"I have done everything possible to reach the end of the season in good condition, both in Paris and London, and I really wanted to play", Nadal said.
"Unfortunately, I had an abdominal problem in Paris last weekend and I also have a problem with an ankle join that needs to be dealt with in the operating room today".
"It is true that we had detected for some time and occasionally bothered me".
Nadal confirmed Monday he would skip the end-of-season finals in London to undergo ankle surgery.
He lost his No. 1 ranking to Novak Djokovic on Monday. I played at a very high level when I was able to compete, but at the same time it was very bad as far as injuries are concerned.
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It would not be fair for me to go on the court knowing that it will not be possible to play the full tournament. Nothing is said at the moment but we're just still trying to figure how we're going to make the schedule.
Instead, an abdominal injury resulted in him missing another Masters 1000 event, his fifth absence from such a tournament this year.
Nishikori was beaten by Federer in the last eight in Bercy last week before getting the call to replace the injured Juan Martin del Potro in the ATP Finals, which start at the O2 Arena on Sunday. "However, right now stomach muscles won't let me go to London, we make use of the time to remove the body and avoid problems in the future", said Nadal.
Meanwhile, reaching the final in London would rank alongside Anderson's US Open and Wimbledon final defeats against Nadal and Djokovic respectively as the most auspicious achievements of his career.
"An arthroscopy will be practiced to remove it and be able to be in flawless conditions for the beginning of next season", Nadal's doctor Angel Ruiz-Cotorro, of Clnica Mapfre de Medicina del Tenis, said in the statement.