Intro: Duly Noted, a health and care podcast, is the official podcast series of Duly Health Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners re-imagine and better understand an extraordinary health and care experience.

Scott Webb (Host): As you may know, pickleball has become very popular in the last couple of years. Lots of new courts, lots of new players, and of course with that has come lots of new ankle injuries. And joining me today to talk about these ankle injuries is Dr. Faraz Haque. He's a podiatrist with Duly Health Care and he's here today to tell us how we can prevent these injuries, best footwear, and how we can enjoy this sport even if we're really competitive and not injure our ankles in the process.

I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about something that's gained a lot of popularity recently, especially in the last year, which is pickleball. Of course, I see aging tennis stars, John McEnroe and Andre Agassi playing pickleball. And it seems like everybody of all ages is playing now, but I know along with that may come some injuries.

Ankle, foot injuries. So, let's talk about that because it's so popular and you're meeting with folks in the office there as a podiatrist, what are some of the common ankle and foot injuries that you're seeing as a result of all the fun playing pickleball?

Dr. Faraz Haque: That's a great question. So, as you know, pickleball is definitely a more trendy sport, as you mentioned, and some of the common injuries that I am seeing aren't very different than other sports, which are very similar in terms of the lateral movements and the quick cutting motions that the sports require.

So, people tend to think pickleball, you know, being a less intense sport, so to speak, compared to basketball or tennis or soccer. However that can still lead to injuries. And so I think that's a little bit of a misconception about the sport itself. Some of the injuries that I have been seeing, so I'd say this past summer, I've treated two Achilles tendon ruptures.

I've had an ankle fracture and a handful of ankle sprains all from pickleball. And, it tends to be very similar to sports like, basketball and, and, tennis.

Host: It's interesting. You know, I was excited when I saw that I was going to get to talk to an expert about pickleball and pickleball injuries, and I started thinking to myself, not being a player myself, are people taking it that seriously? Are they playing that hard that they can sustain injuries playing pickleball? And it sounds like the answer is yes. And it makes me wonder, you know, are there some specific risk factors or maybe preexisting conditions that make some people more prone or susceptible to pickleball injuries?

Dr. Faraz Haque: So I, I think what some of the literature has shown is that the most common participants in the sports tend to be males above the age of 55. So that right there, is a risk factor in and of itself because generally speaking, you know, as we get to the later years in our life, we start losing some of our athleticism and our flexibility.

And, it tends to be people who decide to want to do something other than golf and pick up a more rigorous sport. And so that is one major risk factor. And I think that is one of the largest risk factors as far as where these injuries come from. The weekend warrior, so to speak.

Host: Yes. And I am 55 and I was sort of raising my hand. I'm like, yep, right here, doc. You got me.

Dr. Faraz Haque: But one, risk factor that I think is a major one though, which probably is why I see a lot of the ankle sprains or the ankle injuries is actually ankle instability. Generally speaking, with sports like pickleball, and as I previously mentioned, tennis or basketball, they require a lot of lateral movements and that is a higher risk for inversion injuries, which is a very common mechanism for ankle fractures or sprains and things like that.

Host: Yeah. And as you say, the certain risk factors, age and everything implied by that, of course, are there some preventative measures or exercises that pickleball players can do to sort of, I don't know, beef up their ankles or protect their ankles and feet during games?

Dr. Faraz Haque: Yeah, so some of the things that you want to start off with of some of the baseline, activities, working on our flexibility and ankle joint range of motion. So, often times, as we get older, we lose some of that mobility and staying flexible is important. And improving our core strength as well for overall biomechanical stability.

 Pickleball is a type of sport which is played often times in a squatting position and there's a lot of lateral quick movements. And so, working on our quadriceps, our glutes, and our hip flexors, abductors. And the other thing I like to emphasize is our proprioception, which is our fine motor movements.

A lot of balancing exercises, are important in terms of maintaining stability in the ankle. And then another thing which I previously had mentioned was wearing an ankle brace for those with instability. I know my physical therapy colleagues would disagree, but oftentimes I think an ankle brace can make a big difference in terms of prevention for injury.

 Ideally, physical therapists don't like to have patients be in a brace for an extended period of time because it can weaken the joint, and I don't disagree with that. However, when it comes to prevention for injury, the few hours you're going to play an intense game of pickleball, I think it's more worth it than not.

Host: Yeah, right. If you're just wearing an ankle brace all the time, right? For no reason, sure. But, my daughter plays basketball and so she'll wear ankle braces while she's playing basketball, but then she'll take them off, which I'm assuming pickleball players do.

Dr. Faraz Haque: Right, exactly.

Host: Yeah, and mentioning that, I do a lot of shoe shopping, Doctor, for basketball shoes. My daughter has an extensive collection of basketball shoes, but I must confess, I have not done a lot of shopping for pickleball shoes, and I don't know if they make specific shoes for pickleball or if they're generally wearing shoes that tennis players would wear. Maybe you can take us through that a little bit, like when it comes to choosing the right shoes, if there aren't actual pickleball shoes, what shoes do you recommend?

Dr. Faraz Haque: Yeah, so I think it's like that you mentioned basketball, because as I had mentioned before, some of the injuries are fairly similar due to the nature of the sport. Now I wouldn't recommend someone who's playing pickleball to wear high top basketball shoes necessarily because, uh, just wouldn't be appropriate for it, but things that you do want to look for and particularly with the shoes is you want a shoe that, that has what's called a stiff heel counter.

So that's in the back portion of the shoe where your heel sits. You want it to be stiff and rigid so that it provides support to the back of the heel and the ankle. That way it can help kind of maintain stability as you are performing those lateral movements or quick movements which can lead to ankle sprains or inversion type injuries. Other things you want to make sure the shoe has a more wide forefoot stable base for maintenance of ground stability to again avoid those rolling types of injuries.

Host: Yeah it does sound similar to our concerns when it comes to buying basketball shoes, for sure. And maybe this applies, you know, certainly to pickleball, but maybe just a lot of sports and just life in general. How can players differentiate between just regular soreness, you know, from playing pickleball and signs of a more serious ankle injury? How do we know the difference?

Dr. Faraz Haque: Yeah, so, you know, with all injuries, I kind of tell patients basically the same thing. It's about listening to our body, right? Pain can be a pretty good guide and allow pain to be the limiting factor. If you roll out of bed and just start playing pickleball and you're 55 and above, you're probably going to feel some soreness and pain and in all likelihood, you'll probably have an injury as well.

But, you know, typical signs of injury, I'm sure that most people are aware of number one would be the inability to walk or put weight on it, swelling, bruising, sharp pains, and oftentimes, pain within a joint versus just a muscle group, right? So if you have a soreness, which is more of a tightness, aching sensation, and it'll generally self resolve in a day or two, then that's probably something that's a little bit more benign.

But if it's something that's causing you significant disability or inability to bear weight or persistent swelling, then those are signs of something a little bit more serious.

Host: Yeah and I'm assuming if there's any sort of tenting of the skin, anything protruding, you know, that's time probably to go to the ED, right?

Dr. Faraz Haque: Right, right. So, if you have an ankle that's, you know, twisted sideways and you've got bone poking through your skin, that's probably not soreness.

Host: Yeah, that's probably not going to heal itself for sure. So, doctor, for someone who loves pickleball, right, but struggles with these ankle issues we're talking about here; are there any either modifications to their game or the game itself, or maybe some other activities they can still enjoy without sort of constantly re-aggravating that condition?

Dr. Faraz Haque: I think what it comes down to is knowing your limits, and monitor your intensity when playing. I like to play basketball myself and, you know, I can get pretty competitive and when you get into the heat of the game, you want to push through and your competitive nature takes over and you know that's going to be probably with me for the rest of my life.

And although right now I, like to think I'm still fairly young and athletic enough to play as hard as I can; there are times where you kind of have to be cognizant of that, right? And so, I think, making sure that you take the necessary precautions to allow yourself to play at your maximum intensity level.

So, wearing the appropriate footwear, bracing, stretching before and making sure you actually really do stretch and not just kind of you know, lollygag through that, um, hydration before and afterwards, icing. Those are things that you can do to maintain your ability to perform at a level that you hope to do. And still get something out of it, because you do want to be able to perform at your peak capacity. Because at the end of the day, you know, pickleball is a great form of exercise. And it is something that you can definitely gain a lot of value from.

Host: That's perfect. Yeah, and props to you, Doctor, for using the word lollygag. It's not a word you hear very often. So, fighting the good fight, keeping that one going. I love that. This has been really fun, educational today, Doctor, as we wrap up here, if a pickleball player does suffer from an ankle injury while they're playing, I want you to talk about how Duly Ortho Now can help them to get back out in the court.

Dr. Faraz Haque: Yeah, so Ortho Now you know, it does help expedite the process in which they can be seen and evaluated by the right specialist in a prompt fashion. Generally speaking, whenever you do have any type of orthopedic injury, time is of the essence. And, you know, early intervention has shown to improve outcomes and provide patients to a faster return to activity. So, I think by implementation of Duly Ortho Now, I think it does help allow patients to be seen in a timely fashion by the appropriate specialist so that they get the best of care.

Host: Yeah, that's perfect, of course. You know, whether it's pickleball or anything else, obviously we want the best care, we want it to be timely and effective and all that good stuff. So this is really fun today, Doctor. Thank you so much. You stay well.

Dr. Faraz Haque: Alright, thank you.

Host: That's Dr. Faraz Haque, Podiatrist at Duly Health and Care. For more information, visit DulyHealthAndCare.com. And if you found this podcast helpful, please share it on your social channels and check out our full podcast library for additional topics of interest. This is Duly Noted, a health and care podcast from Duly Health Care.