102 - The Achilles Heel for Achilles Tendinopathy: Tenex as a Minimally Invasive Solution

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

AW

Alvin Wang, DO

Resident Physician
Mount Sinai Hospital
Palo Alto, California, United States

Co-Author(s)

AS

Adam T. Schulman, MD

Resident Physician
Mount Sinai Hospital
NYC, New York, United States
IO

Ian O'Connor, MD

Sports Medicine Fellow
Mount Sinai Hospital
New York, New York, United States

Corresponding Author(s)

RC

Richard G. Chang, MD, MPH

Associate Program Director, Sports Medicine
Mount Sinai Hospital
New York, New York, United States

Submitter(s)

AW

Alvin Wang, DO

Resident Physician
Mount Sinai Hospital
Palo Alto, California, United States

Case Diagnosis: Right insertional Achilles tendinopathy and enthesopathy

Case Description: A 66-year-old male teacher with history of right quad tendon rupture with surgical repair presented with chronic right heel pain. The pain was sharp, 7/10 and provoked by walking and limited his participation in physical activity. He attempted physical therapy, acupuncture, NSAIDS and a percutaneous needle tenotomy (not Tenex) but only found temporary relief. On exam, there was tenderness over the insertion of the Achilles onto the calcaneus. An ultrasound of the right Achilles showed overall thickening and heterogenous texture with cortical irregularity and a small enthesophyte at the medial calcaneus. He underwent an US-guided Tenex procedure of the right Achilles tendon with lavage and barbotage of calcification/enthesophyte. At two weeks and six weeks follow-up, the patient reported 2/10 heel pain and no limitations with walking. He successfully returned to recreational activities.

Discussions: This case is notable for the use of Tenex to treat Achilles tendinosis, persisting despite extensive conservative management. There are currently fewer than 50 documented cases of Tenex used for Achilles tendinopathy in literature and no established clinical guidelines on when to initiate Tenex therapy. In this patient, the decision to proceed with Tenex was driven by persistent symptoms and a desire to avoid surgery. The largest study of Tenex for Achilles tendinopathy was conducted in 34 patients, with 17/20 (85%) that returned for follow-up at 11 months or later reporting mild/no pain. This compares well to the satisfaction rate for open-surgical debridement for Achilles tendinopathy, which ranges from 78% to 85%. Recognition of Tenex as a minimally invasive treatment option and establishment of guidelines for its use may offer sustainable therapeutic effect without need for surgical interventions.

Conclusions: Our case highlights a successful use of Tenex for Achilles tendinosis and supports its use as a minimally invasive option to surgical management.