A prospective cohort study on MRI characteristics and associated factors of ankle injuries in amateur marathon runners.

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.