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Background: Stress fractures are common injuries in athletes, but only 10% of stress fractures are fibular stress fractures. This is likely because the fibula is a mostly non-weight bearing bone, only accepting about 7% of the load through the lower leg. Additionally, 60% of stress fractures occur in people who have had stress fractures before. Thus, when a stress fracture in the fibula occurs there are likely other risk factors at play or potentially reduced energy deficiency syndrome (RED-S) that must be evaluated by the therapist. Purpose: The purpose of this case report is to highlight the challenge associated with treating a fibular stress fracture in a young patient while minimizing the chance for recurrence by identifying potential high risk factors. Case Description: The patient was a 14-year-old female cross country and track athlete who suffered a stress fracture of her fibula while running the 800m event in a track competition. Assessment: Some risk factors were recognized immediately; the patient was a female, who now presents with a history of stress fracture, runs long distances, and has a low BMI. Discussion: Due to the incidence of recurrence in patients who have a stress fracture, it is important to assess and modify risk factors in the patient population. These risk factors include menstrual function, dietary insufficiencies, eating psychopathy, and bone density. Investigating these additional risk factors, screening athletes for RED-S, and well referring athletes to proper health care professional are important responsibilities physical therapists need to consider if they want to be considered serious direct access professionals.