Leicester flanker Lewis Moody looks certain to miss England's summer tour of New Zealand and Australia.
The 25-year-old's last international appearance was as a substitute in the World Cup final four months ago.
But he has now suffered a relapse in the battle to overcome a stress fracture of his foot, and faces an eight-week recovery period after his ankle was put back in plaster. England leave for Auckland in the first week of June.
After the eight-week recovery period, there will be a further period of rehabilitation, and even when the plaster comes off, there is no certainty that the bone will have repaired itself enough for him to progress to the rehab stage, said Leicester coach John Wells.
What we are dealing with is a bit of an unknown in terms of his recovery period. Were hopeful that if everything goes according to plan, then he should be fit and flying by the start of next season.
If that recovery period gets delayed and he is unable to do the work that we want from him, then obviously it will take longer.
If Lewis doesnt get his recovery and rehab right, if it goes again or doesnt mend at all, then that could be the end of his career. He needs to be absolutely spot-on from now to make sure that he plays again.
Moody, capped 24 times by England, made his Test debut against Canada in 2001 and is a key part of Sir Clive Woodwards plans building towards the 2007 World Cup.
He missed this seasons entire RBS 6 Nations campaign, and Woodward will be deeply concerned about what is a serious setback.