Widely considered the greatest female gymnast of all-time, Biles was part of an American quartet that were favourite to defend the title they won in Rio, despite having qualified in second behind the Russian Olympic Committee.
The US began their rotation on the vault, one of Biles’ strongest disciplines, but she bailed out of her planned amanar vault and failed to make her landing stick, scoring just 13.766, the lowest of the six Russian and American gymnasts in the group.
The 24-year-old looked visibly distressed and was consoled by a coach before leaving the arena during the break between rotations.
She returned in time for the start of the second round but put her tracksuit on and was listed on the official Games website as a reserve for the remaining three apparatus, before her withdrawal was confirmed soon after.
A statement from USA gymnastics said: “Simone Biles has withdrawn from the team final competition due to a medical issue. She will be assessed daily to determine medical clearance for future competitions.”
Biles had the chance to win an unprecedented six gold medals in Tokyo. She is next due compete on Thursday, when she will defend her Olympic title in the women’s all-around final.