Epidemiology of Pickleball-Related Foot and Ankle Injuries (2015 – 2023)

Category: Sports; Ankle Introduction/Purpose: Pickleball, a paddle sport that combines elements of tennis, badminton, and ping-pong, is the fastest-growing sport in the United States. The surge in pickleball’s popularity is largely attributed to a growing population of older adults in search of a relatively low-impact yet engaging physical activity. While pickleball is great for promoting both physical fitness and social interaction, it is not without risk of injury. This study seeks to describe the epidemiology of pickleball-related foot and ankle injuries with a goal of providing insight into injury demographics, injury types, and injury patterns. Methods: For this cross-sectional retrospective study, we queried our institutional database for patients with documentation including “pickleball” or “pickle ball” who were seen by a foot and ankle provider between 1/2015 – 12/2023. Sites included two large academic medical centers and two community hospitals. Clinical notes were reviewed and only patients with foot and ankle injuries directly associated with playing pickleball were included. Patient demographics (age, sex, BMI), date of injury, laterality, diagnosis, treatment, and mechanism of injury (when available) were collected. We calculated the annual incidence of injuries over the study period and conducted descriptive analyses on patient demographics, diagnoses, and treatment approaches. Results: We identified 198 patients with pickleball-related foot and ankle injuries. The annual injury incidence rose rapidly over the study period, increasing 6.5-fold from 2019 to 2023 (Figure 1). The mean age at time of injury was 58.3 years (SD=12.2) and mean BMI was 26.7kg/m 2 (SD=4.1). The majority of patients (58.6%) were male and reported a traumatic injury (77.8%) versus exacerbation of a chronic injury. The most common diagnoses were Achilles tendon rupture (39.4%), gastrocnemius injury (16%), and Achilles tendinopathy (12.1%). Of patients with documentation of the mechanism of injury (n=101), the most common causes were running or lunging forward (29.7%), inverting the foot/ankle (14.8%), and moving backward (8.0%). While the majority of injuries (72.7%) were treated non-operatively, 60% of Achilles tendon ruptures were treated surgically. Conclusion: The incidence of pickleball-related foot and ankle injuries has increased dramatically over recent years. Most injuries identified in our cohort were traumatic, with Achilles tendon rupture being the most common diagnosis. Injuries occurred more often in men and players older than 50-years-old while running or lunging for the ball. As the popularity of pickleball increases, there is a corresponding need for expanded education regarding strategies to help prevent foot and ankle injuries among pickleball players, with particular attention towards preventing Achilles tendon rupture. Further research is needed examining functional outcomes and return to sport after pickleball-related foot and ankle injuries.