What is The Tenex Procedure?
Tenex is a minor surgical procedure known as Percutaneous Ultrasonic Tenotomy (or Percutaneous Ultrasonic Fasciotomy in the case of plantar fasciitis). Tenex was developed in conjunction with the world renowned Mayo Clinic and is a new form of minimally invasive surgical treatment for chronic tendon pain, such as achilles tendinopathy and tennis elbow. It is also starting to be used for chronic plantar fasciitis. The Tenex machine is an ultrasonic microcutter, designed to remove scar tissue, which is performed under ultrasound guidance so that the surgeon minimises the risk of injury to the healthy soft tissue. At the same time, a built-in inflow-outflow fluid system simultaneously irrigates and sucks up the broken down, or emulsified, tissue. Once all of the degenerated tissue is cleared away, the probe is removed, and the incision is closed with adhesive skin tape and a pressure bandage. The whole procedure takes only a few minutes, and complications are apparently few.
Here is a video demonstration of the Tenex procedure for a patient with tennis elbow provided by the manufacturers of the technology.
Does it Work?
Currently there is just one study on the Tenex procedure for treating plantar fasciitis, which was a case series of 12 patients. The patients were reviewed 2 years after the procedure and all were pain free. None were restricted in their activity levels or needed to continue taking pain medication. All indicated they were satisfied with the procedure and would have it again. In addition to the reported success in pain relief, the procedure was also deemed safe, with no post-op complications reported. It is noted however, that author of this study is a member of the medical advisory board of Tenex Health, which developed the tissue removal system used in this study.
Although the study above did not report any post-op complications, there are concerns over the safety of this procedure such as injury of the healthy soft tissue of the plantar fascia and surrounding tissue. There have been reported complications published where Tenex has been used for treatment of achilles tendinopathy including tears, excessive swelling and ongoing pain. If you would like to know more about the complications reported check out the article in my blog here
The principles of the Tenex procedure make sense as the aim of the treatment is to remove/breakdown degenerative tissue in a minimally invasive manner. This is a similar aim to other treatments such as shockwave therapy. Tenex is just a notch or two higher on the invasive scale. Personally I would lean towards less invasive treatment options prior to considering Tenex. As Tenex is a newer treatment for plantar fasciitis owing to its recent development, there is lack of evidence available to test how safe and effective this procedure is for plantar fasciitis. Currently this treatment is not available in the UK.