A deep dive into foot and ankle injuries related to Pickleball with evidence-based guidance on prevention, treatment, and recovery

Pickleball was invented in 1965 on Bainbridge Island, Washington, by Congressman Joel Pritchard, businessman Bill Bell, and Barney McCallum as something to keep bored kids busy on a summer afternoon (Source: USA Pickleball). They grabbed some ping-pong paddles, a perforated plastic ball, and used a badminton court. Nobody in that backyard could have guessed what they had started.

Fast forward to 2026, and pickleball is no longer a quiet retirement pastime. It is, by every serious measure, the fastest-growing sport in the United States for the fourth consecutive year. According to the Sports and Fitness Industry Association’s 2025 Topline Participation Report, more than 24 million Americans played pickleball in 2025 alone. Allegedly, the Association of Pickleball Professionals puts that number even higher, suggesting that nearly 50 million adult Americans have played the sport in the last 12 months. This is not a trend, but a transformation.

But behind the energy, the new courts, and the celebrity sponsorships, a quieter crisis is building in emergency rooms, orthopedic clinics, and physical therapy offices across the country. Reportedly, pickleball injuries are rising at a rate that alarms sports medicine professionals,  and the people paying the steepest physical price are the sport’s most loyal demographic: adults over 50.

This article examines what the research tells us, what the data reveals, and most importantly, what aging athletes need to know to protect their feet, ankles, and Achilles tendons before stepping onto the court.

What Are the Most Common Pickleball Injuries?

Pickleball involves quick movements such as sudden turns, side steps, lunges, overhead shots, and rapid changes in direction. These movements can put stress on the muscles, joints, tendons, and ligaments, especially in older adults whose bodies may already have some natural wear and tear.

Research from multiple studies shows that the most common pickleball injuries include:

• Strains and sprains are the most common injuries overall. As per reports, one major medical study found that soft-tissue injuries, such as muscle strains and ligament sprains, accounted for nearly 48 percent of all pickleball injuries treated (Source: PubMed / PMC — Evaluation of Pickleball-Related Injuries at a Single Institution). In men, these injuries are more common in the legs, while in women, they are more common in the arms and shoulders.
• Fractures are the second most common type of injury, accounting for about 27 percent of reported cases. Women over 60 are at higher risk, especially for fractures in the wrist, hand, or arm (Source: AOAO — Rising Orthopedic Injuries in Pickleball: 10-Year National Study).
• Ankle sprains and strains are the most common lower-body injuries. The fast twisting and cutting movements in pickleball can easily lead to rolled ankles. One study found that ankle sprains made up 21.7 percent of all lower extremity injuries (Source: PMC — Pickleball Injuries in the Aging Athlete: A Critical Analysis Review).
• Achilles tendon injuries,including inflammation and complete tendon tears, are among the most serious injuries seen in the sport. These injuries can require surgery and long recovery periods (Sources: PMC — Lower Extremity Injuries, Rothman Institute; PubMed — Pickleball and Return to Sport After Achilles Tendon Rupture).
• Knee injuries, such as meniscus tears and tendon strains, are becoming more common, especially in players who play several times a week without enough rest (Source: UT Southwestern Medical Center).
• Wrist and hand fractures  often happen when players fall and try to catch themselves with their hands. These injuries are especially common in older women.
• Shoulder injuries, including rotator cuff irritation and muscle strain, can develop from repeated overhead paddle movements, accounting for 11% of all cases, followed by back injuries (7.8%) and calf injuries (5.6%) (Source: PubMed — Evaluation of Pickleball-Related Injuries at a Single Institution).
• Eye injuries  have also been reported, although they are less common than other types of injuries. Pickleball-related eye injuries rose by more than 400 cases per year from 2021 to 2024, even as eye injuries in other sports like tennis, baseball, and basketball have been declining. (Sources: PubMed / JAMA Ophthalmology; US News — Pickleball Eye Injuries Surge)

Studies consistently show that older players are more likely to visit emergency rooms, suffer more severe injuries, and need longer recovery times after getting hurt while playing pickleball.

Pickleball’s Toll on the Foot and Ankle

Of all the body regions affected by pickleball, the foot and ankle complex carries one of the heaviest burdens and receives perhaps the least preparation from recreational players.

NIH reports suggest that the most common specific diagnosis was Achilles tendon rupture, which accounted for 39.4 percent of all foot and ankle pickleball injuries in that study, a remarkably high proportion for a single diagnosis.

According to Dr. John Z. Zhao, assistant professor and foot and ankle surgeon with UTHealth Houston and UT Physicians, the pattern is consistent with what he sees clinically: “Although pickleball is a fantastic sport for improving cardiovascular health, it involves sudden, high-impact movements that can lead to lower extremity injuries if players are not careful. I see it all the time, the weekend athlete going for a diving save and ending up with an Achilles tendon rupture.”

Ankle sprains frequently result from the inversion stress of cutting quickly on a hard court surface. Stress fractures in the metatarsals and heel bone can develop gradually in players who increase their playing volume too quickly. Plantar fasciitis, inflammation of the fibrous band connecting the heel to the toes ,  develops in players who train without adequate footwear or spend prolonged time on hard indoor or outdoor surfaces. And big toe joint injuries, including turf toe, arise from the repetitive push-off and pivot demands the sport places on the forefoot.

Does Pickleball Cause Achilles Tendonitis?

The short answer is yes, and the research now connecting pickleball to Achilles tendon injuries, including both tendonitis and full ruptures, is substantial enough that sports medicine specialists are treating it as a defining injury profile for the sport.

The Achilles tendon connects the calf muscles (the gastrocnemius and soleus) to the heel bone (the calcaneus). It is the largest and strongest tendon in the human body, capable of bearing loads several times a person’s body weight during running and jumping. But tendon tissue is not as vascular as muscle, it receives less blood flow, regenerates more slowly, and accumulates micro-damage over time without always producing obvious symptoms until something gives way.

As a person ages, the collagen structure of tendon tissue changes. The crosslinks between collagen fibers become stiffer, the tendon becomes less elastic, and the healing response slows. This age-related degeneration, called tendinosis at the cellular level, makes the tendon more vulnerable to both overuse injury and acute rupture, even during activities that might seem relatively low-intensity compared to competitive running or field sports.

Pickleball creates a specific set of mechanical demands on the Achilles. The sport requires repeated explosive push-offs, sudden accelerations toward the net, backward shuffles to the baseline, and rapid changes in direction. When a player plants their foot to lunge forward, a move that happens dozens of times in a single game, the Achilles tendon is loaded under stretch and then explosively contracted. In a young, well-conditioned athlete with healthy tendon tissue, this is manageable.

In a 62-year-old recreational player who spent the winter sedentary and returned to the court in spring without a structured return-to-play program, it can be the precise mechanism of a catastrophic rupture.

A 2024 study published in Foot and Ankle Spec by researchers at Jefferson Health and the Rothman Orthopaedic Institute specifically investigated trends in pickleball-related Achilles tendon injuries, finding a clear and rising pattern (Source: PubMed — McCahon et al., Foot & Ankle Specialist, October 2024 | SAGE Journals).

Research from Seaview Orthopaedics noted that Achilles tendon rupture accounts for nearly 40 percent of significant pickleball injuries, primarily affecting men in their late 50s, most often resulting from planting the foot and lunging during play(Source: Seaview Orthopaedics — “The Rise of Pickleball Injuries”).

Research from Seaview Orthopaedics noted that Achilles tendon rupture accounts for nearly 40 percent of significant pickleball injuries, primarily affecting men in their late 50s, most often resulting from planting the foot and lunging during play(Source: Seaview Orthopaedics — “The Rise of Pickleball Injuries”).

Prevention: What the Evidence Actually Supports

The research community, from the University of Cincinnati to Brigham and Women’s Hospital to UTHealth Houston, is unified in one conclusion: age and sex-specific injury prevention strategies are urgently needed for pickleball. The American Orthopaedic Foot and Ankle Society released formal guidance in May 2024 offering six evidence-grounded prevention tips for pickleball players.

Here is what the science supports:

A structured warm-up before every session. This is not five minutes of casual walking. An effective pre-pickleball warm-up includes light aerobic activity to raise core temperature, dynamic stretching of the calf complex and Achilles tendon, ankle circles and foot mobility work, and practice movements that replicate the lateral cuts and lunges of play

Progressive return after any period of inactivity. As cited in a May 2024 press release from the American Orthopaedic Foot & Ankle Society (AOFAS), foot and ankle orthopaedic surgeon Dr. Hui Zhang of Aurora Health Care advises gradually introducing more rigorous exercise and activities.

“If you’ve been on the couch all winter and now are looking to get back into shape, don’t go full speed right away into long distance running or playing a rigorous game of pickleball,” Dr. Zhang said. This advice directly addresses the weekend warrior pattern that underlies many Achilles ruptures in the 55 to 70 age group. (Source: AOFAS — “6 Tips to Prevent Pickleball Injuries to Your Feet & Ankles,” May 30, 2024).

Court-specific footwear. Shoes designed for pickleball or indoor court sports provide lateral stability, appropriate cushioning for hard surfaces, and forefoot rigidity that running shoes and cross-trainers do not. Most foot and ankle specialists emphasize footwear assessment as a foundational prevention strategy.

Strengthening the calf and foot complex year-round. Eccentric calf loading, toe curls, single-leg balance work, and foot intrinsic strengthening exercises reduce tendon vulnerability and improve the capacity of the lower extremity to absorb and generate force during play. A strong, well-conditioned calf complex is the best protection an aging player has against Achilles tendon rupture.

Honest self-assessment and load management. Playing 90 minutes of intense doubles three days after a winter of inactivity is a high-risk proposition for any player over 50. Tracking playing volume, building in recovery days, and being willing to reduce intensity when early warning symptoms arise are not signs of weakness, they are the behaviors that keep athletes on the court long-term.

Custom orthotics when indicated. For players with pronation, flat arches, limited ankle dorsiflexion, or a history of lower extremity injuries, custom orthotics can meaningfully redistribute load away from vulnerable structures. A podiatric evaluation before starting or returning to pickleball is a worthwhile investment for any athlete with a history of foot or ankle problems.

When to See a Doctor?

The aging athlete’s tendency to minimize symptoms, to play through pain, to rationalize discomfort as something that will resolve on its own, is perhaps the single most consequential behavioral risk factor in the pickleball injury epidemic. Knowing when a symptom requires professional evaluation is genuinely important clinical information.

See a doctor promptly, within a few days, if you experience:

A sudden sharp pain at the back of the leg during play, especially if accompanied by a sensation of being struck or hearing a pop. This is the classic presentation of an Achilles tendon rupture. If you suspect an Achilles rupture, stop playing immediately, avoid bearing weight on the affected leg, and seek evaluation within a few days.

Any injury involving significant swelling, bruising, or deformity that develops rapidly after trauma on the court, as this may indicate a fracture.

Big toe pain that is severe enough to alter your gait, that involves marked swelling or bruising, or that does not improve with basic self-care within a few days.

See a doctor if symptoms are persistent and not improving, even if not acute, when you experience:

Heel pain that has lasted more than a week despite rest, as this may indicate plantar fasciitis or an insertional Achilles injury that benefits from early intervention.

A palpable bump or nodule on the Achilles tendon that is tender to touch ,  this may represent early tendinopathy that responds well to loading protocols when caught early.

Any ankle pain that limits your ability to bear weight normally after a twisting mechanism on court.

Recurring big toe joint pain that returns with each playing session, as this suggests an underlying structural issue that conservative measures alone may not resolve.

Seek emergency care immediately for:

Any injury that produces severe pain and immediate inability to bear weight. Complete deformity, significant bruising, or a sensation that bones have moved. Signs of an open wound over a joint. Any injury followed by significant lower extremity swelling out of proportion to the apparent mechanism.

A Final Word for Pickleball Enthusiasts 

There is nothing inherently wrong with playing pickleball in your youth or 60s, 70s, or beyond. The sport delivers genuine cardiovascular benefit, social connection, hand-eye coordination challenge, and joy, and the competitive field at the 2025 USA Pickleball National Championships included players from 11 to 87 years old (Source: USA Pickleball Annual Growth Report | USA Pickleball Nationals Recap 2025). At the 2026 USA Pickleball National Championships, wheelchair and adaptive standing divisions were formally incorporated into the rulebook. This sport was built to be inclusive (Source: USA Pickleball 2026 Rulebook Change Document (official PDF) | Selkirk Sport — 2026 Rule Changes | Pickleball Union).

But the data is honest: older recreational athletes who underestimate the physical demands of pickleball, who skip warm-ups, who wear inadequate footwear, who return to play too aggressively after periods of inactivity, and who ignore early warning signs from their tendons and joints are the demographic driving the injury epidemic. The tendons of a 60-year-old body require different preparation, different load management, and more attentive recovery than those of a 30-year-old.

The good news is that the injuries described in this article, Achilles tendinopathy, turf toe, ankle sprains, plantar fasciitis ,  are highly preventable and, when caught early, highly treatable. The athletes who navigate pickleball into their later decades successfully are not the ones who avoid the sport. They are the ones who take it seriously enough to warm up properly, wear the right shoes, respect their tendon health, and see a doctor when something does not feel right.

Pickleball is not going away. The courts are multiplying faster than one per day. The investment money is flowing. For the aging athlete who wants to be part of this, the path forward is not avoidance, it is informed participation.