What are the most common pickleball foot injuries and how you can prevent them

Pickleball has captivated hearts nationwide with its accessible rules, social atmosphere, and seemingly gentle learning curve. As millions flock to courts each year, this paddle sport continues its meteoric rise as America's fastest-growing recreational activity. 

However, beneath the fun and camaraderie lies a concerning trend that rarely makes headlines: the significant increase in foot and ankle injuries among pickleball enthusiasts.

According to recent studies, pickleball-related injuries requiring medical attention have reached comparable levels to tennis injuries among seniors, with an estimated 19,000 pickleball-related injuries recorded in a single year. 

Perhaps most concerning is that approximately 90% of these injuries affect players over 50 years old, with foot and ankle issues representing a substantial portion of these cases.

At Podoks, we're committed to keeping players on the court and off the sidelines. Our biomechanical socks, designed specifically for pickleball players by podiatrists, represent just one aspect of comprehensive foot care for athletes. 

This article explores the most common foot injuries in pickleball, their causes, symptoms, treatments, and -most importantly- how you can prevent them through proper equipment and techniques.

Whether you're a pickleball veteran with thousands of games under your belt or just considering picking up a paddle for the first time, understanding these injury risks and prevention strategies will help ensure your pickleball journey remains enjoyable and pain-free for years to come.

Pickleball's unique demands on your feet

Before diving into specific injuries, it's important to understand what makes pickleball particularly challenging for foot health. Unlike some sports with continuous and predictable movements, pickleball creates a perfect storm of stress factors for your feet:

Quick directional changes

The rapid back-and-forth nature of pickleball rallies requires players to change direction instantaneously. These abrupt lateral movements place tremendous stress on the outer edges of feet and ankles as weight shifts suddenly from one side to another. The ligaments and tendons supporting these structures must absorb and redistribute these forces hundreds of times during a typical play session.

Repetitive impact on hard surfaces

Most pickleball courts feature hard, unforgiving surfaces similar to tennis courts. With each step, jump, and landing, shock waves travel upward through the feet, ankles, and legs. Without proper cushioning and support, this repetitive impact gradually takes a toll on bones, tendons, and connective tissues. A typical pickleball session might involve thousands of these micro-impacts.

Stop-and-start movements

The sport's dynamic nature requires frequent bursts of acceleration followed by sudden stops. These transitions generate significant forces through the feet, particularly in the heel and forefoot regions. The plantar fascia, the tough band of tissue supporting your arch, must repeatedly stretch and contract during these movements, potentially leading to microtears and inflammation.

Plantar fasciitis stands as perhaps the most prevalent foot condition among pickleball enthusiasts.

Extended play durations

Pickleball's addictive nature often leads players to remain on court far longer than initially planned. It's not uncommon for enthusiasts to play for several hours at a time, especially during tournaments or social events. This extended activity period accumulates stress on foot structures that may already be fatigued, significantly increasing injury risk.

Cross-generational appeal

Unlike some sports dominated by younger participants, pickleball attracts players across all age demographics. Older players, who may have naturally less elastic tendons and ligaments or decreased bone density, face increased vulnerability to certain foot injuries without proper precautions and equipment.

Now that we understand the unique demands pickleball places on your feet, let's examine the most common injuries affecting players and how you can recognize, treat, and prevent them.

Plantar Fasciitis: The Pickleball Player's Nemesis

Plantar fasciitis stands as perhaps the most prevalent foot condition among pickleball enthusiasts, characterized by inflammation of the plantar fascia. Plantar fascia is the thick band of tissue connecting your heel bone to your toes. This condition develops when this critical structure experiences excessive stress, leading to tiny tears and inflammation.

Recognizing the symptoms

The hallmark of plantar fasciitis is distinctive: stabbing pain in the bottom of the foot near the heel, typically most intense with the first steps taken after waking up or after periods of inactivity.

Many players describe the sensation as feeling like they're stepping on a knife or sharp stone with every heel strike. The pain often improves  after the foot "warms up" during activity, only to intensify again after play concludes or following prolonged sitting.

Beyond this characteristic morning pain, other symptoms may include:

• Increased discomfort after (rather than during) extended pickleball sessions.
• Pain that worsens when climbing stairs or standing on tiptoes.
• Tenderness when pressing on the bottom of the heel or arch.
• A sensation of tightness along the bottom of the foot.
• Development of a limp or altered walking pattern to avoid heel pain.

Why pickleball players are vulnerable

The sport creates a perfect environment for developing plantar fasciitis through several mechanisms. The rapid side-to-side movements stretch the plantar fascia laterally, while forward lunges and quick stops place it under tension lengthwise.

These multidirectional forces, combined with repetitive impact on hard court surfaces, gradually overload this crucial structure.

Older players face particularly high risk as natural age-related changes reduce tissue elasticity.

Additionally, improper footwear without adequate arch support allows excessive flattening of the foot during weight-bearing, further straining the plantar fascia with each step on court.

Prevention strategies

Preventing plantar fasciitis requires a multifaceted approach that addresses the unique stresses of pickleball:

Specialized Footwear: Invest in court-specific shoes that provide proper arch support and cushioning. Avoid playing in running shoes, which lack the lateral stability needed for pickleball's side-to-side movements.

Biomechanical Socks: Podoks socks feature targeted compression zones that provide additional arch support and help maintain proper foot alignment during play. This reduces excessive stretching of the plantar fascia during explosive movements.

Gradual Activity Progression: Increase playing time by no more than 10% weekly. Starting with 30-minute sessions and gradually building duration allows your plantar fascia to adapt to the sport's demands.

Comprehensive Warm-Up: Before play, perform specific foot and ankle warm-up exercises including ankle circles, gentle calf stretches, and arch rolls using a tennis ball. This increases blood flow to tissues and improves fascia flexibility.

Post-Play Care: After pickleball sessions, ice your arches for 15-20 minutes to reduce inflammation, and perform gentle stretching exercises for the plantar fascia and calf muscles.

Playing Surface Consideration: When possible, choose courts with some shock absorption properties rather than the hardest concrete surfaces.

Achilles tendinopathy: a threat to mobility

The Achilles tendon is the largest and strongest tendon in the human body. It connects your calf muscles to your heel bone and plays a crucial role in walking, running, and jumping. Unfortunately, it's also highly susceptible to injury during pickleball play.

Recognizing the symptoms

Achilles tendopathy typically begins subtly, with mild pain above the heel or in the lower calf that may initially be dismissed as simple muscle soreness. As the condition progresses, players often notice:

• Increasing pain and stiffness along the Achilles tendon, especially during the first steps in the morning.
• Tenderness when squeezing the tendon from the sides.
• Pain that intensifies during activity, particularly when pushing off the ball of the foot.
• Thickening of the tendon.
• A creaking sensation (crepitus) when moving the ankle.

In severe cases, the condition can progress to Achilles tendonosis -a degenerative condition requiring more intensive treatment- or even complete rupture, which produces a sudden "popping" sensation and inability to rise onto tiptoes.

Why pickleball players are vulnerable

The explosive nature of pickleball places tremendous strain on the Achilles tendon. When a player lunges forward to reach a drop shot or quickly changes direction to cover the court, the tendon must rapidly stretch and contract to facilitate these movements. 

Over time, these forces can exceed the tendon's capacity to repair itself, leading to microtears and inflammation. 

Achilles tendon injuries represent a significant concern for pickleball players. According to a study published in the Journal of Emergency Medicine by Forrester et al. (2020), Achilles tendon ruptures accounted for approximately 8.2% of all pickleball-related injuries requiring emergency department visits, with the majority occurring in players over 50 years of age.

Podoks socks incorporate targeted compression around the Achilles region, providing gentle support and promoting blood flow to this vulnerable area.

While comprehensive gender-specific data for pickleball is still emerging, broader sports medicine research by Raikin et al. (2013) in Foot & Ankle International has documented that Achilles tendon injuries in racquet sports generally show higher incidence rates in male recreational athletes, particularly in the 40-60 age demographic that comprises a substantial portion of the pickleball player base.

Older players and those who participate only occasionally face elevated risk of tendon injuries, as do those taking certain medications like fluoroquinolone antibiotics or corticosteroids, which can weaken tendon structure.

Prevention strategies

Protecting your Achilles tendon requires attention to several key factors:

Proper calf flexibility: Tight calf muscles place additional stress on the Achilles tendon. Regular stretching of both the gastrocnemius and soleus muscles improves flexibility and reduces injury risk.

Eccentric strengthening: Perform eccentric heel drops by standing on a step, rising onto your toes, and slowly lowering your heels below step level. This strengthens the tendon and improves its capacity to handle load.

Footwear with appropriate drop: Choose court shoes with a moderate heel-to-toe drop (the difference in height between heel and forefoot). Avoid suddenly switching to minimalist shoes with zero drop, as this places additional tension on the Achilles.

Biomechanical support: Podoks socks incorporate targeted compression around the Achilles region, providing gentle support and promoting blood flow to this vulnerable area.

Activity monitoring: Track your playing time and intensity, being particularly cautious when increasing either factor. Allow adequate recovery between play sessions, especially if you feel any Achilles tenderness.

Technique refinement: Work with a coach to ensure proper footwork technique that distributes forces evenly rather than overloading the Achilles tendon during quick movements.

Ankle sprains: the court's most common acute injury

While many pickleball injuries develop gradually through overuse, ankle sprains represent the most common acute injury on the court. These painful events occur when the ankle rolls beyond its normal range of motion, stretching or tearing the ligaments that provide stability to the joint.

Recognizing the symptoms

Ankle sprains typically produce immediate, recognizable symptoms:

• Sudden pain, usually on the outer (lateral) side of the ankle.
• Swelling that develops rapidly around the injured area.
• Bruising that may appear within hours or days.
• Difficulty or inability to bear weight on the affected foot.
• A sensation of instability or "giving way" when attempting to walk.
• Limited range of motion in the ankle joint.

Sprains range from mild (Grade I) with minimal ligament stretching to severe (Grade III) involving complete ligament tears and significant joint instability.

Even mild sprains should not be ignored, as improper healing can lead to chronic ankle instability and increased risk of future injuries.

Why pickleball players are vulnerable

The quick, multidirectional movements required in pickleball create numerous opportunities for ankle sprains. When reaching for a wide shot or making a sudden change in direction, players may inadvertently place their ankle in a vulnerable position.

This risk increases on slippery surfaces, with improper footwear, or when fatigue affects coordination and balance.

Inversion sprains, where the ankle rolls inward, stretching the lateral ligaments, account for approximately 85% of all ankle sprains in court sports.

These commonly occur when a player lands unevenly after reaching for a shot or when the foot slides during a quick directional change.

Prevention Strategies

Reducing ankle sprain risk requires a combination of physical preparation, proper equipment, and mindful play:

Ankle strength and proprioception: Perform balance exercises like single-leg stands to improve ankle stability and proprioception (your body's awareness of joint position). This helps your nervous system respond more quickly to unstable situations.

Supportive court shoes: Choose pickleball-specific or court shoes with sufficient ankle collar height and lateral stability features. Running shoes with their focus on forward motion provide inadequate lateral support for pickleball's multidirectional movements.

Biomechanical support: Podoks socks feature proprioceptive cues and targeted support around the ankle region, enhancing your awareness of foot position during play and providing gentle stability.

Court awareness: Stay cognizant of court conditions, avoiding areas with debris, moisture, or uneven surfaces that increase sprain risk.

Proper technique: Learn and practice proper footwork that positions your body appropriately for shots, reducing the need for last-second stretches that place the ankle in vulnerable positions.

Controlled play intensity: Match your play intensity to your physical preparation and skill level. Many sprains occur when players attempt movements beyond their current capabilities or when fatigue affects coordination.

Consider prophylactic bracing: Players with previous ankle injuries may benefit from prophylactic bracing during play, which has been shown to reduce sprain recurrence without  affecting performance.

Stress fractures: the silent progression

Unlike the sudden onset of ankle sprains, stress fractures develop gradually as tiny cracks in bone tissue resulting from repetitive forces. These injuries particularly affect the metatarsal bones (the long bones in the midfoot) and the navicular bone, though they can occur in any weight-bearing bone of the foot.

Recognizing the symptoms

Stress fractures often present as a subtle ache that intensifies over weeks rather than producing immediate, acute pain. Key symptoms include:

• Localized pain that develops gradually during activity.
• Discomfort that initially improves with rest but eventually persists even at rest.
• Tenderness when pressing directly on the affected area.
• Mild swelling without significant bruising.
• Pain that progressively increases in both intensity and duration despite no change in activity level.

Many players mistakenly attribute these symptoms to muscle soreness or general foot fatigue, delaying diagnosis and potentially allowing the fracture to worsen.

This highlights the importance of paying attention to persistent foot pain, particularly when it remains localized to a specific area.

Why pickleball players are vulnerable

Stress fractures develop when bone is subjected to repetitive impact forces without sufficient recovery time. Each time your foot strikes the hard pickleball court, microscopic damage occurs in the bone tissue.

Normally, your body repairs this damage during rest periods, gradually strengthening the bone through a process called remodeling.

However, when activity outpaces this repair process, the microdamage accumulates, eventually resulting in a stress fracture.

Pickleball players who rapidly increase their playing time, participate in multiple games or tournaments without adequate rest, or play on particularly hard surfaces face elevated risk. 

Certain individuals face higher stress fracture risk regardless of activity level, including:

• Post-menopausal women due to decreased bone density.
• Players with low vitamin D or calcium levels.
• Those with prior stress fractures or low bone density.
• Individuals with biomechanical issues like flat feet or high arches.

Prevention strategies

Protecting yourself from stress fractures requires attention to both your activity patterns and overall bone health:

Progressive loading: Follow the 10% rule about never increase your playing time by more than 10% per week. This allows bone tissue to adapt gradually to increased stress.

Impact management: Wear court shoes with adequate cushioning to absorb shock, and consider Podoks biomechanical socks with strategic padding in high-impact areas to further dissipate forces.

Surface selection: When possible, choose courts with some shock-absorption qualities rather than playing exclusively on concrete surfaces.

Nutrition for bone health: Ensure adequate calcium and vitamin D intake to support bone strength and repair processes. Consider supplementation if recommended by your healthcare provider.

Cross-training: Incorporate lower-impact activities like swimming or cycling into your exercise routine to maintain fitness while giving your bones recovery time.

Listen to pain signals: Never "push through" persistent, localized foot pain. Pain is your body's warning system. Respect it by modifying activity and seeking professional evaluation when necessary.

Footwear rotation: Alternate between multiple pairs of court shoes to vary the stress patterns on your feet and allow cushioning materials to fully recover between sessions.

Metatarsalgia: when the ball of the foot protests

Metatarsalgia refers to pain and inflammation in the ball of the foot, specifically in the area where the metatarsal bones connect to the toe bones. This condition frequently affects pickleball players due to the sport's high-impact nature and the significant pressure placed on the forefoot during quick movements.

Recognizing the symptoms

Metatarsalgia typically presents with these characteristic symptoms:

• Pain in the ball of the foot, especially during weight-bearing activities.
• A sensation often described as "walking on pebbles" or having a bunched-up sock under the forefoot.
• Pain that intensifies when standing, running, or walking barefoot on hard surfaces.
• Discomfort that improves with rest and worsens during extended play periods.
• Possible tingling or numbness in the toes.
• Development of calluses on the ball of the foot.

The pain pattern often begins as mild discomfort during pickleball that resolves quickly after play. Without intervention, it typically progresses to more persistent pain that begins earlier in play sessions and takes longer to subside afterward.

Why pickleball players are vulnerable

The forefoot absorbs tremendous forces during pickleball, particularly during the quick forward lunges and push-offs that characterize the sport. When you explosively move forward to reach a drop shot or push off to return to the center position, your metatarsal heads bear the brunt of these forces.

Players with certain foot types face increased risk, including those with high arches (which concentrate pressure on a smaller forefoot area) or those with longer second metatarsals. Wearing inadequate footwear without proper forefoot cushioning further elevates the risk of developing this painful condition.

Prevention strategies

Protecting the ball of your foot during pickleball requires attention to several key factors:

Metatarsal support: Use shoes with adequate cushioning in the forefoot region, possibly enhanced with metatarsal pads that redistribute pressure away from painful areas.

Biomechanical socks: Podoks socks feature strategic cushioning under the metatarsal heads to absorb impact forces and reduce pressure peaks during explosive movements. You can find in our catalogue a specialized sock designed for pickleball practice, also a biomechanical sock for metatarsalgia.

Foot-specific exercises: Strengthen the muscles supporting your arch and forefoot with exercises like towel scrunches and marble pickups, which enhance your foot's natural shock-absorption capabilities.

Technique refinement: Work with a coach on proper weight transfer techniques that distribute forces more evenly across the foot rather than concentrating impact on the forefoot.

Footwear rotation: Alternate between several pairs of court shoes to prevent cushioning materials from becoming fully compressed and losing their shock-absorption properties.

Appropriate insoles: Consider adding appropriate insoles that provide specific metatarsal support for your foot type, particularly if you have structural characteristics that increase metatarsalgia risk.

Weight management: Maintain a healthy weight, as each additional pound creates 3-5 additional pounds of force on your feet during dynamic activities like pickleball.

The comprehensive prevention approach

While we've discussed specific prevention strategies for individual conditions, a holistic approach to foot health offers the best protection for pickleball enthusiasts. This comprehensive strategy encompasses several key elements:

Proper equipment selection

Your choice of footwear represents your first line of defense against pickleball-related foot injuries. Court-specific shoes should feature:

• Lateral stability to prevent ankle rollover during side-to-side movements.
• Adequate cushioning to absorb impact forces.
• Proper arch support for your specific foot type.
• A secure fit that prevents foot sliding within the shoe.
• Sufficient toe box width to prevent crowding and friction.
• Durable outsoles with appropriate traction patterns for court surfaces.

Beyond shoes, Podoks biomechanical socks represent a critical second layer of protection. Our podiatrist-designed socks feature:

• Targeted cushioning in high-impact areas.
• Strategic compression zones that support the arch and promote proper alignment.
• Moisture-wicking materials that prevent blister-causing friction.
• Protective padding around vulnerable tendons and ligaments.
• Enhanced proprioception to improve foot position awareness during play.

Remember that equipment degrades over time so you will have to replace court shoes after approximately 300-500 hours of play and refresh your technical socks when compression or cushioning elements begin to diminish.

Physical preparation

Preparing your body for pickleball's unique demands significantly reduces injury risk. A comprehensive physical preparation program should include: 

Foot-specific strengthening: Dedicate time to strengthening the often-neglected intrinsic foot muscles through exercises like towel scrunches, marble pickups, and short-foot drills. These small muscles provide critical stability and support during dynamic movements.

Lower extremity conditioning: Strengthen the kinetic chain from hips through ankles with exercises that enhance both strength and control. Lunges, squats, and calf raises build the power needed for explosive movements while improving joint stability.

Flexibility development: Maintain adequate flexibility in the calves, hamstrings, and hip flexors to ensure proper movement patterns and reduce compensatory stress on the feet.

Balance and proprioception: Regularly practice balance exercises that enhance your body's positional awareness and stability control. Single-leg stands, balance board work, and dynamic stability drills translate directly to improved court movement with reduced injury risk.

Gradual exposure progression: Systematically increase playing duration and intensity to allow tissues to adapt to pickleball's unique demands. Even experienced athletes from other sports should respect this progression principle when beginning pickleball.

Playing smart

Your approach to the game itself significantly influences injury risk. Consider implementing these strategies:

Appropriate warm-Up: Dedicate 10-15 minutes before play to a progressive warm-up that increases blood flow, raises tissue temperature, and prepares movement patterns. Begin with gentle mobility exercises, progress to dynamic stretching, and finish with sport-specific movements at increasing intensity.

Technique refinement: Invest time in learning proper pickleball techniques from qualified instructors. Efficient movement patterns distribute forces appropriately across the kinetic chain, reducing concentrated stress on vulnerable foot structures.

Surface considerations: Whenever possible, choose courts with some shock-absorbing properties rather than playing exclusively on concrete. When traveling to tournaments, arrive early to acclimate to the specific court surface.

Mindful movement: Develop court awareness that allows you to anticipate movements rather than constantly reacting to opponents' shots. This reduces the need for sudden, extreme movements that place excessive stress on foot structures.

Appropriate rest: Schedule adequate recovery time between play sessions to allow tissues to repair and strengthen. For most recreational players, 24-48 hours between intense sessions provides sufficient recovery.

Hydration and nutrition: Maintain proper hydration and nutritional status to support tissue health and optimal neuromuscular function during play.

When to seek professional care

While prevention strategies significantly reduce injury risk, being able to recognize when professional intervention is needed remains crucial. Consider consulting a healthcare provider in these situations:

Pain that persists or worsens despite rest and home treatment.

• Inability to bear weight on the affected foot.
• Visible deformity, severe swelling, or extensive bruising.
• Pain that awakens you from sleep or remains intense even at rest.
• Development of numbness, tingling, or weakness in the foot.
• Any audible "pop" accompanied by immediate pain and dysfunction.

Early intervention often leads to faster recovery and prevention of chronic conditions. Healthcare providers may recommend various treatments based on your specific condition, including:

• Custom orthotics designed for your unique foot structure and biomechanics.
• Physical therapy to address strength, flexibility, or movement pattern deficits.
• Appropriate activity modifications to allow healing while maintaining fitness.
• Specialized interventions for specific conditions, from taping techniques to therapeutic injections.
• Advanced imaging to precisely diagnose complex or persistent conditions.

Remember that returning to play should follow a gradual, structured progression supervised by your healthcare provider to prevent reinjury and ensure complete recovery.

Conclusion: protecting your foundation

Pickleball offers tremendous benefits: physical activity, social connection, cognitive stimulation, and pure enjoyment. By implementing comprehensive foot protection strategies, you can maximize these benefits while minimizing the risk of painful and potentially debilitating injuries.

At Podoks, we're passionate about keeping pickleball players on the court and in the game they love. Our biomechanical socks represent just one component of a complete prevention strategy that encompasses proper equipment, physical preparation, and intelligent play approaches.

Ready to protect your feet on the pickleball court? Explore Podoks' biomechanical socks designed by podiatrists specifically for pickleball players.

Remember that foot health isn't a luxury for pickleball players. It's the literal foundation upon which your game stands. By investing in proper footwear, including specialized biomechanical socks from Podoks, you're not merely preventing potential discomfort; you're ensuring your ability to enjoy this wonderful sport for years to come.

The next time you step onto the pickleball court, do so with confidence knowing you've taken proactive steps to protect your feet from the sport's most common injuries. Your feet will thank you with miles of pain-free pickleball enjoyment.

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Scientific references:

Forrester, J. D., Weisenthal, K. R., & Mitchell, J. (2020). Injuries and preventive strategies associated with pickleball. Journal of Emergency Medicine, 58(4), 655-662.

Raikin, S. M., Garras, D. N., & Krapchev, P. V. (2013). Achilles tendon injuries in a United States population. Foot & Ankle International, 34(4), 475-480.

Stephenson, A. L., Wu, W., Cortes, D., & Rochon, P. A. (2019). Tendon injury and fluoroquinolone use: A systematic review. Journal of Athletic Training, 54(2), 192-199.

Bjordal, J. M., Lopes-Martins, R. A. B., Joensen, J., & Iversen, V. V. (2015). The anti-inflammatory mechanism of low level laser therapy and its relevance for clinical use in physiotherapy. Physical Therapy Reviews, 15(4), 286-293.

U.S. Food and Drug Administration. (2018). FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. FDA Drug Safety Communication.