By Steve Spencer

Pickleball has become one of the fastest-growing sports in the country, drawing players of all ages. But with that surge in participation has come a corresponding increase in foot and ankle injuries, particularly among middle-aged and older adults who are now getting back into sports.

Adam Lukasiewicz, MD, a foot and ankle surgeon with Southlake Orthopaedics, has watched this trend unfold firsthand. His practice has seen a marked rise in pickleball-related injuries over the past few years, and he has advice for players who want to stay on the court.

“For a lot of people, the last time they were playing sports regularly was 40 years ago, and they still feel like they’re 25,” Lukasiewicz said. “Adjusting to the realities of life can take a minute.

“The foundation for avoiding an injury is prevention. It’s essential to stay hydrated, stretch, and warm up properly. And you want to build up gradually. The game’s short court and social pace can be deceptive. The explosive lateral cuts and rapid push-offs place demands on tendons and ligaments that may not have been tested in years. Cross-training with swimming, cycling, or weightlifting helps condition the body for that load.”

Ankle sprains are the most common injury Lukasiewicz sees. They typically involve the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL), which are stretched or torn when the foot rolls inward during a quick side step or an awkward landing. Severity can range from mild soreness to an inability to bear weight, but the treatment philosophy is consistent.

“There’s a lot of evidence to suggest that the faster you can get someone moving and get the range of motion back, the faster they can return to sports,” Lukasiewicz said. “So it’s always a balance. We immobilize the ankle to protect it, get the swelling down, but then we want the patient to get moving again.”

People often underestimate how long ankle sprains take to heal. Research shows that roughly half of sprains serious enough to prompt a medical visit still cause symptoms at eight weeks. “We always think of a broken bone or a fracture as worse,” Lukasiewicz said, “but a bad sprain can take just as long to heal.”

Achilles injuries are another hallmark of the pickleball boom. The sport’s relentless demand for explosive push-offs creates ideal conditions for both tendinitis and, in more serious cases, rupture. Achilles tendinitis, in which the tendon becomes inflamed but remains intact, is especially common among players who spend most of their day seated.

“Most people have a pretty tight calf,” Lukasiewicz said. “The Achilles acts a bit like a spring, and when that spring is constantly under tension, it gets inflamed. A lot of the tendinitis we see in pickleball players is because the calf is too tight so consistent calf stretching can make a difference.”

Achilles ruptures are far more serious. The tendon can tear completely during a forceful lunge, producing sharp pain that often fades within half an hour, leaving the patient surprised to find they can’t push off. Surgical repair is the typical course for active patients, using minimally invasive percutaneous techniques that require a smaller incision than traditional procedures. Recovery takes three to six months before returning to sports.

Plantar fasciitis — inflammation along the bottom of the heel where the plantar fascia attaches to the bone — is also common in pickleball players. The sport’s ready position stance, bouncing lightly on the toes while waiting for the next shot, places stress on the fascia. Like Achilles tendinitis, it’s closely tied to tissue tightness.

“The good thing about plantar fasciitis is it usually goes away,” Lukasiewicz said. “If you have enough time, almost anything works. But stretching is by far the most reliable approach.”

Stress fractures, caused by accumulated overtraining rather than a single traumatic event, and fifth metatarsal fractures round out the most common pickleball-related injuries. Stress fractures rarely require surgery, but demand rest and a gradual return to activity. Fifth metatarsal fractures sometimes need surgical fixation with a screw to ensure reliable healing.

Across all of these conditions, Lukasiewicz returns to a single principle: don’t push through pain and then expect a smooth recovery. “When you have an injury, take it seriously, take some time off, let it rest. If it gets better, you can return to sport. And if it doesn’t, you need to see someone,” he said. “Otherwise you end up doing the yo-yo — I feel good, I play, I feel bad, I stop. That can become a perpetual cycle of never really fully recovering because you won’t give your body the time it needs.”