When a client presents shortly after amputation, the quality of the initial clinical assessment shapes everything that follows. Not just the first prosthesis, but the entire rehabilitation treatment plan, including therapy needs, anticipated socket changes, clinical milestones, and long-term costs. At the London Prosthetics Centre (LPC), goal-led planning starts from day one.

Recently, our team worked with a new client to help him achieve his ultimate goal of completing a Hyrox competition, an indoor circuit-style fitness race that is gaining popularity all over the world. To keep his identity anonymous, we will refer to him as Client A in this article.

Client A was referred to the London Prosthetics Centre one month after receiving a traumatic below-knee amputation as a result of a workplace accident. Before the injury, fitness was a central part of his daily life, attending the gym six to seven days a week. He was clear from his very first appointment that returning to high-level activity was his primary long-term goal.

His case was funded through a personal injury claim, with his legal team seeking a clear, costed rehabilitation plan from the outset.

Senior Prosthetist Carl Cato and the wider clinical team conducted a comprehensive assessment considering Client A's physical condition, residual limb presentation, baseline fitness, and personal goals. From that assessment, a structured, three-phase rehabilitation pathway was produced, with anticipated milestones, socket transitions, and therapy requirements mapped out across the first two years.

Carl explains, "Early assessment to provide a thorough, goal-led rehabilitation treatment plan is critical for long-term success and well-being post-amputation. Based on the physical assessment and the understanding of the patient's motivation and capability, the pathway can be formed in a way that costs out changes at predictable milestones."

The three-phase pathway

Phase one: mobility and independence (0 to 6 months)

The initial focus was on increasing independence, getting him comfortable using an everyday walking prosthesis, supported by weekly one-to-one physiotherapy. By the three to six month stage, Client A had achieved unaided walking. A second socket was anticipated and costed at the outset, reflecting the predictable reduction in residual limb volume as post-operative oedema resolves. This is standard for primary amputees and is best planned for in advance rather than treated as an unforeseeable variation.

Phase two: high activity and running (6 to 12 months)

At the six-month stage, a high-activity prosthesis was introduced alongside specialist running therapy. A change in socket design was required to accommodate the increased loading forces associated with gym-based activity and running, bringing Client A to his third socket phase. This too had been anticipated and costed at assessment. His everyday walking prosthesis continued to be monitored and reviewed throughout.

Phase three: fine-tuning and goal attainment (12 months onwards)

With the residual limb now approaching stability, the clinical team moved to optimise both prostheses for long-term use. The focus shifted to achieving the goals Client A had set at that very first appointment. Less than seven months after his initial assessment, Client A competed in the Hyrox event he had committed to when he first walked through our doors.

What this means in practice

For case managers and legal teams, this kind of structured pathway makes things far easier to manage. Costs can be anticipated early, clinical decisions are clearly documented, and any changes along the way are easier to explain and justify.

It also means that referring professionals are never left chasing progress. Our in-house Patient Coordinator Leigh Purcell works alongside the clinical team throughout, keeping all parties informed and ensuring nothing falls through the gaps. As Leigh puts it: “For complex cases, it takes administrative pressure away from our referral partners. My role ensures that all parties are up to date, meaning the process runs smoothly.”   

For Client A, the results speak for themselves. A clear plan, set out at that very first appointment, and a team committed to seeing it through.