HISTORY: A nine year old female figure skater presented with 6 weeks of atraumatic right foot pain. She recently started training double jumps prior to the onset of pain. Pain was located on the plantar side of the right midfoot and she initially noticed it following practices. Weight bearing increased her pain and eventually it hurt during practice as well as after practice . No changes in training time or frequency. She has been figure skating for two years. No history of previous foot injuries or bone stress injuries. No family history of osteoporosis. Her past medical history is significant for chronic Lyme’s disease. PHYSICAL EXAM: Ht 4' 6" (1.372 m) | Wt 69 lb (31.3 kg) | BMI 16.64 kg/m2 (56 percentile), Healthy and NAD. Accompanied by her mother. Examination: Inspection: Neutral foot type. Normal alignment of lower extremities. There was no redness, swelling, or skin changes. Palpation: moderate tenderness on the right plantar mid foot. Range of motion: there was full active range of motion of the ankle, without significant pain. Strength: Muscle strength (ankle plantarflexion, dorsiflexion, inversion, eversion) full. Special tests: Fracture test (tap, percussion, bump) negative, squeeze test negative, anterior drawer test negative, Talar tilt test negative, Stress test negative, Thompson test negative. DIFFERENTIAL DIAGNOSIS: 1.Navicular bone stress injury 2.Tarsal coalition 3.Anterior tibialis tendinopathy 4.Posterior tibialis tendinopathy 5.Bone tumor 6.Nerve entrapment 7.Heel pad syndrome 8.Sever disease TEST AND RESULTS: 1.Ankle X-ray- No obvious fracture or callus 2.MRI Ankle- bone marrow edema in the neck of the calcaneus 3.DXA- Normal bone density FINAL DIAGNOSIS: Calcaneus bone stress injury TREATMENT AND OUTCOMES: 1.Decreased activity level 2.Non-weight bearing on crutches for 2 weeks 3.Walking boot for 3 weeks with partial weight bearing on crutches 4.PT 1-2x/ week for 2-3 weeks 5.Vitamin D 2000 IU everyday 6.Partial weight bearing to full weight bearing as tolerated 7.Gradual return to sports after 12 weeks of injury, when she did not have pain with ambulation, and repeat MRI showed no evidence of residual bone marrow edema.