Ankle Injuries And Pickleball


Orthopedic surgeon Gary Pattee describes how to avoid and recover from a variety of ankle injuries.

GARY A. PATTEE, M.D. is a Diplomate of the American Board of Orthopaedic Surgery, a Fellow of the American Academy of Orthopaedic Surgeons, and a motorcycle-racing enthusiast. 

PICKLEBALL, like other paddle and racket sports, involves frequent and sudden changes in direction, which place stress on the ankles. But before I explain the different types of ankle injuries and the best way to recover from them, let’s talk first about prevention. One of the best defenses against this pickleball problem is to wear shoes specific to court sports. 

You wouldn’t wear flip-flops to run a marathon, so don’t wear running shoes on the pickleball court. Running shoes are not designed with support for cutting from side to side. They are light and meant for running in a straight line. Tennis shoes, in general, are heavier than running shoes and constructed with support for lateral movements. The soles are made to grip the surface of the court to provide the traction required for rapid direction change without causing you to slip and fall.

Despite this, even those wearing the correct shoes may find themselves at some point suffering from an ankle injury, of which there are many types. Here is what happens. 

The bones of the ankle are held together and stabilized by multiple ligaments, which are tough bands of fibrous tissue. Normally, the ligaments withstand and absorb the stress of rapid direction changes, but if the stress is excessive, the ligaments may be injured, or “sprained.”

At the time of the injury, the player may experience a twisting or “rolling” of the ankle with sudden pain and difficulty bearing weight. Occasionally, one will feel or hear a tearing or popping sensation. There may be subsequent swelling and even bruising, depending on the degree of injury. 

A sprain is an injury to the ligaments that attach bone to bone, whereas a strain is an injury to muscle and/or its attachment to bone. A grade 1 (mild) sprain involves stretching of ligaments, while partial tearing is a grade 2 (moderate) sprain. Complete tearing of ligaments is classified as a grade 3 (severe) sprain. 

Most ankle sprains are relatively mild and can be managed with rest (avoid playing), icing, and elevation to reduce pain and swelling, and occasionally a compressive wrap. However, if the injury seems more severe, with an inability to bear weight, a visit to your physician or an orthopedic specialist is advised to rule out more serious conditions. A fracture, cartilage damage, or instability as a result of ligament disruption may require further treatment, such as immobilization, bracing, or, rarely, surgery. 

After the initial period of rest, and once the pain and swelling are under control, the next phase in recovery involves restoring ankle motion and strength. This may be achieved with a home program under the guidance of a physical therapist. The time for return to play varies, depending on many factors, but can be anywhere from several days to several months. 

Repeated ankle sprains may result in instability, with the ankle “giving way” or “rolling” with a rapid change in direction. Support with a brace or ankle stirrup may help, but muscle strengthening is important in helping to stabilize the joint. 

As with many sports-related injuries, maintaining muscle strength and flexibility goes a long way, but due to the nature of racket sports, ankle sprains are one of the more common injuries in pickleball. Fortunately, most of these injuries are relatively mild without permanent damage. Although not all sports injuries can be prevented, strengthening, conditioning, flexibility, and the use of proper shoes are all important steps you can take to minimize the risks.