Lower Extremity Injuries
The lower body takes a tremendous amount of stress in pickleball. Dr. Engasser covers the most common knee, ankle, and foot injuries — and what to do about them.
Why the Lower Extremity?
Pickleball demands rapid lateral movement, quick stops and starts, and frequent changes of direction. These forces are transmitted primarily through the lower extremity — the feet, ankles, knees, and hips.
For the mature athlete, years of accumulated wear and pre-existing conditions like osteoarthritis can make these joints more vulnerable. Understanding the most common lower extremity injuries helps you recognize problems early and seek appropriate care.
Plantar Fasciitis
Overview
Plantar fasciitis is inflammation of the thick band of tissue (plantar fascia) that runs along the bottom of the foot, connecting the heel bone to the toes. It is one of the most common causes of heel pain.
Symptoms
Sharp heel pain with the first steps in the morning or after periods of rest. Pain typically improves with activity but may worsen after prolonged standing or play.
Treatment
Stretching the calf and plantar fascia, supportive footwear, heel cushions, and anti-inflammatory medication. Night splints and physical therapy are helpful in persistent cases.
Achilles Tendinitis & Rupture
Overview
The Achilles tendon connects the calf muscles to the heel bone. Tendinitis (inflammation) is common from repetitive pushing off. In severe cases, the tendon can rupture — a serious injury requiring prompt attention.
Symptoms
Tendinitis: pain and stiffness along the back of the heel, especially in the morning. Rupture: a sudden 'pop,' severe pain, and inability to push off the foot.
Treatment
Tendinitis: rest, ice, heel lifts, eccentric calf exercises. Rupture: surgical repair or cast immobilization depending on the patient's age and activity goals.
Ankle Sprains
Overview
Lateral ankle sprains (rolling the ankle outward) are the most common acute injury in court sports. They range from mild ligament stretching to complete ligament tears.
Symptoms
Pain, swelling, bruising on the outside of the ankle. Difficulty bearing weight with more severe sprains.
Treatment
RICE protocol for the first 48–72 hours. Functional rehabilitation with balance and strengthening exercises is important to prevent re-injury. Severe sprains may require imaging to rule out fracture.
Knee Osteoarthritis
Overview
Osteoarthritis (OA) is the most common form of arthritis and is extremely prevalent in the mature pickleball population. It involves the gradual breakdown of cartilage in the knee joint.
Symptoms
Pain, stiffness, and swelling in the knee. Crepitus (grinding or clicking). Worse with activity and at the end of the day.
Treatment
Weight management, low-impact conditioning, anti-inflammatory medication, and corticosteroid or hyaluronic acid injections. Knee replacement is considered when conservative measures fail.
Meniscus Tears
Overview
The menisci are two C-shaped pieces of cartilage that act as shock absorbers in the knee. Tears can occur from a twisting injury or from degenerative wear in older athletes.
Symptoms
Pain along the joint line, swelling, stiffness, and sometimes locking or catching of the knee.
Treatment
Many degenerative meniscus tears in mature athletes respond to physical therapy and activity modification. Arthroscopic surgery (partial meniscectomy or repair) is considered for mechanical symptoms that do not improve.
Patellar Tendinitis
Overview
Also called 'jumper's knee,' patellar tendinitis is inflammation of the tendon connecting the kneecap to the shinbone. It is caused by repetitive jumping, squatting, and quick direction changes.
Symptoms
Pain just below the kneecap, especially with activity. Tenderness when pressing on the tendon.
Treatment
Rest, ice, eccentric strengthening exercises, and a patellar tendon strap. Physical therapy is very effective for this condition.