The Most Common Pickleball Foot and Ankle Injuries: A Foot & Ankle Surgeon's Complete Guide
Updated: Aug 27
═══════════════════════════════════════
The Most Common Pickleball Foot and Ankle Injuries: A Foot & Ankle Surgeon's Complete Guide
By Sarang Desai, DO — Fellowship-Trained Orthopedic Foot and Ankle Surgeon
Sports Medicine | McKinney and Flower Mound, Texas
═══════════════════════════════════════
Pickleball is the fastest-growing sport in the country, and I'm seeing the injury wave firsthand in my McKinney and Flower Mound offices. Here's the big picture: the most common pickleball foot and ankle injuries are Achilles tendon ruptures, ankle sprains, foot and ankle fractures, and overuse tendon problems — and they cluster in active adults over 50. In the largest foot and ankle-specific study to date, pickleball foot and ankle injuries rose 6.5-fold from 2019 to 2023, the average patient was 58 years old, and Achilles tendon rupture was the single most common diagnosis at nearly 40%.[1]
This guide walks through each of the major injuries — what they feel like, why pickleball causes them, how serious they are, and how to prevent them — so you can stay on the court and know when something needs a specialist.
For related reading: Achilles Tendon Injuries in Pickleball Players · A Pro Sports Team Physician's Guide to Foot and Ankle Sports Injuries
───────────────────────────────────────
WHY PICKLEBALL IS TOUGH ON FEET AND ANKLES
Pickleball looks gentle, but it combines quick starts, stops, pivots, and lunges to the "kitchen" line — on an older, often deconditioned body. Most players are 35 and older, and injuries skew toward the 50-plus crowd, who account for the vast majority of pickleball ED visits.[1][2][3] The classic injury mechanisms in the foot and ankle study were running or lunging forward (31%), planting the foot (16%), and rolling/inverting the ankle (16%) — exactly the movements that tear tendons, sprain ligaments, and break bones.[1]
A sobering trend: hospital admissions for pickleball injuries are climbing faster than for other racquet sports, driven largely by fractures in older adults — pickleball injuries carry a significantly higher admission rate than other racquet and paddle sports.[4]
───────────────────────────────────────
THE MOST COMMON PICKLEBALL FOOT & ANKLE INJURIES AT A GLANCE
Injury | Who / How | Key Warning Sign | Typical Treatment | References |
Achilles tendon rupture | 50+, lunging/pushing off | Sudden "pop," weak push-off | Surgery or functional bracing | |
Ankle sprain | All ages, rolling/planting | Pain & swelling on outer ankle | Brace, rehab (rarely surgery) | |
Foot & ankle fractures | Older adults, falls | Can't bear weight, bony tenderness | Boot/cast or surgery | |
Achilles/peroneal tendinopathy | Overuse, ramp-up too fast | Gradual aching, morning stiffness | Loading exercise, load management | |
Fifth metatarsal fracture | Rolling the foot | Outer-foot pain, tenderness | Boot or surgery (Jones type) |
───────────────────────────────────────
1. ACHILLES TENDON RUPTURE — THE #1 SERIOUS INJURY
This is the injury I most want pickleball players to understand. In the foot and ankle study, Achilles rupture made up 39.4% of all injuries and was the leading diagnosis.[1] It typically happens when a middle-aged player lunges forward or pushes off explosively — the tendon, already weakened by age, snaps. Patients describe a sudden "pop" or feeling like they were kicked or hit by a paddle in the back of the ankle, followed by a weak or absent push-off.
Both surgery and modern functional (nonoperative) bracing work well; in this study, 63% of Achilles ruptures were treated surgically, reflecting how active this population is.[1] The key is early, accurate diagnosis — this injury is frequently mistaken for "just a bad sprain."
Full detail here: Achilles Tendon Rupture Surgery: The Complete Guide · Can You Walk on a Torn Achilles Tendon? · When Do You Need Surgery for an Achilles Tear?
───────────────────────────────────────
2. ANKLE SPRAINS — THE MOST FREQUENT OVERALL
Ankle sprains are the most common injury across nearly every pickleball population. Among elite/professional pickleball players, ankle sprains were the single most common injury, and lower-extremity injuries made up about half of all injuries.[9] Among recreational players, the ankle/foot is one of the top injury sites.[12] Sprains happen when you roll or plant the foot awkwardly — the inversion mechanism (rolling the ankle inward) stretches or tears the outer (lateral) ligaments.[8]
Most sprains recover with protection, relative rest, ice, compression, elevation, early motion, and a brace, followed by balance/strengthening rehab. The mistake I see most is under-treating them: recurrent sprains and lingering instability are common, and untreated instability can damage cartilage over time.[8][13]
More here: Ankle Sprains & Chronic Ankle Instability · Chronic Ankle Instability: When Do You Need Surgery?
───────────────────────────────────────
3. FOOT AND ANKLE FRACTURES — THE INJURY DRIVING HOSPITAL STAYS
Fractures are a major and growing concern, especially in older players. In national ED data, fracture was one of the top two diagnoses among pickleball injuries, and fractures were the injury most likely to require hospital admission.[3][14] Notably, women were three times more likely than men to sustain fractures in pickleball.[2] Many fractures come from falls — a lunge, a backpedal for an overhead, or a trip on the court.[4]
Common fracture sites include the ankle (lateral malleolus, bimalleolar), the fifth metatarsal on the outer foot, and the wrist from bracing a fall. Warning signs: inability to bear weight, bony tenderness, and deformity. Treatment ranges from a boot or cast to surgery depending on the bone and displacement.
More here: The Complete Guide to Ankle Fractures · Fifth Metatarsal Fractures: Types, Treatment, Surgery and Recovery · Do All Ankle Fractures Need Surgery?
───────────────────────────────────────
4. OVERUSE TENDON INJURIES (ACHILLES & PERONEAL TENDINOPATHY)
Not every pickleball injury is dramatic. A large share are overuse problems — in recreational players, overuse injuries were slightly more common than traumatic ones, and muscle/tendon injuries predominated.[12] The Achilles and peroneal tendons are frequent culprits. Playing several sessions a week without conditioning leads to gradual aching, morning stiffness, and tendon thickening. In related racquet sports like padel, the lower leg/Achilles tendon is a top injury site, and tendinopathy is the most common injury type.[11]
The best treatment is progressive loading exercise and load management, not complete rest. Greater weekly playing hours independently raise injury risk, so smart scheduling matters.[12]
More here: Achilles Tendinitis: Causes, Symptoms, Treatment and Recovery · Peroneal Tendon Injuries: Causes, Symptoms, Treatment · Best Exercises for Achilles Tendon Pain
───────────────────────────────────────
5. PERONEAL TENDON INJURIES AND OTHER FOOT PROBLEMS
The inversion (rolling) mechanism that causes sprains — responsible for about 16% of foot and ankle injuries — can also injure the peroneal tendons that run behind the outer ankle bone, causing tears or subluxation.[1] The same forces can cause fifth metatarsal fractures and midfoot injuries. Pickleball's start-stop nature also aggravates plantar fasciitis in players who ramp up quickly on hard courts.
───────────────────────────────────────
WHO'S MOST AT RISK?
- Age 50 and older — the dominant injured group, especially for fractures and Achilles ruptures.[1][3][14]
- Men — three times more likely to sustain strains and sprains; women — three times more likely to fracture.[2]
- High weekly playing volume — more hours per week independently raises injury risk.[12]
- Rapid ramp-up without conditioning — the classic "weekend warrior" pattern.
- Prior ankle injury or instability, reduced ankle motion, higher BMI, and hard playing surfaces.[8]
───────────────────────────────────────
HOW TO PREVENT PICKLEBALL FOOT & ANKLE INJURIES
The best injury is the one that never happens. What I tell every pickleball patient:
- Warm up before you play — 5–10 minutes of light movement and dynamic stretching. Never start cold.
- Strengthen your calves and ankles 2–3x/week — progressive heel raises and single-leg balance work build tendon resilience and prevent both ruptures and sprains.[13]
- Ramp up gradually — don't jump from zero to five sessions a week; rapid load increases drive both tendon and overuse injuries.[12]
- Wear proper court shoes — not running shoes; court shoes give the lateral support pickleball's side-to-side movement demands.
- Respect early warning pain — morning heel/calf stiffness or aching is tendinopathy talking; treat it early.
- Be cautious with certain medications — fluoroquinolone antibiotics and corticosteroids raise tendon-rupture risk; ask your doctor if you play.
- Manage your health — controlling diabetes, weight, and cardiovascular health supports tendon and bone health.
───────────────────────────────────────
WHEN TO SEE A FOOT & ANKLE SPECIALIST
Get evaluated promptly if you:
- Felt a sudden pop and now have a weak push-off (possible Achilles rupture)
- Can't bear weight or have bony tenderness after a twist or fall (possible fracture)
- Keep rolling or re-spraining the same ankle (possible instability or tendon tear)
- Have pain that isn't improving after a week or two despite rest and bracing
- Want a clear plan to return to pickleball safely
Early, accurate diagnosis preserves the most options and gets you back on the court faster — and it prevents the common mistake of a missed Achilles rupture or fracture being treated as "just a sprain."
───────────────────────────────────────
THE BOTTOM LINE
The most common pickleball foot and ankle injuries are Achilles ruptures, ankle sprains, fractures, and overuse tendon problems — and they're rising fast as the sport grows, especially in players over 50.[1][4] Most are treatable, and many are preventable with calf/ankle strengthening, a proper warm-up, gradual ramp-up, and good court shoes. When something pops, won't bear weight, or won't improve, see a foot and ankle specialist early — that's what protects both your ankle and your time on the court.
───────────────────────────────────────
RELATED READING
───────────────────────────────────────
ABOUT THE AUTHOR
Dr. Sarang Desai is a fellowship-trained orthopedic foot and ankle surgeon with particular expertise in sports medicine. With over 15 years of experience, Dr. Desai serves as a professional sports team physician and treats the full spectrum of foot and ankle conditions. He is a published researcher, an orthopedic implant inventor, a national lecturer, and a former University of Texas All-American athlete.
Offices in McKinney and Flower Mound, Texas, serving Plano, Frisco, Denton, Lewisville, Southlake, Dallas, Fort Worth, Arlington, and the greater Dallas–Fort Worth metroplex.
📞 (972) 591-6468 🌐 theachillesdoc.com 📍 McKinney, TX | Flower Mound, TX
This article is for educational purposes only and does not constitute personal medical advice. Always consult a qualified physician about your individual situation.
References
Emerging Patterns of Foot and Ankle Injuries in Pickleball Players: A Short Report. Kingston K, Parker EB, Higgins A, Smith JT. Foot & Ankle International. 2024;45(11):1266-1269. doi:10.1177/10711007241271215.
Pickleball: A Standard Review of Injury Prevalence and Prevention in a Rapidly Growing Sport. Azar FM, Lamplot JD, Bernholt DL, Spence DD. The Journal of the American Academy of Orthopaedic Surgeons. 2024;32(22):e1130-e1141. doi:10.5435/JAAOS-D-24-00151.
Pickleball-Related Injuries Treated in Emergency Departments. Forrester MB. The Journal of Emergency Medicine. 2020;58(2):275-279. doi:10.1016/j.jemermed.2019.09.016.
Racket and Paddle Sports-Related Injuries Treated in United States Emergency Departments, 2000-2023. Ferguson K, Badeti J, Zhu M, et al. The American Journal of Emergency Medicine. 2026;109:58-68. doi:10.1016/j.ajem.2026.06.040.
ACR Appropriateness Criteria® Acute Trauma to the Ankle. Smith SE, Chang EY, Ha AS, et al. Journal of the American College of Radiology : JACR. 2020;17(11S):S355-S366. doi:10.1016/j.jacr.2020.09.014.
Management of Acute Ankle Sprains: Common Questions and Answers. Wu V, Padilla CA, Smith NA. American Family Physician. 2025;112(6):609-617.
Electromagnetic Field Stimulation for Treating Delayed Union or Non-Union of Long Bone Fractures in Adults. Griffin XL, Costa ML, Parsons N, Smith N. The Cochrane Database of Systematic Reviews. 2011;(4):CD008471. doi:10.1002/14651858.CD008471.pub2.
Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement. Herring SA, Kibler WB, Putukian M, et al. Medicine and Science in Sports and Exercise. 2024;56(3):385-401. doi:10.1249/MSS.0000000000003324.
Injuries and Return to Play in Elite Pickleball Players: A Review of the Professional Pickleball Association Tour. Swisher J, Burbank K. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2026;:00042752-990000000-00406. doi:10.1097/JSM.0000000000001464.
Epidemiology of Musculoskeletal Injuries in Tennis Players: Risk Factors. Minghelli B, Cadete J. The Journal of Sports Medicine and Physical Fitness. 2019;59(12):2045-2052. doi:10.23736/S0022-4707.19.09842-6.
Incidence of Injuries and Associated Risk Factors in a Sample of Italian Recreational Padel Players. Thomas E, Giustino V, Ferrisi E, et al. The Journal of Sports Medicine and Physical Fitness. 2023;63(12):1324-1330. doi:10.23736/S0022-4707.23.15221-2.
Prevalence and Associated Factors of Pickleball-Related Injuries Among Korean Recreational Players: A Multi-Tournament Cross-Sectional Study. Lee KJ, Jeong B, Nam SH, et al. Frontiers in Public Health. 2026;14:1898734. doi:10.3389/fpubh.2026.1898734.
Functional Outcomes and Rehabilitation Behaviors Following Ankle Sprain in Amateur Padel Players: A Cross-Sectional Study. Alanazi F, Al Dera HS, Al Shammary T, et al. Frontiers in Medicine. 2026;13:1887372. doi:10.3389/fmed.2026.1887372.
The Perils of Pickleball: A Two Decade Analysis of Upper and Lower Extremity Injuries From America's Fastest Growing Sport. Boroumand S, Park N, Katsnelson B, et al. Journal of Sports Sciences. 2025;43(14):1378-1385. doi:10.1080/02640414.2025.2496089.
Comments