Objective: To explore the MRI characteristics and associated factors of ankle injuries in amateur marathon runners through a prospective cohort study, with particular emphasis on the role of running pace.
Materials and methods: 72 amateur marathon runners as the study group, alongside 32 healthy volunteers serving as the control group. MRI findings and risk factors, including foot strike pattern, running pace (divided into < 6:00 min/s/km and ≥ 6:00 min/s/km), and running years, were analysed using chi-square tests.
Results: Amateur marathon runners exhibited higher prevalence of ankle injuries, including peritendinous effusion, chronic lateral collateral ligament injuries, and Achilles tendinopathy. Faster running pace ( < 6:00 min/s/km) was identified as a novel risk factor for anterior talofibular ligament injuries (78.2% vs. 60.0%, p = 0.039). Female sex was associated with calcaneofibular ligament injuries (p = 0.012), while non-rearfoot strike pattern and greater running years ( > 3 years) increased the risk of Achilles tendinopathy (p = 0.044 and p = 0.042, respectively).
Conclusion: Running pace emerged as a critical factor in anterior talofibular ligament injuries, highlighting the need to monitor training intensity alongside volume. These findings provide evidence for injury prevention strategies targeting running biomechanics and training parameters.
Keywords: MRI; Marathon; ankle; foot strike pattern; injury; running pace.