Purpose of Review <p>To evaluate lower extremity musculoskeletal injury incidence, distribution, and risk factors associated with marathon preparation and race-day running. Evolving trends in specific injury types and body region(s) affected, as well as runner demographics, are highlighted, along with advances in footwear and wearable technologies that may influence injury patterns. The impact of these factors on athlete preparation and race-day participation is discussed.</p> Recent Findings <p>Recent studies demonstrate a rising proportion of marathon runners requiring medical attention during races, with musculoskeletal injuries accounting for the largest proportion of race-day injuries. Injuries to the knee, thigh, hip, and leg remain the most prevalent, with varying injury rates between male and female runners. Both non-modifiable (e.g., age, sex, prior injury) and modifiable (e.g., training volume, technology use, alcohol consumption) factors contribute to injury risk.</p> Summary <p>As marathon participation continues to grow and runner demographics shift, an increased understanding of injury patterns, during both preparation and on race-day, is essential to optimize runner safety and performance.</p>