Oneil Cruz’s recovery from a fractured left ankle was off and running but hit a speed bump that could prevent the Pittsburgh Pirates shortstop from returning to play in the majors this season.

Pirates director of sports medicine Todd Tomczyk said Cruz’s rehabilitation has “plateaued,” and he stopped his running program seven to 10 days ago because of general soreness in his left foot. Tomczyk said the setback has put Cruz’s return this season in jeopardy.

“That’s going to be challenging due to the days left on the calendar, not only the season but just how we feel when he’ll potentially re-engage in running. So, too tough to tell right now,” Tomczyk said, adding that he continues to have discussions with Pirates general manager Ben Cherington and manager Derek Shelton. “But, I think we’re running out of days and we’re continuing to have discussions with Ben and and Shelty and Cruzer, notably. But he remains upbeat, that’s for sure. Think you’ll continue to see him smiling. And, he wants to push through this. And get back to playing as soon as he can.”

Pirates manager Derek Shelton said after Wednesday’s 6-4 loss to the St. Louis Cardinals that the key for Cruz is to stay positive and keep pushing through the recovery process.

“When you’re dealing with a significant injury like he’s dealing with, it’s just making sure that his spirits stay up, and he continues to attack his rehab,” Shelton said. “He’s done a really good job with his rehab. I think the expectation when you have something like this, there are gonna be times where it does plateau. We just have to make sure that we keep pushing forward, and he keeps working hard. He’s done a good job with that.”

Tomczyk said the Pirates consulted with NFL and NBA medical staffs and found that it’s not uncommon for athletes to experience soreness coming off traumatic injuries. Tomczyk said the structure of the ankle remains “really good” and the long-term prognosis is “very encouraging.”

Tomczyk said Cruz can play catch and field ground balls but, based on their findings in his foot biomechanics, the Pirates aren’t having him do any baseball activities at the moment but rather focusing on working with weights and plyometrics until the soreness subsides.

“Really, what they’re trying to do is get everything in sync again, and everything to communicate effectively,” Tomczyk said. “That kind of sounds weird, I know. But there’s so many little nooks and crannies and ligaments and muscles and tendons and that foot, with all the metatarsals, the little small bones, that if one thing is off, it’s gonna be a domino effect and continue to affect the other one. So, working on the mobility, working on the foot intrinsics of how it operates is the main focus.”

Tomczyk acknowledged that Cruz is running out of time to start running and begin a rehab assignment in the minors, which could prevent his return to the Pirates this season. Playing in the instructional league in Bradenton, Fla., or the Arizona Fall League are possibilities the Pirates will explore to get Cruz into “high-level reps.”

“From a rehab perspective,” Tomczyk said, “getting an athlete psychologically to a point before he begins an offseason of at least back to baseline is going to be a huge, huge psychological boost for when he comes into spring training next year.”

Pirates designated hitter Andrew McCutchen, who suffered a season-ending torn ACL in his left knee in 2019, assumed Cruz had a chance to return this season and was both surprised and disappointed to learn about his setback.

“That was the hope. That’s what everyone hopes,” McCutchen said. “But I had an ACL and they told me I’d be back in four to six months, and it took me a whole year to get myself back on the field. The doctor can say whatever they want, but your body is your body, and the body needs to get back and the mind needs to get back. When that happens, that happens. It’s just the way that it goes sometimes.”

In other Pirates injury news:

• Left-handed reliever Angel Perdomo (left forearm discomfort) also could be in jeopardy of dealing with a season-ending injury. Tomczyk said Perdomo, who was placed on the 15-day injured list, underwent imaging tests and has a flexor strain in his left forearm so he will be shut down from throwing for two to three weeks.

• Right-handed reliever Carmen Mlodzinski (right elbow soreness) is scheduled to throw a live bullpen session either Thursday or Friday and is “trending in a good direction.”

• Right-handed starter Max Kranick, who underwent Tommy John surgery in June 2022, has appeared in two games during his rehabilitation assignment and “felt good.”

• Right fielder Henry Davis, who was placed on the 10-day injured list with a right hand strain that affects his thumb, has consulted with hand specialists and was recommended to keep a bat out of his hands for five days.

“He’s been dealing with it for a bit,” Tomczyk said. “He’s feeling better every day. He respectfully wants to push the limits (but is in a) holding pattern from any gripping or hitting.”

• Shortstop Tucupita Marcano, who is two weeks removed from having surgery on the ACL in his right knee, had his stitches removed and showing “encouraging signs” in returning to the functional stages of his rehabilitation, Tomczyk said.

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