Development of a Bone Stress Injury in a Runner With Type 1 Diabetes: A Case Report

BACKGROUND: Individuals with type 1 diabetes mellitus (T1DM) have lower bone mineral density and increased fracture risk. Female distance runners are particularly prone to bone stress injury. CASE PRESENTATION: A 29-year-old female runner with T1DM experienced left shin pain and was diagnosed with a medial tibial stress fracture. After conservative therapy and 8 weeks of physical therapist (PT) treatment, a return-to-run program (RTRP) for those at high-risk of refracture was initiated. Increased shin pain after beginning the RTRP led to follow-up imaging. A magnetic resonance imaging scan revealed periosteal edema without a fracture line, and a dual-energy x-ray absorptiometry scan showed decreased bone mineral density. The patient was prescribed a bone stimulator and a walking boot, and received integrated multidisciplinary care provided by a PT, a physical medicine and rehabilitation physician, and an endocrinologist. OUTCOME AND FOLLOW-UP: The patient resumed PT treatment after 8 weeks of using the bone stimulator and walking boot as prescribed. After 8 weeks of PT treatment, the patient was pain-free while walking and resumed the RTRP. Three months after resuming PT treatment and improving her Lower Extremity Functional Scale score from 64% to 94%, she was discharged with an RTRP and strength training program. She resumed marathon training without pain. DISCUSSION: This case highlights bone stress injury management in a young female with T1DM, emphasizing the need for careful monitoring due to altered bone metabolism. JOSPT Cases 2025;5(4):244-251. Epub 29 September 2025. doi:10.2519/josptcases.2025.0112