Opening batsman Graeme Smith has all but been ruled out of South Africa's fifth and final ODI against Pakistan in Benoni on Sunday.

Smith sustained a recurrence of an ankle injury during Friday's fourth ODI, which the tourists won by three wickets to level the five-match series two-all.

"Graeme's chronic left ankle problem has surfaced again during this ODI series. We have been trying to manage him but unfortunately the impingement syndrome slowed him down and he is quite symptomatic," said team manager Dr Mohammed Moosajee.

"As things stand, he is unlikely to play in the last ODI - but we will make a final decision soon. He has had surgery on this ankle a while ago and I think the load and the volume of cricket for the year and particularly during this ODI series, has troubled him."

A Proteas XI already without the services of the injured Faf du Plessis, who was replaced by fellow batsman David MIller in Durban, is likely to recall the left-handed Quinton de Kock if Smith is sidelined.