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Tel: 239-430-3668New England Patriots starting right guard Mike Onwenu was carted off the field Sunday after initial X-rays revealed a broken right ankle, ESPN reported. A broken ankle — an ankle fracture — is one of the most common serious injuries we see at Family Foot & Leg Center (FFLC), and how it is treated in the first days and weeks makes a real difference in how the ankle works for years afterward. Here is what was reported, what the injury actually involves, and what treatment looks like for the professional athlete and the weekend pickleball player alike.
What happened to Mike Onwenu
During the Patriots’ 20-3 win over the Pittsburgh Steelers, Onwenu was injured late in the first quarter on a play in which quarterback Drake Maye was sacked and Steelers linebacker T.J. Watt landed on the back of Onwenu’s legs. He was carted from the field and quickly ruled out for the rest of the game. Initial X-rays showed a broken right ankle, according to ESPN’s Mike Reiss. Onwenu, 28, is the longest-tenured Patriot from his draft class, and Sunday marked his 100th career regular-season game. Veteran Greg Van Roten replaced him in the lineup.
The mechanics of the injury matter. A 260-plus-pound lineman taking a direct pile-on from behind creates a sudden, forceful twist-and-crush across the ankle joint — exactly the kind of mechanism that breaks the bones that make up the ankle, rather than merely spraining the ligaments around them.
What a broken ankle actually is
The ankle joint is formed where three bones meet: the tibia (shinbone), the fibula (the thinner bone on the outside of the leg), and the talus (the bone that sits between them and the foot). The knobby ends of the tibia and fibula are called malleoli, and a fracture can involve one, two, or all three of them — what surgeons call a bimalleolar or trimalleolar fracture. The fracture can also be displaced, meaning the bone pieces have shifted out of their normal alignment, and it can occur together with a dislocation, where the joint itself pops out of place. A dislocated ankle fracture is an emergency that needs attention the same day, because the shifted bones can stretch skin, nerves, and blood vessels.
Broken ankles and severe ankle sprains can feel nearly identical at the moment of injury — sharp pain, rapid swelling, bruising, and an inability to bear weight. That is why no one should assume “it’s just a sprain” without imaging. Onwenu’s case followed the standard pathway: examination, then X-rays, which are the first-line test that shows whether bone is broken and whether the joint remains aligned.
How a broken ankle is diagnosed
Diagnosis starts with the story of the injury and a physical exam: where it hurts, whether the skin is intact, whether pulses and sensation are normal, and whether the patient can take even a few steps. From there:
- X-rays confirm the fracture and show how many malleoli are involved and whether the fragments are displaced.
- CT scans map complex fractures in detail before surgery, especially when the joint surface is involved.
- MRI is used when the X-ray is clean but suspicion remains high — for a hidden fracture or a badly torn ligament.
Severe swelling can temporarily delay surgery, so physicians often splint and elevate the leg for several days first. That waiting period is treatment, not stalling: operating on a tense, swollen ankle raises the risk of wound problems.
Treatment: from a boot to the operating room
Treatment depends on two questions: Is the bone broken in a stable position? And is the ankle joint still lined up?
Non-surgical treatment. A fracture that is nondisplaced and leaves the joint stable is typically treated with a cast or a walking boot, protected weight-bearing, and roughly six weeks of healing, followed by physical therapy to restore motion and strength.
Surgical treatment. When the fracture is displaced or the joint is unstable — the likely scenario in an NFL lineman — the standard operation is open reduction and internal fixation (ORIF): the surgeon repositions the bone fragments and holds them with plates and screws so the joint surface heals smoothly. Restoring the joint’s alignment matters enormously; an ankle that heals even a millimeter out of position wears unevenly and can develop post-traumatic arthritis. In some cases ankle arthroscopy is used at the same time to check and clean up cartilage damage inside the joint.
Recovery. Bone typically needs 6 to 12 weeks to heal, with early weeks non-weight-bearing or in a boot, then progressive weight-bearing and rehabilitation. Athletes’ timelines vary widely with fracture pattern; for a professional lineman who must absorb enormous force at the ankle, a realistic return is measured in months, and sports-medicine analysts have already suggested surgery and an extended absence are likely in Onwenu’s case. For the rest of us, most people walk normally again within a few months, though stiffness and mild swelling can linger for up to a year.
When a sore ankle needs a specialist — now
You do not have to be tackled by an NFL edge rusher to break an ankle. A slip on wet tile, a bad landing from a ladder, a lunge for a wide forehand in pickleball, or an awkward step off a curb can do it. Seek same-day care if you have:
- Pain directly over the ankle bones that does not settle
- Rapid swelling or bruising on both sides of the ankle
- Inability to bear weight for four steps
- Visible deformity, numbness, or skin that is stretched or pale over the injury
Southwest Florida’s sports calendar — pickleball, golf, tennis, running — puts mid-life and senior athletes at risk of exactly this injury every week, and early diagnosis is what separates a clean six-week recovery from a chronic, arthritic ankle.
Southwest Florida’s foot and ankle experts are here for you
At Family Foot & Leg Center, our board-certified podiatrists — specialists in foot and ankle medicine and surgery — treat broken ankles, severe sprains, and every fracture in between, with on-site imaging and same-day appointments across 9 Southwest Florida locations from Marco Island to Sarasota, including Naples, Estero, Fort Myers, Cape Coral, Port Charlotte, and Sarasota. Our foot and ankle trauma and urgent care pathway means you are seen quickly, imaged accurately, and given a clear plan — conservative care when it is appropriate, and expert surgical fixation, including arthroscopy, when the fracture requires it. We keep athletes from pickleball players to runners moving, and we serve pediatric through geriatric patients.
Schedule an appointment at FFLC — call 239-430-3668 (our AI agents answer 24/7) or use our 24/7 self-service scheduler at https://naplespodiatrist.com to book a same-day visit with a board-certified foot and ankle specialist.
