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

Tenex Procedure for Tendinopathy: Minimally Invasive Relief for Chronic Tendon Pain

For patients with chronic tendinopathy who haven’t responded to physical therapy, injections, and other conservative treatments — but aren’t ready for open surgery — the Tenex (ultrasonic percutaneous tenotomy) procedure offers a compelling middle path. This minimally invasive technique uses ultrasonic energy to remove degenerative tendon tissue through a needle-sized incision, with recovery measured in weeks rather than months. Here’s what it is, who it’s for, and what to expect.

What Is the Tenex Procedure?

Tenex (and its equivalent, TENEX HEALTH TX or percutaneous ultrasonic tenotomy/fasciotomy) is a procedure that uses a precisely controlled ultrasonic probe inserted through a small incision under ultrasound visualization. The probe emits ultrasonic energy that selectively breaks down and emulsifies degenerative (pathological) tendon or fascia tissue while leaving healthy tissue intact — due to the difference in mechanical properties between degenerated and healthy tissue. The emulsified material is simultaneously removed through irrigation. The entire procedure is performed under local anesthesia in an office or outpatient setting and takes 15-30 minutes.

Which Conditions Are Treated?

Tenex is FDA-cleared for the treatment of chronic tendinopathy — specifically, for tendons with documented areas of intrasubstance degeneration on ultrasound (what appears as hypoechoic [dark] zones within the normally uniform tendon). The most commonly treated foot and ankle conditions include mid-portion and insertional Achilles tendinopathy, plantar fasciitis (fasciotomy variant), peroneal tendinopathy, tibialis anterior and posterior tendinopathy, and extensor tendinopathy on the dorsum of the foot. MRI or diagnostic ultrasound confirmation of degenerative tissue is typically required before the procedure is appropriate.

Who Is a Good Candidate?

Ideal candidates are patients with: documented degenerative tendinopathy on imaging; a history of 3-6 months of failed conservative treatment including physical therapy and at least one injection; and a desire to avoid open surgical intervention with its longer recovery. Patients who have had complete tendon tears rather than partial degeneration are not candidates for Tenex — the procedure treats degeneration, not acute ruptures. Patients with primarily inflammatory rather than degenerative tendinopathy (acute tendinitis) are also poor candidates, as their pathology should respond to anti-inflammatory approaches rather than tissue removal.

The Procedure Experience

The procedure begins with diagnostic ultrasound confirming the area of degeneration. Local anesthetic is injected around the target tissue. The Tenex probe is introduced through a small skin puncture (no formal incision or stitches required), positioned under real-time ultrasound guidance precisely within the degenerative zone, and activated. Patients typically feel minimal discomfort during the procedure itself due to anesthesia. The target tissue feels a vibration sensation. Post-procedure, the puncture is covered with a bandage — no sutures needed. Total office time is typically under 1 hour.

Recovery After Tenex

Recovery is substantially faster than open surgery. Most patients are weight-bearing in a walking boot within 1-2 days, transition to supportive shoes within 2 weeks, and begin progressive physical therapy at 4-6 weeks. Return to running and high-impact activity is typically possible at 6-12 weeks — significantly faster than the 3-6 month timeline for traditional open tendon debridement. The recovery period still requires adherence to weight-bearing restrictions and progressive activity guidelines; attempting to return to full activity immediately after Tenex risks re-injury to the healing tissue.

Evidence and Results

Clinical studies of Tenex for Achilles tendinopathy and plantar fasciitis show significant improvements in pain scores and function at 6 and 12 months compared to pre-procedure baseline, with most studies reporting 70-80% of patients achieving meaningful pain reduction. Comparative studies against PRP injection and corticosteroid injection show favorable or equivalent results for chronic tendinopathy. As with any procedure, outcomes are best when patient selection is appropriate (documented degenerative pathology, failed conservative care) and the treatment is performed by an experienced provider using real-time ultrasound guidance.

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Tenex Procedure: Minimally Invasive Tendon Treatment

The Tenex procedure uses ultrasonic energy through a tiny incision to remove damaged tendon tissue while preserving healthy tissue. It offers faster recovery than traditional surgery for chronic Achilles and plantar fascia problems.

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Clinical References

1. Barnes DE, et al. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. Journal of Shoulder and Elbow Surgery. 2015;24(1):67-73.
2. Koh JS, et al. Percutaneous needle tenotomy for chronic tendinopathy. Clinical Orthopaedics and Related Research. 2016;474(7):1604-1611.
3. Razdan T, et al. Percutaneous ultrasonic fasciotomy: a novel approach for recalcitrant plantar fasciitis. Foot and Ankle Specialist. 2017;10(5):417-422.

Dr. Tom Biernacki, DPM

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.