NEW YORK -- Cross your fingers, Red Sox fans. And your toes, if you can.
In a cruel blow to one of their co-aces and their championship aspirations, the Red Sox last night faced the prospect of losing Curt Schilling to season-ending ankle surgery before he fires another pitch in pursuit of October glory. The Sox disclosed that Schilling pitched in Tuesday's 10-7 loss to the Yankees in Game 1 of the American League Championship Series with a dislocated tendon behind his right ankle.
The Sox, who initially described the injury as tendonitis, said they would explore every possible means to enable Schilling to start a potential Game 5 Sunday. But they could make no guarantee since their best effort to stabilize his injured ankle so he could pitch effectively Tuesday failed.
"We're going to take another shot at it and continue to use every medical technique under the sun to try to get this tendon stabilized so he can go out there again," general manager Theo Epstein said. "If we can't, he's done."
As in, wait till next year, at least for Schilling. He would undergo surgery both on his injured peroneal tendon and his right ankle joint, which he injured earlier in the season. The procedures would require him to devote the entire offseason to recuperating and rehabilitating.
The stunning twist forced the Sox to develop alternatives to their blueprint for postseason success as they prepared for the possibility of deploying exiled starter Derek Lowe to replace Schilling for Game 5. They also would finish the Championship Series with a 24-man roster.
As they scrambled to prolong Schilling's season, the Sox enlisted Dr. George H. Theodore, chief of the foot and ankle service at Massachusetts General Hospital, to rush to the Bronx and help team medical director William Morgan create a new brace to stabilize Schilling's tendon. A customized plastic brace the medical team developed for Game 1 worked during a test run Sunday in the bullpen at Fenway Park but lost its effectiveness under game conditions.
The Sox said they hoped to test a new brace as early as today at Fenway Park, though Schilling said after last night's game that the medical specialists had yet to fashion a better brace and he was uncertain if he would throw today.
"I'm not going to guess about anything," he said. "We're going to go the park [today], and we have some things we're going to try."
Schilling will receive an injection of the numbing agent Marcaine if he throws today, as he did before Tuesday's start.
"If he fails the next bullpen session, it's unlikely he'll go [Sunday]," Morgan said, "because he has to be able to pitch effectively."
Schilling said after Tuesday's loss he would not pitch again unless he was confident he could be more effective. Two peroneal tendons run across the back of the ankle and are critical to providing balance for the foot and ankle.
"As far as the team goes, we can't have an ineffective pitcher out there," Epstein said. "And we obviously want to preserve Curt's long-term health."
The Sox had considered flipflopping Schilling and Pedro Martinez, who started Game 2 last night, to give Schilling an additional day of rest. But Epstein and Morgan said the extra rest would not have helped because Schilling's effectiveness hinged almost entirely on whether the brace kept the dislocated tendon in place, allowing him to drive off the pitching rubber without physical restrictions or pain.
"This was not an injury that would benefit from one, two, even three, four, five days' rest," Epstein said. "It's not a matter of rest. It's a matter of [stabilizing] the tendon."
Schilling said Tuesday he first felt discomfort in the tendon while pitching against the Orioles Sept. 21 at Fenway Park. He made one more start in the regular season Sept. 26, allowing the Yankees two runs on one hit and four walks over seven innings in an 11-4 victory. Then he aggravated the injury last week in Game 1 of the Division Series when he went 6 2/3 innings in Anaheim, surrendering three runs (two earned) on nine hits and a pair of walks in winning, 9-3.
The Sox said the sheath surrounding Schilling's tendon ruptured early in the game, causing the tendon to pop out. Schilling gabbed his ankle in discomfort but continued to pitch.
"At that point it became apparent that he had more than just tendinitis in his peroneal sheath and it became apparent to us that he had dislocated a tendon," Morgan said. "It was snapping over the side of the bone itself, snapping in and out, and it became an unstable situation."
The Sox had no definitive explanation for how the brace worked for Schilling in his bullpen session but failed in the game.
"It worked right up until the time we needed it to work most," Epstein said.
Morgan speculated that Schilling may have exerted more force on the ankle under game conditions than he did in the bullpen, a theory that Schilling seemed to endorse after Tuesday's game.
"You can't replicate these [game] conditions," he said. "I knew I wasn't going to get the juice and the adrenaline in the bullpen that I was going to get going into this game. Sure enough, the place was electric. It was everything I hoped it would be until I pitched."
Epstein said the brace worked well "until about the first inning or so." Schilling allowed the Yankees two runs in the first inning and retired them in order in the second inning. Throughout Schilling's brief outing, manager Terry Francona tried to carefully monitor him. He knew Schilling changed the tape on his ankle and adjusted the brace after the first inning, and Francona was encouraged by the second inning.
Then came the third inning, when the Yankees tagged Schilling for four more runs before Francona lifted him with two out.
"It looked to me like it was rapidly deteriorating," Francona said.
Had the injury occurred in midseason, Morgan indicated, Schilling either would have been placed in a cast and put on the disabled list or would have undergone surgery. In October, the only option is surgery, Morgan said, unless the Sox can devise an effective brace. The doctor said Schilling would not risk further injury to his ankle by continuing to pitch, though the Sox were concerned that Schilling could hurt his arm or shoulder by using an awkward delivery to compensate for his injured ankle.
Amid concern about the team's postseason hopes, the Sox remained cautiously optimistic Schilling would return for Game 5.
"I don't think I've ever seen a guy with more heart or the ability to compete than Schill," Francona said. "That's part of the season why I think we still feel fairly upbeat that he's going to pitch again."
Yankee manager Joe Torre said he expects Schilling to return in the series.
"If for some reason it's impossible, then we won't see him," Torre said. "But until that happens, I'm sure he's not counting himself out. He's too much of a competitor. You don't get here and win the way he's won by being soft."
If Schilling is unable to return, all is not lost, the Sox insisted.
"This is the same bunch of guys that lost their starting shortstop and their starting right fielder in spring training and went out and had a great April," Epstein said. "It's the same team that fought through adversity in the middle of the season. We can win this series with Curt and we can win the series without Curt. It's not one guy. We can still win this series, that's our plan."
Schilling's teammates said they would forge ahead without him if necessary.
"We won with five starters all year," Jason Varitek said. "We're going to have to lean on someone else if he's not able to go."
Keith Foulke suggested good teams find ways to compensate for unexpected losses.
"We've had plenty of people step up all year," he said. "`In the unfortunate situation that Curt is not able to go, we're just going to have to pick him up. He's picked us up many, many times this year, so we're going to have to find ways to win and get the job done."
As for Lowe filling Schilling's role, Foulke said, "The guy has pitched his heart out all year. If he steps in there, we would have all the confidence in the world in him."