Pickleball Foot Injuries: Ankle Sprains Plantar Fasciitis and Knee Pain in Pickleball Players

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Why Pickleball Is Hard on Feet and Ankles

Pickleball has exploded in popularity across the United States and Michigan is no exception. Courts are packed at recreation centers from Clarkston to Canton, with players ranging from teenagers to retirees all competing on the same compact 20×44 foot surface. The sport demands rapid lateral cuts, sudden stops, and explosive dinks at the kitchen line — movements that generate significant stress on the feet, ankles, and knees.

At Balance Foot & Ankle, we have seen a meaningful increase in pickleball-related injuries over the past several years. The sport uniquely combines the lower-body demands of tennis with the starting-and-stopping pace of racquetball, creating injury patterns that podiatrists must understand to treat effectively.

Common Pickleball Foot and Ankle Injuries

Lateral Ankle Sprains

The most frequent acute injury in pickleball is the lateral ankle sprain, caused by inward rolling of the ankle during a quick lateral shuffle or when landing after a jump. The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) are the structures most commonly damaged. Mild sprains recover in one to two weeks with RICE therapy and functional taping. More severe sprains benefit from evaluation to rule out associated fractures and a structured rehabilitation program to restore proprioception and prevent chronic ankle instability.

Plantar Fasciitis

The hard court surfaces typical of indoor pickleball facilities — often polished concrete or sport court tile — provide minimal shock absorption. The repetitive stopping and starting stresses the plantar fascia at its heel attachment repeatedly throughout a match. Middle-aged and older players who do not regularly perform calf and fascia stretching are particularly vulnerable. Morning heel pain that improves with activity is the classic presentation.

Achilles Tendon Injuries

Perhaps the most feared injury in pickleball is the Achilles tendon rupture. The sport attracts many recreational athletes who are active but not always conditioned specifically for explosive court movements. A sudden powerful push-off — to reach a drop shot near the kitchen line or to sprint for a lob — can rupture the Achilles tendon in a player who has underlying tendinopathy. Players describe hearing a loud pop and feeling as though they were struck from behind. Immediate evaluation and surgical consultation are essential for complete ruptures.

Metatarsal Stress Fractures

The repetitive forefoot loading during lateral movements and quick-step volleys creates conditions favorable for metatarsal stress fractures. The second and third metatarsals are most commonly affected. Pain is insidious in onset, diffuse across the forefoot, and worsens with activity. X-rays may be negative early; bone scan or MRI confirms the diagnosis. Treatment involves a walking boot and activity modification for six to eight weeks.

Posterior Tibial Tendon Strain

The posterior tibial tendon stabilizes the arch and resists excessive pronation during push-off. Pickleball players who overpronate or who lack sufficient arch support in their court shoes may develop medial ankle and arch pain consistent with posterior tibial tendon dysfunction. Early stage dysfunction responds well to orthotics, physical therapy, and anti-inflammatory treatment.

Footwear Recommendations for Pickleball

Pickleball should be played in court shoes — not running shoes. Running shoes are designed for linear forward motion and lack the lateral stability needed for sideways court movements. Court shoes provide firmer lateral support, flatter outsoles for better court contact, and cushioning configurations suited to multi-directional movement. Tennis shoes are an appropriate alternative. Avoid playing in casual sneakers or worn-out athletic shoes.

Players with flat feet benefit significantly from custom orthotics inserted into their court shoes. A 3D foot scan allows fabrication of an orthotic precisely contoured to the individual arch, providing superior stability compared to any over-the-counter product.

Treatment at Balance Foot & Ankle

Our evaluation of pickleball athletes includes a biomechanical gait analysis, assessment of ankle stability, and review of footwear. For acute injuries we provide immediate care including bracing, taping, and anti-inflammatory treatment. For chronic conditions we employ a comprehensive approach incorporating orthotics, physical therapy referrals, injection therapy, and shockwave therapy as appropriate.

Most pickleball injuries do not require surgery, and our goal is always to return players to the court as quickly and safely as possible. If surgical intervention becomes necessary — for complete Achilles rupture, osteochondral lesions, or chronic ankle instability — our fellowship-trained surgeons are experienced in the procedures best suited to active, recreational athletes.

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Frequently Asked Questions

Why do pickleball players get so many ankle injuries?

Pickleball involves quick lateral movements, sudden stops, and pivoting on a hard court. Players often wear running shoes that lack lateral support, dramatically increasing ankle sprain risk.

What shoes should I wear for pickleball?

Wear dedicated court shoes designed for tennis, volleyball, or pickleball. These have flat, non-marking soles with lateral support, unlike running shoes with raised, cushioned heels.

How long does pickleball ankle sprain recovery take?

Mild sprains heal in 1-2 weeks with RICE and bracing. Moderate sprains require 3-6 weeks. Severe sprains with ligament tears can take 2-3 months and may need physical therapy.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.