Andrew Flintoff has been ruled out of England's forthcoming one-day series in Sri Lanka because of ongoing problems with his left ankle.
Flintoff was in obvious discomfort during the World Twenty20
The decision was taken following the team's elimination from the ICC World Twenty20 in South Africa.
Flintoff will be replaced in the tour party by Hampshire's Chris Tremlett.
An ECB statement said the ankle needed time "to settle and recover before the process of further strengthening and assessment is intensified".
Flintoff underwent a third operation on his ankle in June but made his international comeback during the recent home one-day series against India.
He experienced further problems with the ankle joint, but the selectors decided it was nevertheless safe to take him to the World Twenty20.
"This in an on-going process. We needed to test out how the ankle was and this tournament was ideal because he could only bowl four overs a match," said England coach Peter Moores.
"Now he will go back to England for strengthening work and we will see where we go from there."
A number of past and present players, including former England skipper Mike Gatting and Kent captain Rob Key, believe Flintoff should be given an extended break from the game.
And Australia captain Ricky Ponting said on Wednesday: "Maybe it's got to the stage where the England management need to give him six months away from the game to get his ankle looked after and get back his fitness. He might just need some really good rehab time."
But despite ruling Flintoff out of the one-dayers in Sri Lanka later this month, the selectors have not, however, given up on the possibility of him being available for the three Tests which follow in December.
The Lancashire all-rounder was one of the heroes of England's Ashes triumph over Australia in 2005, but is one of a number of players from that side to struggle with injuries since then.
Flintoff has been urged to try and modify his bowling action
Ashley Giles has been forced to retire from the game because of a hip problem, Simon Jones has yet to regain full fitness following knee surgery and Steve Harmison has missed a significant part of the summer following hernia surgery and a side strain.
Fears have been expressed that Flintoff will never again be able to stand the rigours of Test match cricket.
But Moores insisted: "He is only 29 and he has got a huge amount of cricket left in him."
He added: "The surgery hasn't been a complete failure, but like most things it's not an exact science.
"They are trying to find the solution to an ankle that has had a lot of hard wear over seven or eight years of bowling and they have got to try and manage that.
"He's seeing the top surgeons and he is quite happy with the way it has gone...we're trying to get to a situation where he can play pain-free and do the things he wants to do."