How Injuries Hit Pro Marathoners in the Wallet
Staying healthy can get expensive—quickly.
Elite marathon runners face a significant financial burden due to injuries. Fiona O’Keeffe, who once set an American course record in the NYC Marathon, had to withdraw from the 2025 race due to a fully retracted tendon tear in her hamstring, forfeiting $50,000 in prize money and appearance fees. Pro runner Lindsay Flanagan missed three marathons, including Boston, Chicago, and Valencia, losing a potential income that would have surpassed her base contract and coaching earnings.
Pro runners must bear the cost of their own healthcare, which is covered differently than in leagues like the NFL or NBA, as they operate as independent contractors. While some shoe contracts offer support, they usually don’t include health insurance. This leaves runners responsible for expensive treatments, such as the $15,000 Flanagan spent out-of-pocket for her high hamstring tear and subsequent Achilles tendon issues.
Some shoe companies have reduction clauses that penalize athletes for missing races, potentially affecting future contracts. The decision to pull out of a race due to injury involves weighing the costs against the potential benefits, with athletes often facing a tough balance between competing and covering medical expenses.
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