Participating in marathons, such as the recent TCS New York City Marathon, can be a remarkable achievement, but it comes with significant health risks. According to a study conducted in 2024 involving over 1,000 runners, nearly 40% reported injuries while training, and about 14% sustained injuries during the race. Experts highlight that many of these issues arise from overuse or inadequate preparation.
Dr. Mariam Zakhary, director of running medicine at Mount Sinai Health System, emphasizes that while running a marathon is a commendable feat, it imposes unique stresses on the body. A range of physical ailments can result from this demanding event, and understanding these risks can help runners prepare more effectively.
Common Injuries and Conditions Associated with Marathons
One prevalent issue is plantar fascia injuries, as noted by Dr. Rock G. Positano, founder and director of the Non-surgical Foot and Ankle Service. The plantar fascia serves as the body’s primary shock absorber, connecting the heel to the toes. During a marathon, the stress placed on this area can lead to degeneration and potential tearing, resulting in sharp pain in the heel or arch.
Stress fractures are also common among marathon runners, particularly in bones like the metatarsals and tibia. Dr. Positano explains that these may not manifest until days after the race, often causing significant pain when bearing weight.
Achilles tendinopathy is another frequently encountered condition, which arises from repetitive strain. Dr. Adam Bitterman, chair of orthopedic surgery at Huntington Hospital, notes that runners may experience inflammation and pain in the Achilles tendon, exacerbated by sudden increases in mileage or running uphill.
Ankle sprains are often the result of uneven terrain or fatigue, leading to stretched or torn ligaments. Runners may also face muscle cramps, particularly in the calf, due to dehydration and electrolyte imbalances, especially during the later stages of a marathon.
Skin and Gastrointestinal Challenges
In addition to musculoskeletal injuries, marathon runners face a range of skin conditions. Dr. Jacob Beer, a board-certified dermatologist, mentions that friction blisters are common, particularly when runners wear poorly fitting shoes. Other areas prone to chafing include the nipples, often referred to as “jogger’s nipple,” which can be painful and lead to infection.
Superficial fungal infections, such as athlete’s foot, are also frequent among long-distance runners, thriving in the damp environment of sweaty feet. Dr. Beer warns that the combination of sweat and friction can also lead to hair follicle infections in sensitive areas.
Gastrointestinal issues, often termed “runner’s trots,” can plague marathon participants. Dr. Dana Zalkin, a gastroenterologist, explains that blood flow is diverted away from the stomach and gut during intense exercise, potentially causing irritation and diarrhea. Mechanical jostling during the run can also lead to nausea and abdominal cramping.
Long-Term Health Implications
The stress of marathon running may negatively impact the immune system, leaving participants more vulnerable to infections for up to 72 hours post-race. Dr. Jeremy Polman notes that running can exacerbate conditions like acid reflux due to the mechanical stress on the stomach.
More alarmingly, a study from 2025 identified a potential link between marathon running and an increased risk of colorectal cancer. Researchers found that among a sample of 100 individuals aged 35 to 50 who had completed multiple marathons, nearly 50% exhibited precancerous polyps, significantly higher than the 1% to 2% normally found in average-risk adults.
While many of the injuries and conditions associated with marathon running can be managed or mitigated with proper training and preparation, the potential long-term health risks cannot be ignored. Runners are encouraged to undergo pre-marathon health screening to identify any underlying issues before embarking on the challenging journey of marathon running.
