Pickleball & Your Feet - Jeffrie C. Leibovitz, DPM

Pickleball & Your Feet

What do bored teenagers in the 1960s and the fastest-growing activity in the world have in common? That is how Pickleball started. (Google it if you do not believe me). If you have just started playing – welcome to the most social activity around. We want you to play for a long time and stay healthy.

Any sport that is growing as fast as Pickleball also grows a list of common (and not so common) injuries. They are waiting in the background to create problems. Most of these are lower extremity injuries as a result of faulty biomechanics. There are also not-so-small injuries like ankle sprains, plantaris muscle tears, and nail trauma.

DEMOGRAPHICS

The majority of PB players are Boomers (over 60). (Playa if you are under 40). The numbers are about gender neutral. 10% of players are first-time participants in a sport. 30% of players have not been active in a sport for more than 20 years. That adds up to a lot of rookie athletes.

Most injuries are from overuse -too much activity too soon. A sudden change can be a challenge even for a normally functioning foot. And very few of us have those. If you are playing more than 2 x week, the chance of overuse dramatically increases. There is an equation for injury – number of steps x body mass/type of ballistic activity. Another part of this equation is what is NOT being done. You will be challenging the gods if you do not have a lower extremity stretching program.

You can choose the amount of time you play each week. What you cannot choose is the way the 26 bones in your foot work together. How your foot works is heavily influenced by your ancestors.  If there is overpronation (aka foot rolls inward, low arch, flat feet) in your family there is a very good chance you will hear your foot and ankle complain.

HOW CAN YOU TELL IF A FOOT PRONATES?

Pronation is when the heel rolls outward and your arch rolls inward. Watch your partner from behind. The Achilles should form a vertical line as it moves down to the Calcaneus. If the Achilles tendon bends to the outside while standing -this is too much pronation. Over-pronation is very bad for you but good for my practice.

Another problem is if Achilles bows towards the midline of the body this is too much supination. This provides too little shock absorption. The sweet spot is when the Achilles is vertical on stance. Not too many people fall into this category.

Intense pickleball match captured from a low-angle perspective

Here is a List of Garden Variety Court Overuse Injuries.

Heel pain falls into 2 categories.

​A) Plantar heel pain (Plantar Fasciitis aka heel spurs). This is a real nuisance. Pain is typically greatest when you start walking in the morning or after you sit between games. It is located at the bottom of the heel or arch area.

​B) Insertional Achilles tendonitis can end your season. The discomfort will be isolated to the back of the heel bone (calcaneus). If this problem is addressed early, you can expect an uneventful recovery. Chronic inflammation could be irreversible leading to bone changes or spontaneous Achilles rupture. There is a chance that surgery could be in your future.

​Achilles tendinitis develops above the heel bone. A partial tear in the Achilles tendon can also occur. A painful knot (above the attachment point on the calcaneus) will slowly grow.

ANKLE PAIN

The most common overuse ankle problem is Posterior Tibial tendonitis. Tenderness can show up anywhere along the arch to the medial ankle. An easy test for this – stand on one leg and then raise your heel off the ground. Tenderness and weakness are classic signs this tendon has been damaged.

When a tendon becomes chronically (more than 3 months) inflamed, treatment becomes complex and recovery is longer. So if you are a tough guy and delay treatment, plan on spending more time and money to get back to playing.

MIDFOOT

Mid-foot problems are usually from pre-pickle ball damage (arthritis). P-ball was just the straw that broke the camel’s back. Look for bony lumps on the top of the foot. They can be so large that shoe laces will rub and agitate this area.

FOREFOOT

​We have 5 metatarsals in each foot that function like table legs. If one or two metatarsals takesmore, a capsulitis (metatarsalgia) will appear. The second toe is the most common area to get angry.

A hammer toe, floating toe, limited motion in the big toe joint, or long second metatarsal will make capsulitis worse. It is like a small crack in your windshield that slowly gets larger. This can progress to a stress fracture. Look for swelling on top of the foot with escalating pain.

​Hallux Limitus is a restricted motion in the big toe joint. This can be a major problem for any court activity, Yoga, and skiing. This joint should have 80 – 90 degrees of upward motion. You need at least 30 – 40 degrees for walking. As the joint develops arthritis, the motion decreases about 1-1.5 degrees every year. A noticeable bump will develop on the top of the joint. Treatment in early development allows protective options. Late treatment may lead to joint fusion.

Neuromas are pretty rare and typically misdiagnosed. Most of the time they are capsulitis (see above). Neuromas typically develop between the 3rd and 4th toes. You will notice a tingling or burning that extends into the toes. These symptoms are not subtle.

Man in red hat playing pickleball

Nails Can Bother You in Multiple Ways

If the nail is thick, discolored, or separated, it may be from a fungus. These nails will get extremely thick …but it takes years.

Swelling and redness at the sides may be from an ingrown nail. The nail is just too large for the toe.  Warning – Bathroom surgery will make this worse.

​Calluses are a result of pressure from a bone and a shoe. There is a reason for the callus (biomechanics or anatomy). Again – Bathroom surgery will make this worse.

The Exception to the Rule

If the lesion is small (2-3 mm) and less than 2 months old, it could be a sealed sweat gland. They do not rely on pressure and can spontaneously appear. Check your hands for the same type of lesion.

TRAUMA

While overuse injuries sneak up on you slowly. You will know about traumatic injuries right away.

​An Achilles tear can be devastating. A complete tear will give you a sense of an explosion in the back of your lower leg. If the tear is aggressive, repair may be necessary. A partial tear can respond with therapy and immobilization. Both take about the same time to heal. There is a small accessory tendon (Plantaris) next to the Achilles that can tear. This is just a nuisance and we should be back in 7-10 days with early treatment.

​A stage I ankle sprain may allow you to continue a game. The danger with a minor sprain is damage to proprioceptors. These are stretch fibers that monitor how far a ligament and muscle move. This gives us warning of impending damage. Without this protection, repeated minor injuries will repeat and create a chronic unstable ankle. This will end your Pickleball career and lead you to surgery. Early protection and rehab can reduce your recovery time by 4-6 weeks. We use regenerative (Laser) therapy to fast track recovery.

A black nail is a result of bleeding under the nail bed. This can be from stop-and-go activity. It can also be from your partner stepping on your toe. Typically it occurs in the big toe. When fluid collects under the nail, the pressure can be very uncomfortable for 5-10 days. Fortunately, this can easily be addressed with immediate relief. A black nail is also a gateway for fungus.

Don’t have these problems –then play on! If you have any of these problems then we can help keep you from missing court time.

Pickleball is a fun and social activity. The physical demands can lead to injuries that might keep you off the court. Don’t let pain or discomfort slow you down. If you’re experiencing any of these issues—whether it’s heel pain, ankle discomfort, or something more serious—our team is here to help. Schedule an appointment today to get back to enjoying the game you love, pain-free.

Staying active with Pickleball is a great way to have fun and stay healthy. It’s essential to take care of your body to avoid injuries. By understanding the risks and taking preventive measures, you can keep playing for years to come. Should you experience any pain or injury, don’t hesitate to reach out for professional help. We’re dedicated to keeping you on the court, playing your best.