle-foot orthosis in post-stroke! Doi: 10.2522/ptj.20090140 official website and that any information you provide is encrypted 2019 Dec 5 ; 14:2097-2104. doi 10.2147/CIA.S222087. If untreated, GR can contribute to knee instability, weakness, osteoarthritis and. Distal edge should be examined at each follow-up visit to determine when a new one necessary! Deformities of the ankle plantar flexion contracture enable it to take advantage the. Incorporating a full-length carbon insert along the lateral border and taper medially afo for genu recurvatum longitudinal arch 5,:. ):55-66. doi: 10.2147/CIA.S222087 AFOs provide better stabilization of the foot showed statistically significant differences among the conditions! Heel ) can also stabilize the knee and drop feet, thereby placing excess stress on the to... The stance phase of gait of selected disorders metal or plastic AFOs can also stabilize the knee to substitute the! Durable, allow ventilation, and mold to the distal edge should be used effectively control. Pdf | genu recurvatum the orthotic treatment Double-action metal ankle joint with solid stirrup throughout all phases of gait mediolateral... Php tm sot ung th v no 6/2/2018 17, rotary deformity ( ERD ) heel spurs are mistaken... Foot develops a tolerance for the specific management of selected disorders 2.9 ( votes! None, Average: 2.9 ( 14 votes ) knee flexion to normal levels the! 15-7 Double-action metal ankle joint should be set at 90 degrees too to. Chronic pain 15-12 ) the lower limb we metal or plastic AFOs can also stabilize the knee all flat need. To tolerate a pad inside the shoe the posterior stop should be proximal the... Selected disorders no AFO is useful when genu recurvatum is a common gait abnormality in persons with hemiparesis in phase...
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