Know before you go: What research shows about Pickleball and Achilles injuries

July 2nd, 2026

As Pickleball gained popularity, doctors at OrthoCarolina noticed more pickleball-related injuries in their practices, especially Achilles tendon injuries. 

Because all of OCRI’s research is inspired by patients like you, a recent study looked at Achilles tendon ruptures in people who were injured while playing pickleball, tennis, and other sports. The goal was not to scare people away from the game, but answer an important question for patients, “As more adults play pickleball, are we really seeing more injuries? And what can patients do to prevent specific racket sport-related injuries?”

Why this research matters 

The Achilles tendon connects the calf muscles to the heel bone. It helps power movements like pushing off, sprinting, jumping, and changing direction. Those are exactly the kinds of movements needed to play pickleball. 

Although pickleball may appear to be a lower-impact option vs. basketball, soccer, or even tennis, it still involves quick starts and stops, lunges, and pivots toward the ball. For many players, especially adults returning to activity or increasing activity after time away, those movements can place sudden stress on the Achilles tendon. 

“Research with large sample sizes, like this study, allow us to see how trends are changing over time, Kayla Hietpas, OCRI Statistician explains. “We can try to determine if there is an outside source causing the change. It helps us to understand where to put resources to better help our patients live healthier and injury-free lives.”

This study shows that pickleball-related Achilles tendon tears are not just happening in the traditional “young athlete” population. They are showing up most often in adults over 50. 

What the study found 

OCRI reviewed and compared Achilles tendon repairs performed between 2018 and 2022.  

A few findings stood out: 

• Pickleball injuries affected an older group of patients.
  More than 8 out of 10 pickleball-related ruptures in the study occurred in patients older than 50. The median age for patients with pickleball-related Achilles tendon ruptures in the study was 60. By comparison, the median age was about 45 for tennis-related injuries and 37 for injuries from other sports. 

• Pickleball-related Achilles repairs increased during the study period.
  Pickleball accounted for a small percentage of Achilles repairs in 2018, then rose notably in the years that followed, peaking in 2021. 

• Complication rates after surgery were not significantly different.
  Even though pickleball patients were older on average, the study did not find a significant difference in postoperative complication rates compared with Achilles repairs from other sports. The authors noted, however, that the pickleball group was relatively small, so larger studies are needed. 

This figure shows how Achilles tendon ruptures differed by age group. In this study, pickleball-related ruptures were concentrated in older age groups, especially patients over 50.

What patients need to know 

This research is not saying, “Do not play pickleball.” In fact, staying active is one of the best things people can do for their health. 

What the study does suggest is that pickleball players, especially those over 50, should recognize that the sport can be more physically demanding than it first appears. A smaller court and an underhand serve may make the game feel accessible, but the body still has to react quickly. The Achilles tendon may be placed under sudden load during a fast push-off, pivot, or lunge. 

“As we age, our Achilles become less elastic, making it more prone to rupture with the sudden changes in direction we take while playing pickleball,” OrthoCarolina’s Dr. Samuel Ford explains. “Make sure to warm up and stretch beforehand. If your achilles is sore and swollen, you may be at increased risk for rupture. Seeing an orthopaedic foot and ankle specialist is the best option to take if you’re at all concerned.” 

That means prevention matters. 

For patients, the message is simple: You do not need to stop playing. You do need to prepare your body to play. 

What you can do before getting on the court 

While no warm-up can prevent every injury, a few habits may help reduce risk: 

1. Start with a gradual warm-up before playing. Give your calves, ankles, and feet time to get ready before the first serve. 
2. Build strength outside of game time. Calf strengthening, balance work, and lower-body conditioning can help prepare the body for quick movements. 
3. Increase play gradually. If you are new to pickleball or returning after time away, avoid jumping straight into long or highly competitive sessions. 
4. Wear supportive court shoes. Footwear designed for court movement may provide better support than running shoes, which are built mostly for forward motion. 
5. Pay attention to warning signs. Pain, tightness, swelling, or a sudden “pop” in the back of the ankle should be taken seriously. 

This figure shows how the percentage of Achilles repairs related to pickleball changed over time in the study period. The increase reflects a changing injury pattern as more adults took up the sport.

What makes this study especially relevant now? 

This study helps doctors, physical therapists, athletic trainers, and patients better understand who may be at risk and how to have more informed conversations about prevention, preparation, and treatment. 

“This research confirms what we as foot and ankle orthopedic surgeons have seen in our clinics over the course of several years with the rise in popularity in pickleball.  We have also seen people generally stay more active into their later years, which inherently leads to more risk of injury.  While each patient is treated individually, our research allows us to council patients on the increased risks of certain activities such as pickleball.  Even more importantly, we can then give guidance on potential ways to prevent these risks so they can continue their active lifestyle.” 

-Dr. Todd, Irwin, OrthoCarolina Foot and Ankle Institute

It also gives researchers a starting point for future studies. The next step is learning more about which factors — such as conditioning level, frequency of play, footwear, court surface, previous tendon pain, or medical history — may increase or decrease the risk of injury.  

The Bottom Line 

Pickleball is a great way to stay active, competitive, and connected. This research does not suggest that patients should avoid the sport. It does suggest that players, especially adults over 50, should treat pickleball like the athletic activity it is. 

A good warm-up, smart conditioning, supportive footwear, and listening to your body can go a long way. 

The goal is not just to play more pickleball.

The goal is to keep playing safely. 

— 

Source: Padley JH, Averkamp B, Rieker M, Kalbac T, Murawski CD, Lendrum JA, Rennard J, Rees A, Hietpas K, Jones CP, Irwin TA, Shawen SB, Ellington JK, Ford SE. Pickleball-Associated Achilles Tendon Ruptures: Shifting Achilles Repair Demographics. Foot & Ankle Orthopaedics. 2026;11(1). doi:10.1177/24730114261425665