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Flintoff returned home after the World Twenty20, where he played in all England's matches but continually showed the strain on his ankle. The decision to carry out further surgery in Holland was taken following extensive consultation with leading international specialists including those from the UK, Australia and the United States.
"The operation involved the removal of extra bone, including fragments, from the front and back of the ankle which were causing bony impingement and compression of a tendon in the back of the ankle," said the ECB. "The nature of these bone changes was such that there were additional difficulties in the normal functioning and stability of the ankle. The operation was carried out by one of the world's leading authorities on arthroscopic ankle surgery."
The statement added that the surgeon was confident this latest operation would solve the underlying problem in Flintoff's ankle which has required three previous surgeries. The first came after the South Africa tour in 2004-05, followed by another during the 2006 season and a third in June this year.
In all, Flintoff has missed out on 11 of England's last 16 Tests, including the whole of the 2007 home programme against West Indies and India, as well as 21 of their last 48 ODIs, including the current series in Sri Lanka. He returned to England action in the one-day series against India, but had to be carefully managed and only played four of the seven matches.
Last week, a source close to Flintoff said: "We are looking anywhere on the planet for help. There might be a surgeon in America, for example, who has encountered something like the problems Freddie is suffering ... maybe a baseball player or basketball player ... anything, to be honest."
It is expected that Flintoff will return to training in the New Year with a view to a playing comeback for England's 2008 international programme, which begins in May with a Test series against New Zealand.
"We would love to have him in the squad but we won't risk Andrew in the Test matches," said England's coach, Peter Moores, after Flintoff was reported by the Daily Mail to be "frustrated and worried" by his constant struggle for fitness.