Have you or your friends recently started playing pickleball? If that’s the case, you’re not alone. Pickleball is the fastest-growing sport in the United States, with an average annual growth rate of 11.5% over the last five years and over 4.8 million players countrywide.

Although pickleball requires less running due to smaller courts, it can strain a player's feet and ankles. According to a 2018 study, the annual number of senior pickleball injuries equaled the number of senior tennis injuries that year.

This isn't surprising given that, like tennis, pickleball includes repetitive pounding on a hard court, which can lead to Achilles tendinitis and heel pain. Furthermore, sudden side-to-side motions and directional shifts can cause ankle sprains and other lower extremity injuries.

In this video, we'll look at the most common pickleball foot and ankle injuries, as well as their remedies and strategies for prevention.

Acute Injuries in Pickleball

Let’s first address acute injuries. These are injuries that occur suddenly—such as spraining an ankle or falling after a sharp turn or pivot.

Ankle Sprains in Pickleball

Ankle sprains are one of the most common injuries seen in pickleball due to the specific movements needed to play the game.

Swelling, discomfort, and bruising are common symptoms, as are acute pain and difficulties walking.

Get an ankle sprain treated as soon as possible. Initially, RICE techniques (rest, ice, compression, and elevation) are used to minimize swelling, inflammation, and pain. It's critical to see a podiatrist for X-rays or an MRI to rule out any serious injury.

You may also need to wear a walking boot and use crutches if your injury is severe. Physical therapy may also be recommended to improve strength and range of motion. Other treatments and information about prevention can be found in the link in the description below.

Ankle Fracture in Pickleball

Pickleball can also cause ankle fractures. Treatment is similar to that of an ankle sprain. Imaging can determine the degree of the fracture as well as any damaged ligaments.

A third acute injury is an Achilles tendon rupture. This tendon can rupture when the tendon is stretched beyond its capacity which can happen during pickleball's twisting and fast motions. Older players, those with a history of Achilles tendonitis, and those using medications, such as steroids or specific antibiotics, are at a higher risk, as these might weaken the tendon, increasing the likelihood of rupture.

If you rupture your Achilles, you’ll probably know it.  You’ll feel a stabbing pain in the back of your ankle and you’ll likely hear a popping sound or snapping sensation. Walking uphill in particular will be difficult.

Treatment is very similar to an ankle sprain only the need for surgery is much more likely.

Chronic Injuries in Pickleball

Now let’s look at chronic injuries in pickleball.

These type of injuries develop overtime due to frequent play, inappropriate footwear, hard surfaces (like a pickleball court), and poor foot mechanics.

Two of the most common chronic injury conditions are plantar fasciitis and Achilles tendonitis. They can start out mild and then worsen gradually. Additional risk factors for these two conditions are age, tight calf muscles, and being overweight.

In plantar fasciitis the plantar fascia becomes inflamed. This is a ligament that runs from the heel to the base of the toes. You’ll notice pain in the bottom of your heel and possibly your arch when you first get out of bed in the morning with pain easing up as you move around.

Because of the multiple factors involved in developing plantar fasciitis, comprehensive treatment is often required. Aside from rest, successful treatment can include reducing inflammation, custom orthotics, stretching exercises, a change to more appropriate footwear, and, in certain cases, physical therapy.

Achilles Tendonitis in Pickleball

Now let talk about Achilles Tendonitis

As I just mentioned Achilles tendonitis shares many of the same risk factors with it’s cousin plantar fasciitis. In addition, pickleball players who take particular medications called fluoroquinolones or have high blood pressure are also more vulnerable.

You’ll notice mild pain from the back of the heel to just below the calf muscle first. This will gradually intensify with time. Treatment methods are similar to those used for plantar fasciitis. Inadequate treatment can lead to Achilles tendonosis, a degenerative condition that may require surgery or injections to repair.

Stress Fracture in Pickleball

Another common chronic injury in pickleball is a stress fracture.

Pickleball can cause stress fractures and tiny bone fissures. Stress fractures can result from the faulty foot mechanics, unsuitable or worn out shoes, increasing your pickleball play too rapidly, and running on hard surfaces.  Also, underweight and postmenopausal women are at a higher risk due to bone loss often found in these groups.

Symptoms may include sudden onset of foot or ankle pain that resolves with rest, as well as pain, swelling, redness, or bruising near the top of the foot or ankle.

To recover you’ll need to take 6 weeks off to rest and keep your foot immobile in a walking boot.

Injury Prevention Tips for Pickleball

Injury prevention should always be a top priority. Here are some important pickleball foot and ankle injury prevention steps.

Choose Appropriate Footwear for Pickleball

Pickleball requires the proper footwear. Choose badminton, racquetball, or squash shoes for indoor play and tennis shoes for outdoor play. Your footwear needs to provide foot and ankle stability during lateral movements and twists. Be sure to measure your feet to ensure proper fit and wear any inserts or custom orthotics you need to keep your feet properly aligned.

You may also want to visit the website Pickleball Central to purchase your shoes. I’ll put a link in the description below.

Choose the Right Socks for Pickleball

Pickleball socks should wick away moisture from your feet to prevent blistering. You can also visit Pickleball Central to purchase your socks or ask for these types of socks at REI or another athletic store you trust.

Gradually Increase Your Court Time

Increase your play time by no more than 10% a week. This allows your body to adapt and build the necessary muscles for the game. Listen to your body. If you feel tired or are having any pain, stop and rest. This is particularly important for older, less active players.

Wear Appropriate Inserts

Most shoes do not come with adequate inserts. Even if you don’t suffer from heel pain, it’s a good idea to replace the ones you have with an over-the-counter insert from a company like Redi-thotics. This will help with foot aches and fatigue.

If you do have faulty foot mechanics like flat feet or feet that roll inwards or outwards or tend to get heel pain, you’ll likely need custom orthotics. Go to a podiatrist to receive an evaluation and ask if they also do a gait analysis. If you do need them, be sure you wear them every time you play to prevent a heel pain flare up.


Stretching is also crucial before and after you play to prevent plantar fasciitis pain, Achilles tendonitis flare-ups, or an Achilles tendon rupture. Incorporate stretching into your routine to enhance flexibility and reduce the risk of injuries. I’ll include a link in the description below.

Eat A Healthy Diet

It’s critical to eat a healthy diet to keep up your energy and to prevent a stress fracture. A diet with plenty of foods with Calcium and vitamin D can help keep your bones strong.

Do Conditioning Exercises

Conditioning workouts can help your body prepare for pickleball. Before beginning any fitness plan, consult with a healthcare practitioner, especially if you have a chronic disease or have been inactive for a long time. I’ll include a link to a video showing some great workouts just for pickleball players.

In conclusion, you can dramatically reduce the chance of injury and improve your overall pickleball experience by taking these precautions and being sure to get podiatry treatment if you end up with any of the conditions we discussed.

Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.