Schilling’s right ankle will require surgery

Red Sox making plans in case their ace won't be able to pitch in Game 5

? Boston ace Curt Schilling might not be able to pitch Game 5 of the AL championship series Sunday and needs surgery on his injured right ankle.

Schilling, who led the major leagues with 21 wins, lasted just three innings and 58 pitches in Boston’s 10-7 loss to the New York Yankees in Tuesday night’s opener, allowing six runs, his poorest postseason performance since 1993. He had trouble with his balance and pushing off the rubber, which cut his velocity.

“We won’t send Curt out unless the tendon is stable,” general manager Theo Epstein said Wednesday. “We won’t compromise the team by sending out a Curt Schilling who won’t be effective.”

If Schilling can’t pitch, he likely would be replaced in the Red Sox rotation by Derek Lowe, a starter all season who struggled down the stretch and has thrown just 12 pitches in relief in the playoffs.

“If we’re not able to overcome some adversity,” manager Terry Francona said, “we’re not a good enough team.”

Red Sox team physician Dr. Bill Morgan said before Wednesday’s game that the sheath that covers two tendons in Schilling’s ankle is torn, allowing one of the tendons to slip out of its groove and rub against a bone. Schilling didn’t feel pain while pitching Tuesday because he had an injection of Marcaine, an anesthetic.

The Red Sox are trying to create a customized brace to hold the slipping tendon in place outside the sheath. Morgan was “relatively optimistic” that the ankle could be stabilized.

“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,” Morgan said. “We have no guarantees.”

Schilling is to throw in the bullpen before Friday’s third game. If he doesn’t have more success, he probably wouldn’t pitch again this year, even if the Red Sox reach the World Series, Morgan said.

“Knowing Curt, he might want to try,” Morgan said. “If we can’t accomplish getting him his next start, then he has to make a decision if he wants surgery right away.”

He suspected that Schilling would delay surgery so he could stay with the team even if he can’t pitch. Schilling will need about three months to recover from an operation and should be ready for spring training.

“If this was midseason and we had a few months to play with, he would have been placed in a cast and potentially undergone surgery,” Morgan said.

Schilling had pitched well after sustaining the injury, first diagnosed as tendinitis, on Sept. 21 against Baltimore. In that game, a 3-2 Red Sox win, he struck out 14 and allowed three hits and one walk in eight shutout innings.

Five days later in an 11-4 victory over the Yankees, he gave up two runs and one hit in seven innings. And in the opener of the AL division series in Anaheim, he allowed two earned runs and nine hits in 62/3 innings.

Schilling appeared to aggravate the injury in the seventh inning against the Angels when he fielded Garret Anderson’s grounder, threw wildly to first and grabbed his right ankle. He faced just one more batter in that 9-3 victory.

Schilling wears a removable boot when he’s not in uniform.

“I think Schill has been shooting for last night’s game since last Thanksgiving when Theo and those guys went out and signed him,” Francona said. “He was waiting to pitch that game and he could not pitch that game the way he’s able to physically. I’m sure that was very discouraging.”

Francona declined to confirm that Lowe would start if Schilling can’t, but said, “I have no doubt that we would have the ability to adjust.”

And Lowe, one of the best closers in baseball before becoming a starter, is eager to pitch more than he has.

“I’m proud of what I’ve done the last four years. I’ve won games. I’ve pitched in All-Star games. To get relegated to this role is frustrating because you feel like you can help out,” he said. “It’s all speculation right now.”