Tenex Procedure

Updated 3/7/2024
Tenex - University Foot and Ankle Institute

If you’re one of 8 million Americans experiencing pain and discomfort in the Achilles tendon and/or plantar fascia, the Tenex Health Procedure, a minimally invasive treatment for soft tissue damage, may help.


Developed with Mayo Clinic, Tenex Health created a new conservative tendon procedure to help remove damaged tissue and leave behind healthy tissue, reducing tendon pain, aiding healing, and reducing the likelihood of more invasive treatment in the future.

What can cause fascia discomfort or tendon pain? 

Tendons can be considered rubber bands that help hold your joints in place and connect your bones to your muscles. They’re found alongside ligaments — fibrous soft tissues that connect bone to bone.


Overuse through repetitive motion can cause the build-up of scar tissue in the tendons. Hence, some forms of chronic tendon pain receive names like golfer’s elbow, jumper’s knee, or tennis elbow.


When scar tissue builds up on the Achilles tendon (the tendon that connects your calf muscles to your heel) due to damage to its insertional point, it is known as Achilles tendinopathy.


Similarly, the thick band of tissue that connects the heel bone to the toes, the plantar fascia, can become inflamed. This is known as plantar fasciitis. In some cases, it is not sports activities or repetitive movement that causes tendon pain but trauma, such as a trip, fall, or sudden twist of the foot.


Regardless of the culprit of scar tissue build-up, if left untreated, it can cause pain and limited range of motion. Achilles tendinopathy and plantar fasciitis are commonly present as heel pain or foot pain, especially when walking or running. Other symptoms include stiffness, swelling in the affected area, skin that feels warm to the touch, and trouble lifting onto the toes.


How are Achilles tendinopathy and plantar fasciitis traditionally treated? 

Traditional methods for treating tendon or ligament pain usually begin conservatively. University Foot & Ankle Institute’s podiatrists often start with rest to see if the tendon will heal itself. After a period of limited activity, you may begin physical therapy to help strengthen the muscles surrounding the tendon. To assist with pain, we may suggest custom orthotics or anti-inflammatory medication. If the pain is severe, cortisone injections can help temporarily alleviate discomfort.


Persistent pain from tendinosis (chronic damage to your tendon) or tendinitis (a swollen tendon) can signal the need for a more thorough procedure. Historically, this would have meant pursuing surgical options, such as Achilles tendon repair surgery. Surgical Achilles tendon repair could include open surgery, debridement of damaged tissue, the suture repair of any tears, a tendon transfer, and possibly a fasciotomy to relieve pressure from swelling.


Similar methods are used to relieve swelling of the plantar fascia. In some cases, repair surgery could even involve detaching the plantar fascia from the heel bone.


However, these surgical procedures usually mean a larger incision and longer downtime during recovery.


What is the Tenex procedure? 

The Tenex Procedure is an ultrasound-guided percutaneous needle tenotomy (PCNT). We’re able to surgically cut the damaged tendon through the skin, without the need for an open incision. During the Tenex treatment, our doctor will use diagnostic ultrasound to pinpoint the exact area(s) of damage. Ultrasound imaging uses a real-time specific frequency that, with our specially trained doctors and technicians, can locate the difference between healthy tissue and scar tissue without the need for open surgery.


Then, they use local anesthesia to numb the target area and use an ultrasonic needle to target the scar tissue. Ultrasonic energy is sent through the needle and helps break down the scar tissue on your tendon. The needle also removes the damaged scar tissue after it is broken down. Healthy tendon tissue remains unaffected.


In most cases, the treatment takes about an hour, with the actual Tenex Procedure taking only about 15 minutes. General anesthesia isn’t required, and only a very small incision is necessary. Afterward, there can be minor swelling.


However, recovery time is greatly reduced from several months (with traditional surgery) to one to two weeks with Tenex. You can usually begin light weight-bearing exercise within two weeks after your follow-up appointment. Most patients see significant pain relief in four to six weeks and experience full recovery by six months. During recovery, we may suggest wearing a walking boot for the first week or so and starting physical therapy to maximize Tenex results and help prevent future injury.


The TenJet System: a new and better alternative to Tenex? 

As great as the Tenex surgery is, the TenJet minimally invasive procedure is considered an improved version. Instead of the larger needle probe of the Tenex, which could theoretically cause scar tissue as a result of the procedure itself, the Tenjet Hydrocision system uses water jet technology. While University Foot & Ankle Institute’s surgeons are trained in Tenex, we prefer the TenJet.


What is the TenJet procedure? 

This outpatient procedure begins the same as the Tenex one: with ultrasound imaging to identify areas of concern. Then, after applying local anesthetic, we cut a minute hole, the size of a needle, allowing a tiny probe to be inserted into the target area. Once at the scar tissue site, a high-strength water jet breaks up the damaged tissue.


However, the jet is not strong enough to destroy healthy tissue, so it remains intact. The TenJet allows better precision of scar tissue break-up, and the attached suction machine allows scar tissue to be effortlessly removed from the body.


There is even less downtime following TenJet Hydrocision Therapy. Patients can bear weight on the foot immediately after the procedure. However, our doctors often provide crutches and a walking boot for optimal healing. After a week you’ll be able to return to light, normal activities. It’s at this time we suggest you begin physical therapy to rebuild strength and flexibility.


While both Tenex and TenJet can be used for foot and ankle pain caused by things like Achilles tendinitis or plantar fasciitis, our doctors at UFAI stand behind the TenJet treatment as the best option. They can also combine the procedure with additional therapy options such as platelet-rich plasma (PRP) or amniotic cell injection to boost healing and get you back to a pain-free life.


Why Turn to UFAI for your TenJet or Tenex procedure

University Foot and Ankle Institute stands at the forefront of these exciting new podiatry procedures. Our doctors maximize every traditional and advanced technological modality to safely heal your foot and ankle concerns.


For a consultation, please call (877) 736-6001 or make an appointment online now.


University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot and ankle surgeons are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Sherman Oaks, the San Fernando Valley, El Segundo, the South Bay, LAX, Calabasas, Agoura Hills, Westlake Village, Valencia, Santa Clarita, and Santa Barbara.





Tenex FAQs


What is the success rate of Tenex? TenJet? 

The Tenex procedure success rate for plantar fasciitis treatment is good. According to one study, 70% of individuals with plantar fasciitis who underwent the Tenex procedure reported being still satisfied with their results over 3.5 years later. In a study of 100 individuals with lateral epicondylitis (tennis elbow), zero patients needed open surgery following a TenJet procedure, and the 95 that completed the study reported significant improvement in pain and mobility.


Is Tenex better than PRP? 

UFAI strives to provide the safest care to each patient, beginning with the most conservative treatment options. Generally, our doctors prefer to use the TenJet, and, if indicated, combine it with a PRP injection. The injection can often be done during the TenJet procedure or right after.


What is the difference between Tenex and TenJet? 

The TenJet tenotomy incision is smaller than the Tenex procedure and has better preciseness when breaking up scar tissue. Following the procedure, the TenJet does not require stitches, unlike the Tenex, and the patient can bear weight on the foot immediately after the treatment.


  • Foot and Ankle Surgeon at University Foot and Ankle Institute
    Dr. Justin Franson, DPM, University Foot and Ankle Institute, Foot and Ankle Surgeon

    Dr. Justin Franson, DPM, is a Board Certified Podiatric Foot and Ankle Specialist and Diplomate of the American Board of Podiatric Surgery. He attended the School College of Podiatric Medicine in Chicago, graduating in 2001. Dr. Franson then accepted a three-year residency program at the Greater Los Angeles VA and UCLA County Hospital. 


    Dr. Franson specializes in several areas including total ankle replacement and sports medicine. Treating athletes and weekend warriors like himself brings him a lot of joy. Dr. Franson keeps active with running marathons, triathlons, hiking, basketball, and golf.

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