Peter Milligan of Cherry Hill, New Jersey, who has participated in dozens of bull runs at Pamplona, said he was knocked to the ground by another runner fleeing a bull that broke free from the pack just before entering the city's bullring.
"There were a lot of panicky people. Somebody slammed into me from behind and pushed me over," the 42-year-old lawyer told AFP as he lay in a hospital bed with his right ankle in a cast as he waited to have surgery.
"I heard it, it sounded like a tree falling, it cracked. At first I thought I was fine but as soon as I started to walk on it I knew something was wrong."
Six bulls and six steers -- castrated bulls that keep the herd together -- charged through the narrow, cobbled streets of the city, clearing a path through a sea of runners mostly dressed in white with red handkerchiefs around their necks.
The bulls from the Torrestrella ranch in the southern province of Cadiz, which are famous for being aggressive and have gored runners in Pamplona in the past, completed the 848.6-metre (928-yard) course from a holding pen to the city bull ring in two minutes and 47 seconds.
Just before the herd reached the end of the course a huge tan-coloured bull turned around to face the crowd behind it instead of heading toward the ring, sending runners scrambling in all directions.
After several tense moments the animal was lured away by a runner who tapped its behind with his hand.
A 20-year-old Spanish man suffered a head injury in a fall during the run and was also taken to hospital but he was discharged several hours later, regional health authorities said.
Mulligan, a married father of two, said he was taken by stretcher to the infirmary of the bull ring where he received first aid before being whisked to the hospital by ambulance.
He took part in the bull run with his childhood friend, Aryeh Deutsch, who was gored in the calf last year on the third day of Pamplona's San Fermin festival by a bull that also broke free from the pack just before entering the ring.
The two men have taken part in 63 bull runs in Pamplona and they plan to return next year to the annual festival which became world-famous with the publication of Ernest Hemingway's 1926 novel "The Sun Also Rises".
"We will make our hotel reservations for next year before we leave. It is a bit of an art form that you want to pursue to do right," said Mulligan.
"We have been coming back trying to master our craft. I would not miss it for the world." Deutsch, a 39-year-old engineer, said he took part in a bull run a day after he was gored last year.
"They said, do not run the next day, they wanted me to lay in bed. I lay in bed for about an hour," he said as he sat on a chair by Mulligan's bed.
In total, 15 men have been sent to hospital during the five bull runs held so far this year due to falling, including three Americans, an Australian and a British national. Nobody has been gored.
Dozens of other participants have been treated at the scene for scrapes and bruises. Fifteen people have been killed in the bull runs since records started in 1911.
People from around the world flock to the city of 200,000 residents to test their bravery and enjoy the nine-day festival's mix of round-the-clock parties, religious processions and concerts. The festival ends on Sunday.
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