May 2021

The Challenges with Pickleball: A Clinician’s Perspective

Photograph courtesy of Alan Herzberg, Jr.

By Robert Weil, DPM

Pickleball has exploded in popularity the past decade or so. Especially with seniors! More than 3 million people of all ages in the United States alone play and that number is growing by 10% every year, according to Athletic Business. The allure of the sport, especially for seniors, is that there isn’t a lot of running, but there is a lot of competition.

I remember 6 or 7 years ago when a husband/wife “tennis-playing couple” in their mid-60s had come for their orthotics follow-up (they’ve benefited from them for 20 years). They told me about their new passion – pickleball! My response was “What’s that?” Turns out pickleball is a paddle sport (like a racquet sport) that uses paddles, a net, and a whiffle-like ball played on a court about half the size of a basketball court. It’s a combination of badminton, table tennis, and tennis. It can be played singles or doubles, inside or out. Sounds like fun, right? It does offer some great exercise and even competition. However, pickleball is PHYSICAL! Think tennis and racquetball – lots of quick movements, starts and stops, multiple directions. Given the sport’s growth, clinicians can expect clients to report playing. Here are some important factors to pay attention to: patient history, shoes and equipment concerns, and injury prevention and common lower extremity injuries.

  1. Patient’s Medical history. As with most things, getting the patient’s history (if you don’t already have it) is important when they report starting a new activity. Be sure to elicit physical joint and muscle history, body type and foot mechanics. Does the client have flat, hyper-pronated or high arch feet? Is the client bow-legged or knocked kneed? Are there problems with arthritis? Because pickleball is physical and multi-directional, History of the foot, ankle, knees, hips, and back is key! And of course, the upper extremity is important, too. This history helps identify existing and potential weak links in the kinetic chain and provides an opportunity to talk about how to prevent injuries. Provide guidance on how to properly warm up and stretch and strengthen all these areas. Explain how doing so is essential to preventing problems and may even enhance performance.
  2. Shoes and Paddles. Like all sports and physical activities, proper shoes are key. Proper fitting of shoes is also of major importance. It surprises many that almost 50% of individuals do not have correctly fitting shoes, especially in width. At present, there are no dedicated pickleball shoes. But players can look for shoes created for other sports that share the qualities needed for pickleball. For the most part, you want a good basketball-type, low or mid-top shoe with wood surface traction for indoors on basketball wood surfaces. Outdoors, look for good tennis, basketball-hard surface traction shoes. Cross-trainers with specific sole surfaces work well, too. Running shoes are OUT – they have no side-to-side, multiple direction stability. As always, custom orthotics can play a major role in helping many persistent lower extremity problems.

To avoid upper extremity issues, players should pay attention to the paddle they are using and make certain the weight, the grip, and the overall size are correct for their musculoskeletal needs and their style of play.

  1. Injury Prevention. Common injuries, as spelled out on page 25 run the gamut with acute injuries like ankle sprains, or knee injuries leading the way. Players should be advised to wear proper bracing for these areas if there is a history of problems.

Overuse injuries can be a problem as well. These are often related to what I call “the terrible 2s” – 2 much – 2 aggressive – 2 often. These are warning signs to back off and allow proper recovery. Plantar fasciitis, Achilles, lower leg, shin and knee tendinitis are all conditions caused, aggravated, and perpetuated by multiple direction, start-and-stop sports like pickleball – particularly when foot mechanics are faulty. Often my famous “Intelligent Rest” recommendations make good sense – trying to play through injuries or mask them with over-the-counter pain meds is not smart! Injury concerns of these types need to be identified and treated promptly, especially in older players.


  1. Be aware that pickleball is physical – players should be in fairly good physical condition before they start.
  2. Advise players to pay attention and identify previous joint or muscle problems. Strengthening all lower extremity – core, hips, knees, and ankles – makes big sense. If needed, physical therapists or athletic trainers can provide guidance.
  3. Encourage players to pay attention to proper shoes and proper fitting of said shoes.
  4. Lastly, but more important, encourage players to have fun and enjoy the physical activity this new trend offers.

Robert A. Weil is a sports podiatrist in private practice in Aurora, Illinois. He hosts “The Sports Doctor,” a live weekly radio show on His book, #HeySportsParents written with Sharkie Zartman, is available on Dr. Weil was inducted into the prestigious National Fitness Hall of Fame in April 2019.

One Response to The Challenges with Pickleball: A Clinician’s Perspective

  1. I found this article very informative about “The Challenges with Pickleball: A Clinician’s Perspective”. Looking forward for more informative articles like this related to The Pickleball Paddles

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