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Understanding Taysom Hill's Lisfranc Prognosis and Outlook

Taysom Hill is going to have to recover this offseason from injuries, but none bigger than a Lisfranc injury. So, what's all that mean, and what is the prognosis and outlook for the Saints quarterback?

Saints quarterback Taysom Hill is expected to have offseason surgery for a Lisfranc injury suffered against the Falcons in the regular season finale. Sean Payton mentioned on the FOX broadcast Sunday that that was the concern for Hill, and later revealed on Monday that it was the case.

"Yeah, it's a Lisfranc," Payton said. 

"He actually had one, he just was up here we were talking. He had one before in his right foot so when he planted, because I didn't see how it happened, but when he planted with his left foot he felt something. My take is they will have to do a surgery. That's what I heard today. So it's a Lisfranc. They'll repair that area and then do a smaller surgery to remove the hardware after it's healed."

What does that actually mean? 

We connected with Scott J. Ellis, MD, a foot and ankle surgeon at the Hospital for Special Surgery. The idea was to get a better understanding of the injury, the impact for Hill, and how things could potentially play out going into the next season. Understand that Ellis has not seen nor treated Hill, but the HSS is nationally ranked No. 1 in orthopedics by U.S. News & World Report (2021-2022) and is a world leader in sports medicine performance and rehabilitation.

With the surgery option Sean Payton described (repair and remove hardware), what type of injury severity would Hill have likely suffered?

The different types of Lisfranc injuries include purely ligamentous injuries of the midfoot (i.e. tears of those ligaments otherwise termed more generally “sprains”) and combined bone + ligamentous injuries in which there have been fractures of the metatarsals or cuneiforms in addition to the ligamentous tears. Other classification systems describe how much widening has occurred between the first and second metatarsal, with the worst injuries demonstrating more widening. I highly suspect this was a purely ligamentous injury given that he was able to walk off the field and because the surgery proposed was the placement (ORIF) and subsequent removal of screws. With more severe injuries involving bone, joint fusion is more often considered in which case the screws do not need to be removed.

Are there multiple options to repair a Lisfranc injury, or would this be the most straightforward approach?

The two options for treatment generally are ORIF in which case the joints of the midfoot are put back into position (i.e. “reduced”) and then held with screws to allow for healing versus fusion in which case the joints of the midfoot are fused. There is debate as to which is better. However, ORIF is generally done for lesser and more ligamentous injuries whereas fusion is indicated in injuries with bone fractures and more severe ligamentous injuries. The more straightforward is probably the screw fixation described for Taysom. There are benefits to both ORIF (preservation of joints) and fusion (stable healing, no need to remove screws) but it is constantly debated among Foot and Ankle Orthopaedic Surgeons. With ORIF, the screws need to be removed at a second much smaller surgery.

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What is the typical timetable for recovery on this particular procedure?

The timetable can vary depending on the severity of injury, with worse injuries and those requiring fusions probably taking longer to recover. With ORIF and screw removal, it is possible that players could return to play around 5 to 6 months after the injury. However, the average return to play demonstrated in studies is 10 to 11 months which I think is a more realistic timetable.

Some have speculated that this type of injury could make Hill's outlook for being a mobile quarterback questionable. Are there specific setbacks or issues that we should look for?

If the bone heals well and in the correct position, Hill probably can make a return. Studies show that roughly 80 to 90 percent of NFL players will return to full competition after a Lisfranc injury. More specific studies indicate that defensive players are more likely to return than offensive players, but this does not include quarterbacks who can potentially function well without constant sprinting or running.

Dr. Ellis added that the treatment of Lisfranc injuries is evolving and is controversial. 

Most likely Taysom has a ligamentous injury and given the position as a quarterback, there is a relatively high chance that he will be back for next season. If it takes 10 to 11 months his return will obviously not occur until the middle to end of last season, but with good rehab he likely will return sooner.

Offseason workout programs kick up on April 20, according to the NFL calendar. Hill suffered a Lisfranc injury in his senior season at BYU in the other foot and had a very eventful journey back from it. He had a surgery in early September 2015 and had the hardware removed four months later in January 2016, but apparently one of the screws had broken.

Hill said, "They went in the top of my foot, and they carved out two different areas in my bone: next to where the screw came out at so they could get the little drill in there, and … around where the screw was, so they could get it out. Afterwards, my foot was so swollen, so black and blue."

Eventually, Hill was ready for the 2016 season for the Cougars, and ended up playing in all 12 games. Every injury is different, but if things play out the way that's predicted, then it won't be surprising to see Hill start off on the PUP list, and could possibly be in the mix when training camp starts.

The Saints quarterback room will be interesting to see in 2022, as it's a huge area for the team to address. While injuries are a part of the game, it's unfortunate to see Hill end his season with an injury like this. He powered through a painful finger injury and plantar fascia in his right foot to be there for his team. As always, we'll see what happens.


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