Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Is the Tenex Procedure?

The Tenex procedure — formally known as percutaneous tenotomy using ultrasonic energy — is a minimally invasive technique for treating chronic tendon degeneration in the Achilles tendon, plantar fascia, and other tendons. Using a small probe inserted through a needle-sized skin opening under ultrasound guidance, the procedure applies ultrasonic energy to precisely break down and remove the degenerative (tendinopathic) tissue within the tendon while leaving healthy adjacent tissue intact. The result is removal of the pain-generating pathological tissue through a procedure performed under local anesthesia in an office or clinic setting.

At Balance Foot & Ankle, we offer the Tenex procedure as a non-surgical option for patients with chronic Achilles tendinopathy and insertional plantar fasciitis who have not adequately responded to physical therapy, orthotics, and injection therapy.

How Tendinopathy Creates a Treatment Challenge

Tendons heal through scar-like fibrous tissue rather than regenerating the original organized collagen architecture. In chronic tendinopathy, the tendon develops areas of disorganized, poorly vascularized degenerate tissue — tendinosis — that does not heal with rest or stretching alone. This pathological tissue is the pain generator in chronic Achilles and plantar fascia conditions. Traditional surgical options require open or endoscopic debridement with significant recovery time. The Tenex procedure provides a percutaneous alternative that achieves similar tissue removal with minimal disruption.

Indications and Candidate Selection

The Tenex procedure is appropriate for patients with chronic mid-tendon or insertional Achilles tendinopathy, chronic insertional plantar fasciitis with degenerative tissue on ultrasound, and other chronic tendinopathy at the elbow, knee, or hip that has failed conservative management for at least 3 to 6 months. Ultrasound imaging confirming the presence of tendinopathic tissue and ruling out significant tendon tears is performed before the procedure. The procedure is not appropriate for complete tendon tears or for patients with infection or significant calcification at the treatment site.

The Procedure

After local anesthesia, a small skin nick is made over the affected tendon. Under real-time ultrasound visualization, the Tenex TX MicroTissue Removal System probe is inserted and positioned within the area of tendinopathic tissue confirmed on pre-procedure ultrasound. The ultrasonic energy emulsifies the degenerate tissue, which is simultaneously aspirated through the probe. The procedure typically takes 15 to 20 minutes. No sutures are required for the tiny skin opening. A small dressing is applied and the patient walks out of the office.

Recovery and Expected Outcomes

Recovery after Tenex is significantly shorter than open tendon surgery. Most patients bear full weight immediately. Light activity resumes within 1 to 2 weeks. Return to running and sport typically occurs at 6 to 8 weeks. Clinical studies report 80 to 90 percent of patients achieving significant pain reduction and returning to activity. The procedure can be repeated if residual tendinopathic tissue remains after initial treatment.

If you have chronic Achilles or plantar fascia pain that has not responded to conservative treatment, contact Balance Foot & Ankle to learn whether the Tenex procedure is appropriate for you. We serve Southeast Michigan with same-week appointments.

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Frequently Asked Questions

How long is recovery after Tenex?

Most patients return to daily activities within 1-2 weeks and athletic activity in 4-6 weeks. Recovery is significantly faster than traditional open debridement, which requires 3-6 months.

Is Tenex covered by insurance?

Tenex is typically covered by commercial insurance and Medicare when conservative care has failed (documented 6+ months of treatment). Prior authorization may be required. Our office handles insurance verification.

Does Tenex really work for chronic tendinopathy?

Studies show 70-85% success rates for chronic Achilles tendinopathy and plantar fasciitis that has failed conservative care. Outcomes depend on accurate patient selection and targeting diseased tissue with ultrasound guidance.

Advanced Tenex Treatment at Balance Foot & Ankle

The Tenex procedure offers a minimally invasive alternative to traditional surgery for chronic Achilles and plantar fascia conditions. Dr. Tom Biernacki performs ultrasonic tissue debridement at Balance Foot & Ankle, helping patients recover faster with less downtime at our Howell and Bloomfield Hills offices.

Learn About Our Advanced Treatment Options | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Barnes DE, Beckley JM, Smith J. “Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study.” Journal of Shoulder and Elbow Surgery. 2015;24(1):67-73.
2. Razdan R, et al. “Ultrasonic percutaneous tenotomy for recalcitrant plantar fasciitis.” Foot & Ankle International. 2020;41(10):1207-1213.
3. Koh JS, et al. “Percutaneous ultrasonic fasciotomy for recalcitrant plantar fasciitis with and without Achilles tendinosis.” Journal of Foot and Ankle Surgery. 2019;58(4):747-751.

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Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.