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<Provider Id="sundheddkcms"> <Item Id="{1A9BB006-58D1-4CB0-BC36-59BB5614B615}" Name="plantar-fasciitis" Type="LHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{02851690-7266-4B57-B98E-D30DB1AE8AB3}" SortOrder="1800" PublishDate="2010-05-26T10:57:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2> <h3>Diagnostiske kriterier</h3> <ul> <li>Typisk sygehistorie og lokale fund</li> </ul> <h3>Sygehistorie</h3> <ul> <li>Gradvis tiltagende smerter under hælen, specielt på medialsiden, og typisk ca. fem centimeter fra hælens bagerste ende</li> <li>Smerterne er i begyndelsen kun til stede ved belastning, men efterhånden også i hvile</li> <li>Af og til stråler smerterne fremad i foden, og de kan omfatte størstedelen af hælens underside</li> <li>Smerterne er ofte værst om morgenen, for så at aftage i løbet af dagen <ul> <li>De første skridt ud af sengen om morgenen er de værste</li> <li>Hvis smerterne er til stede også i hvile, vil disse typisk være mest intense om aftenen</li> </ul> </li> <li>Smerterne kan lindres hos nogle patienter, ved at de går på tæer</li> <li>Mange patienter kan berette om udløsende forhold, f.eks. øget træningsintensitet, nye sko eller træning på andet underlag</li> </ul> <h3>Kliniske fund</h3> <ul> <li>Palpationsømhed i forkanten af tuber calcanei, mest udtalt på hælens medialside ved udspringet for plantarfascien</li> <li>Dorsalfleksion af tæerne kan forværre smerten ved palpation (Windlass effekt)</li> <li>Påvisning af palpabel defekt ved tuber calcanei, samt lokal hævelse og blødning, tyder på ruptur af plantarfascien</li> </ul> <h3>Supplerende undersøgelser i almen praksis</h3> <ul> <li>Klinisk undersøgelse med vurdering af "Windlass effekt"</li> </ul> <h3>Andre undersøgelser hos specialist</h3> <ul> <li>Ultralyd <ul> <li>Kan differentiere mellem normal plantar fascie og plantar fasciitis<a title="Mahowald S, Bradford SL, Grady JF, The correlation between plantar fascia thickness and symptoms of plantar fasciitis. J Am Podiatr Med Assoc 2011;101: 385-9" href="EditorPage.aspx?da=core&id=%7B1A9BB006-58D1-4CB0-BC36-59BB5614B615%7D&ed=FIELD28967629271&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H28967629499&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Mahowald S, Bradford SL, Grady JF, The correlation between plantar fascia thickness and symptoms of plantar fasciitis. J Am Podiatr Med Assoc 2011;101: 385-9" data-value-piped="Mahowald S, Bradford SL, Grady JF|The correlation between plantar fascia thickness and symptoms of plantar fasciitis|J Am Podiatr Med Assoc|2011|101|385-9" data-url="reference-link">1</a></li> </ul> </li> <li>MR-scanning <ul> <li>Er sjældent indiceret, men er den mest sensitive undersøgelse. Kan påvise fortykket proksimal plantarfascie (7-8 mm mod normalt 3-4 mm), inflammation, omliggende bløddelsødem, reaktivt knoglemarvødem i calcaneus og ruptur af midterste eller proksimale segmenter</li> </ul> </li> <li>Røntgen <ul> <li>Undersøgelsen er hverken sensitiv eller specifik og udføres først og fremmest for at udelukke andre lidelser f.eks. stressfraktur af calcaneus</li> <li>Hælspore forekommer hyppigt blandt personer uden plantarfasciit. Modsat har mange med fasciit ikke hælspore<a title="Schneider HP, Baca JM, Carpenter BB, Dayton PD, Fleischer AE, Sachs BD, American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain. J Foot Ankle Surg 2018;57: 370-381" href="EditorPage.aspx?da=core&id=%7B1A9BB006-58D1-4CB0-BC36-59BB5614B615%7D&ed=FIELD28967629271&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H28967629499&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Schneider HP, Baca JM, Carpenter BB, Dayton PD, Fleischer AE, Sachs BD, American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain. J Foot Ankle Surg 2018;57: 370-381" data-value-piped="Schneider HP, Baca JM, Carpenter BB, Dayton PD, Fleischer AE, Sachs BD|American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain.|J Foot Ankle Surg|2018|57|370-381|29284574" data-url="reference-link" data-pubmedid="29284574">2</a></li> </ul> </li> </ul> <h3>Differentialdiagnoser</h3> <ul> <li>Se artikel om <a href="~/link.aspx?_id=8E8703C0AC664C2C82041615A9D97F40&_z=z">hæl- og fodsmerter</a></li> </ul> <h2>Behandling</h2> <h3>Behandlingsmål</h3> <ul> <li>Lindre ubehag, dæmpe inflammation og forebygge fremtidige gener</li> </ul> <h3>Generelt om behandlingen</h3> <ul> <li>Almindeligvis konservativ</li> <li>Operation <ul> <li>Kan komme på tale i kroniske tilfælde eller ved mistanke om ruptur, men resultaterne er ikke overbevisende</li> </ul> </li> <li>Videnskabelig dokumentation <ul> <li>Der foreligger et stort antal forskellige behandlingsmodaliteter, og dokumentationen for effekt er sparsom<a title="Salvioli S, Guidi M, Marcotulli G, The effectiveness of conservative, non-pharmacological treatment, of plantar heel pain: A systematic review with meta-analysis. Foot (Edinb) 2017;33: 57-67" href="EditorPage.aspx?da=core&id=%7B1A9BB006-58D1-4CB0-BC36-59BB5614B615%7D&ed=FIELD28967629271&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H28967629499&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Salvioli S, Guidi M, Marcotulli G, The effectiveness of conservative, non-pharmacological treatment, of plantar heel pain: A systematic review with meta-analysis. Foot (Edinb) 2017;33: 57-67" data-value-piped="Salvioli S, Guidi M, Marcotulli G|The effectiveness of conservative, non-pharmacological treatment, of plantar heel pain: A systematic review with meta-analysis.|Foot (Edinb)|2017|33|57-67|29126045" data-url="reference-link" data-pubmedid="29126045">3</a>. Dette er et vidnesbyrd om, at ingen af behandlingerne har vist sikker effekt i gentagne undersøgelser, hvor naturforløbet med svingende smerteintensitet tages i betragtning</li> </ul> </li> </ul> <h3>Håndtering i almen praksis</h3> <ul> <li>Forsøg konservativ behandling og først ved manglende effekt henvisning til specialafdeling eller privatpraktiserende ortopædkirurg </li> </ul> <h3>Råd til patienten</h3> <ul> <li>Aflastning</li> <li>Hensigtsmæssigt fodtøj <ul> <li>God længdebue i skoen modvirker udstrækning og træk i senepladen</li> <li>Hælopbygning</li> <li>Evt. specialindlæg med udsparing udfor det smertefulde område</li> <li>Der er ikke enighed om, hvilke ændringer der er bedst. Måske er det vigtigst at kunne skifte fodtøj hyppigt og bruge sine egne erfaringer</li> </ul> </li> <li>Alternativ træning <ul> <li>Patienten bør undgå langvarig stand eller gang på hårdt underlag</li> <li>Udspænding af plantarfascien</li> </ul> </li> </ul> <h3>Medicinsk behandling</h3> <ul> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/213010">NSAID</a> <ul> <li>Evt. <a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/215000">lokalbehandling</a></li> <li>Kortvarig smertelindring, men ingen dokumenteret langtidseffekt</li> </ul> </li> <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/171050">Lokal injektion af steroider</a> <ul> <li>Stressfraktur skal udelukkes før injektionsbehandling</li> <li>Et <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/225000#IndledningLK">lokalanæstetikum</a> og et <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/171050">kortikosteroidpræparat</a> deponeres i det bløde væv medialt mellem calcaneus og plantarfascien <ul> <li>Injiceres ved det ømmeste punkt</li> <li>Må ikke injiceres i fascien da det kan føre til ruptur</li> <li>Se <a href="~/link.aspx?_id=DA7C1924A69A4FE3B3BAB4463A2AC1A8&_z=z">tegning af injektion</a></li> </ul> </li> <li>Bør ikke gentages ved manglende effekt af første sprøjte</li> <li>Synes at have korttidseffekt, men ikke langtidseffekt</li> <li>Bør kun foretages af ortopædkirurg</li> </ul> </li> </ul> <h3>Anden behandling</h3> <ul> <li>Udstrækning, indlæg og tapening synes at være bedst dokumenteret</li> <li>Fysioterapi med specifik udstrækning af fascien</li> <li>Indlæg<a title="Walther M, Kratschmer B, Verschl J, Volkering C, Altenberger S, Kriegelstein S, Hilgers M, Effect of different orthotic concepts as first line treatment of plantar fasciitis. Foot and Ankle Surgery 2013;19: 103-107" href="EditorPage.aspx?da=core&id=%7B1A9BB006-58D1-4CB0-BC36-59BB5614B615%7D&ed=FIELD28967629271&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H28967629499&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Walther M, Kratschmer B, Verschl J, Volkering C, Altenberger S, Kriegelstein S, Hilgers M, Effect of different orthotic concepts as first line treatment of plantar fasciitis. Foot and Ankle Surgery 2013;19: 103-107" data-value-piped="Walther M, Kratschmer B, Verschl J, Volkering C, Altenberger S, Kriegelstein S, Hilgers M|Effect of different orthotic concepts as first line treatment of plantar fasciitis|Foot and Ankle Surgery|2013|19|103-107" data-url="reference-link">4</a> <ul> <li>Støddæmpende hælindlæg, evt. med udsparing ud for det ømme sted og med støtte af svangbuen</li> <li>Hælkop almindeligvis for at stabilisere fedtvævet under hælen</li> </ul> </li> <li>Natskinne <ul> <li>Med foden i let dorsalfleksion har vist at have effekt. Mange oplever dog, at den er ubehagelig at ligge med </li> <li>Behandlingstid 1-2 måneder</li> </ul> </li> <li>Plasterbandage, hvor hælen tapes op med plasterstrimler. Se video: <a href="https://www.youtube.com/watch?v=LK2QfFD2kI4">Best Taping Technique for Heel Pain (low-dye taping for Plantar Fasciitis</a></li> <li>Ekstrakorporal chokbølgebehandling (EWST), laster, ultralyd, udspænding af lægemuskulaturen og natskinner, er alle sammen tiltag, som i enkelte studier har vist (kortvarig) effekt. Det samme gælder injektion af Platelets rich plasma<a title="Ragab EMS, Ahmed MAO, Platelets rich plasma for treatment of chronic plantar fasciitis. Archives of orthopaedic and trauma surgery 2012;132: 1065-70" href="EditorPage.aspx?da=core&id=%7B1A9BB006-58D1-4CB0-BC36-59BB5614B615%7D&ed=FIELD28967629271&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H28967629499&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Ragab EMS, Ahmed MAO, Platelets rich plasma for treatment of chronic plantar fasciitis. Archives of orthopaedic and trauma surgery 2012;132: 1065-70" data-value-piped="Ragab EMS, Ahmed MAO|Platelets rich plasma for treatment of chronic plantar fasciitis|Archives of orthopaedic and trauma surgery|2012|132|1065-70" data-url="reference-link">5</a> </li> </ul> <h3>Kirurgi</h3> <ul> <li>Er aktuel i kroniske tilfælde eller ved mistanke om afrivning af fascie</li> <li>Dette kan dreje sig om partiel fasciektomi, fjernelse af stor hælspore og dekompression af nerveender</li> <li>En evt. hyperpronationsfod kan forværres noget i tiden efter en operation. Det er vigtigt, at patienten får tilpasset indlæg for at modvirke dette</li> <li>Opfølgning af opererede viser, at kun halvdelen er tilfredse med resultatet</li> </ul> <h3>Forebyggende behandling</h3> <ul> <li>Aflastning</li> <li>Hælindlæg</li> <li>Fodtøj, som sørger for god støddæmpning, sikrer støtte under hulfod og modvirker hyperpronation</li> <li>Omlægning af fysisk aktivitet så langvarig jogging og gang på hårdt underlag undgås</li> </ul> <h2>Henvisning</h2> <ul> <li>Henvisning er sjældent nødvendig</li> <li>Ved kroniske tilfælde kan operation komme på tale<a title="Rosenbaum AJ, DiPreta JA, Misener D, Plantar heel pain. Med Clin North Am 2014;98: 339-52" href="EditorPage.aspx?da=core&id=%7B1A9BB006-58D1-4CB0-BC36-59BB5614B615%7D&ed=FIELD28967629271&vs&la=da&fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&di=0&hdl=H28967629499&us=sitecore%5Canvi&mo&pe=0&fbd=1" data-type="journal-reference" data-value="Rosenbaum AJ, DiPreta JA, Misener D, Plantar heel pain. Med Clin North Am 2014;98: 339-52" data-value-piped="Rosenbaum AJ, DiPreta JA, Misener D|Plantar heel pain|Med Clin North Am|2014|98|339-52" data-url="reference-link">6</a></li> </ul> <h2>Opfølgning</h2> <ul> <li>Primært i almen praksis og først ved injektionsbehandling eller operation i speciallægepraksis eller hospital</li> </ul> <h2>Sygdomsforløb, komplikationer og prognose</h2> <h3>Sygdomsforløb</h3> <ul> <li>Tilstanden er selvbegrænsende, men kroniske tilfælde kan ses</li> </ul> <h3>Komplikationer</h3> <ul> <li>Hælspore, som er en ossøs forandring langs fæstet af fascien, blev tidligere opfattet som en komplikation eller senfølge til fasciitis plantaris. Forandringen findes dog både hos raske og syge. Den tillægges derfor ikke betydning for, hvorledes tilstanden forløber</li> <li>Bristning af fascia plantaris <ul> <li>Obs: Som følge af gentagne steroidinjektioner?</li> </ul> </li> </ul> <h3>Prognose</h3> <ul> <li>De fleste bedres spontant inden 1-2 år</li> </ul> <h2>Baggrundsoplysninger</h2> <h3>Definition</h3> <ul> <li>Inflammationstilstand ved fæstet af fascia plantaris på undersiden af hælen, svarende til forreste del af tuber calcanei<a title="Schneider HP, Baca JM, Carpenter BB, Dayton PD, Fleischer AE, Sachs BD, American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain. J Foot Ankle Surg 2018;57: 370-381" href=" " data-type="journal-reference" data-value="Schneider HP, Baca JM, Carpenter BB, Dayton PD, Fleischer AE, Sachs BD, American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain. J Foot Ankle Surg 2018;57: 370-381" data-value-piped="Schneider HP, Baca JM, Carpenter BB, Dayton PD, Fleischer AE, Sachs BD|American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain.|J Foot Ankle Surg|2018|57|370-381|29284574" data-url="reference-link" data-pubmedid="29284574">2</a></li> </ul> <h3>Forekomst</h3> <ul> <li>Er en af de hyppigste årsager til smerter under hælen </li> <li>Rammer mennesker i alle aldre, men er almindeligst fra 40-årsalderen og opefter </li> <li>En hyppig lidelse hos idrætsudøvere (løbere) og militærpersonel</li> </ul> <h3>Klinisk anatomi</h3> <ul> <li>Fascien fæster til de tre vigtigste vægtbærende punkter i foden (calcaneus, 1. og 5. metatarsal-hoved) og støtter fodens længdebue og sørger for optimal biomekanik i forbindelse med afviklingen af gangen </li> <li>Tilstande som øger tensionen i plantarfascien og kan give smerter, inkluderer pes planus, pes cavus, nedsat subtalar ledbevægelighed og en stram akillessene</li> </ul> <h3>Ætiologi og patogenese</h3> <ul> <li>Plantar fasciitis opstår formodentlig som følge af en kombination af en række årsager betinget af forhold hos patienten (fejlstillinger, muskelspændinger osv.) samt ydre påvirkninger (valg af fodtøj, belastning fra daglige aktiviteter)<a title="Beeson P, Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg 2014;20: 160-5" href=" " data-type="journal-reference" data-value="Beeson P, Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg 2014;20: 160-5" data-value-piped="Beeson P|Plantar fasciopathy: revisiting the risk factors|Foot Ankle Surg|2014|20|160-5" data-url="reference-link">7</a> </li> <li>Overbelastning <ul> <li>Overbelastning af plantarfasciens tilhæftning på tuber calcanei </li> <li>Kronisk traktion fører til mikrorupturer i senevævet og inflammation. Patofysiologien kan også være en ikke-inflammatorisk, degenerativ proces (plantar fasciose) </li> <li>Langvarig stående stilling, gang eller løb på hårdt underlag hos utrænede og med dårligt fodtøj. Idræt som medfører mange hop</li> </ul> </li> <li>Fejlstilling i foden <ul> <li>Øger belastningen på fascien</li> </ul> </li> <li>Rheumatiske lidelser associeret med vævstype HLA-B27 (Mb Reiter, Mb<a href="~/link.aspx?_id=2B3022F9A5604E188E7E032EDBB010FC&_z=z"> Bechterew</a>, <a href="~/link.aspx?_id=68262A579C404E3B83DEDB66EB738254&_z=z">SLE</a>) kan debutere med dobbeltsidig plantar fasciitis</li> </ul> <h3>Disponerende faktorer</h3> <ul> <li>Sandsynligvis en multifaktoriel tilstand </li> <li>Hulfod, valgusdeformitet eller platfod </li> <li>Aktiviteter som løb og hop </li> <li>Arbejde som indebærer langvarig stående stilling </li> <li>Overvægt </li> <li>Fodtøj med hårde såler </li> <li>Vævstype HLA-B27</li> </ul> <h3>ICPC-2</h3> <p>[ICPC]</p> <h3>ICD-10/SKS-koder</h3> <p>[ICD10]</p> <h2>Patientinformation</h2> <h3>Hvad du bør informere patienten om</h3> <ul> <li>Tilstanden er selvbegrænsende, og de fleste bliver bedre inden 1-2 år</li> <li>Informere om egenbehandling og profylakse</li> </ul> <h3>Hvad findes af skriftlig patientinformation</h3> <ul> <li><a href="~/link.aspx?_id=4CE9B9AB8FDF4880AB33F793A227DD16&_z=z">Plantar fasciitis</a></li> <li><a href="~/link.aspx?_id=3A210B2BEAD24C89BF4A7C7DEC4C3F3F&_z=z">Kortisoninjektion</a></li> </ul> <h3>Træningsfilm for underben og fod</h3> <ul> <li><a href="~/link.aspx?_id=1F6D4E5CBD3F4692BA93BE7541182DB7&_z=z">Øvelsesprogram, 3 øvelser</a><br> <a href="~/link.aspx?_id=66FD9B729628437E98D9A0A38C191DB8&_z=z"><img alt="" src="E5F85279BD074A85A25EAE999BECACD2-135-84" style="height: 84px; width: 135px;" height="84" width="135"></a> </li> </ul> <h3>Socialmedicin</h3> <ul> <li>Sygemelding kan være aktuelt hos patienter, som står eller går meget i arbejdssammenhæng</li> </ul> <h2>Link til vejledninger</h2> <ul> <li>Forløbsbeskrivelser og regionale pakkeforløb [ICPC]</li> </ul> <h2>Illustrationer</h2> <h3>Plancher eller tegninger</h3> <ul> <li> <a href="~/link.aspx?_id=75BB96021BB94FF69B7B2705D73AE08D&_z=z">Illustration af plantarfascie med fasciitis</a> </li> <li> <a href="~/link.aspx?_id=DA7C1924A69A4FE3B3BAB4463A2AC1A8&_z=z">Illustration af injektionsteknik</a> </li> <li> <a href="~/link.aspx?_id=6B2ADBC1C6F244AEAD950A3D5AB52A1F&_z=z">Tegning af hælspore</a> </li> </ul>]]></HtmlField> <HtmlField Name="Resume"><![CDATA[<h2>Resumé</h2> <h3>Diagnose</h3> <ul> <li>Smerter under hælen, specielt på medialsiden, som i begyndelsen kun er til stede ved belastning, men efterhånden også i hvile</li> <li>Smerterne er ofte værst om morgenen, for så at aftage i løbet af dagen</li> <li>Palpationsømhed i forkanten af tuber calcanei, mest udtalt på hælens medialside</li> <li>Dorsalfleksion af tæerne kan forværre smerten ved palpation (Windlass effekt)</li> </ul> <h3>Behandling</h3> <ul> <li> Aflastning, hensigtsmæssigt fodtøj og udstrækning evt. vejledt af fysioterapeut</li> <li>Steroidinjektion eller kirurgi kan i sjældne tilfælde komme på tale</li> </ul> <h3>Henvisning</h3> <ul> <li>Specialisthenvisning er sjældent nødvendig</li> <li>Ved kroniske tilfælde kan operation komme på tale</li> </ul>]]></HtmlField> <LinkListField Name="Spot2"> <LinkField linktype="internal">{99A85AFD-2F7A-4B5D-A1C9-C2701D5E7D30}</LinkField> </LinkListField> <TextField Name="DoctorsHandbookID">2794</TextField> <TextField Name="PageTitle">Plantar fasciitis</TextField> <TextField Name="NavigationTitle">Plantar fasciitis</TextField> <CheckBoxField Name="ShowInMenu">true</CheckBoxField> <CheckBoxField Name="ShowInContentField">true</CheckBoxField> <DateTimeField Name="RevisedDate">2022-08-04T13:12:00</DateTimeField> <LinkListField Name="Authors"> <LinkField linktype="internal">{10F0E7D2-8D6D-49AE-94B3-998114356326}</LinkField> <LinkField linktype="internal">{D71FC9B8-8D14-48C6-920F-BE9256067C0B}</LinkField> <LinkField linktype="internal">{57953E6C-F4F3-419B-B65F-08FB99B945E8}</LinkField> </LinkListField> <LinkListField Name="Organization"> 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]]></Media> 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