40. Prosthetic Limbs

Summary

Podcast Summary: The Economics of Everyday Things — "Prosthetic Limbs"

Podcast: The Economics of Everyday Things
Host: Zachary Crockett (Freakonomics Network)
Episode: 40. Prosthetic Limbs
Date: May 18, 2026

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Episode Overview

This episode explores the economics, technology, and lived experiences associated with prosthetic limbs in the United States. Host Zachary Crockett examines the journey of amputees from injury to rehabilitation, highlights the cost structure and innovation in prosthetics, and discusses the challenges and solutions in accessibility and coverage. Through rich interviews with amputee Jordan Beckwith ("Footless Jo") and prosthetist Eric Neufeld, the episode delves into both personal and systemic aspects of prosthetic limb use.

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Key Discussion Points & Insights

1. Personal Story: Losing and Regaining Mobility

• Jordan Beckwith’s Journey (01:18)
  • Jordan (Footless Jo), a YouTuber with over a million subscribers, lost her lower leg after years of pain and surgeries stemming from a riding accident at age 13.
  • Describes the decision and process of amputation: “From the time that I sent the email in, being like, yes, let's go ahead and do this. I think it was three weeks from then... It's funny, I mean, the process is like minor knee surgery or wrist surgery. It's all the same. When they're also removing a limb, they come in smiling. They're like, this is the one we're taking off today, right?” (01:28)
• Rehabilitation and Adaptation
  • Started using a prosthetic within 6-8 weeks post-surgery.
  • Develops a close and ongoing relationship with her prosthetist, emphasizing the trust and time spent together (04:14).

2. The Role of the Prosthetist

• Industry Overview
  • Eric Neufeld (Agile Orthopedics) explains the job's technical and personal side: “We get to know [patients] very, very well... It's ideally a lifelong relationship. Periodically maintaining the device, replacing parts, keeping in touch...” (05:17)
  • Pathway into the profession includes an MPO—Master's of Prosthetics and Orthotics—plus certification and a residency (04:51).
• Payment Structure
  • Prosthetists are reimbursed by insurance per device delivered, not by hours of service. “It's a real nuance... The financial model is based on a single item, and all the services associated with it is tied into that payment for that device.” (06:06)

3. The High Cost of Prosthetic Limbs

• Typical Costs
  • Below-knee prosthesis: $15,000–$20,000 (07:53).
  • Just the ankle component can cost $16,000 (08:01).
  • Full prosthetic device (standard, mechanical): about $30,000 (08:38).
• Advanced Prosthetics
  • Microprocessor-controlled knees: $70,000–$80,000+ (09:27).
  • Myoelectric upper limbs (using muscle signals): can exceed $100,000 (09:27).

4. Design and Customization

• Custom Construction
  • Central piece is the socket; uniquely crafted for each individual.
  • Components assembled based on the patient’s body, needs, and activities (07:02).
• Technology Spectrum
  • Devices range from purely mechanical to sophisticated digital and sensor-equipped models with feedback systems (09:14).
  • Simpler devices sometimes prove more functional for user-specific needs, as with an amputee creating a "carrot arm"—just a fork at the end of a socket for kitchen use (10:57).

5. Insurance, Maintenance, and Ongoing Costs

• Insurance Approval
  • Coverage depends on strict medical necessity, including documentation of physical abilities, home environment, and long-term prognosis (14:03).
  • “Quite a bit of documentation is required both from the prosthetist and the physician... We have a staff of administrative people fighting with insurance companies...” (14:26)
• Out-of-Pocket Expenses
  • Insurance may only cover new major components every three years, yet parts like liners ($1,000 each, lasting 6 months) and sleeves ($300–$400, lasting 2 months for active users) wear out much faster (15:19).
  • Patients often have to "ration" their use of parts (15:19).

6. Accessibility Challenges and Global Innovation

• Global Perspective
  • In low-resource environments, people use creative solutions—like reinforcing soda bottles for sockets and attaching them to wooden limbs (16:11).
• 3D Printing’s Promise
  • 3D printing could reduce costs and increase access: “You know, for instance, a scan could be taken in Ecuador and I could print a socket in Denver that night from that scan.” (17:13)
  • Drawback: load-bearing limbs still require carbon fiber, which isn’t 3D printable (17:59).
• Component Reuse
  • Organizations recycle prosthetic parts (not sockets, which are unique to each user); parts are distributed globally to improve access (18:20).

7. The Future and Community

• Rising Need
  • Number of amputees in the US is expected to double between 2005 and 2050, largely due to diabetes and vascular disease, especially in low-income communities (16:50).
• Support and Resilience
  • Advocacy and online communities (like Footless Jo’s YouTube channel) help amputees adjust and thrive.

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Notable Quotes & Memorable Moments

• Jordan Beckwith’s humor:
  “There's the assumption that it came from something military related and I have to break their little hearts and be like, no, I just fell off a horse. You know I'm not that cool.” (19:54)
• On prosthetist relationships:
  “The relationship that you have with your prosthetist as an amputee is really important. There's a lot of trust that’s placed in them.” — Jordan Beckwith (04:14) “It's a very intimate relationship.” — Eric Neufeld (04:29)
• On costs:
  “You're talking large dollar signs when it comes to anything prosthetics related.” — Jordan Beckwith (08:38)
• On maintenance and rationing:
  “There's a rationing that comes along with being an amputee for all the additional parts and pieces.” — Jordan Beckwith (15:19)
• On global ingenuity:
  “People using upside down soda bottles that are reinforced in a way to become a socket and then attached to just wood, just scrap wood and twine, tying everything together... I’ve really come to appreciate that kind of innovation.” — Eric Neufeld (16:11)
• On 3D printing’s potential:
  “A scan could be taken in Ecuador and I could print a socket in Denver that night from that scan. So it allows us to work together in ways that we were never able to before.” — Eric Neufeld (17:13)

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Timestamps for Important Segments

• 01:18 — Introduction to Jordan Beckwith, her accident, and decision to amputate
• 02:24 — Beginning of rehabilitation with prosthetics
• 03:28 — The prosthetist-patient relationship
• 04:41 — Prosthetist education and career path (Eric Neufeld)
• 06:06 — Prosthetist payment model and insurance structure
• 07:53 — Cost breakdown for prosthetic limbs and components
• 09:27 — Advanced prosthetic technologies and price escalation
• 10:57 — Story of designing a custom, simple "carrot arm"
• 13:56 — Insurance approval process for prosthetics
• 15:15 — Routine maintenance parts, their costs, and rationing by patients
• 16:11 — Prosthetic innovation in resource-constrained regions
• 17:13 — 3D printing advances and their implications
• 18:20 — Reuse/recycling of prosthetic components
• 19:54 — Footless Jo’s closing anecdote on societal perceptions

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Episode Takeaways

• The world of prosthetic limbs is intricate and expensive, balancing custom engineering, insurance hurdles, rapidly advancing technology, and end-user needs.
• Despite high-tech options, sometimes “simpler is better”—adaptation is deeply personal.
• Access, affordability, and maintenance remain significant barriers, especially for underinsured Americans and people in less wealthy countries.
• The future holds promise through technology (3D printing, recycling) and community-driven solutions.
• Real-life experiences, like those of Jordan Beckwith, illuminate both the setbacks and resiliency behind mobility loss—and recovery.

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(This summary omits ad sections, focusing entirely on the episode’s main content and discussions.)

Transcript

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[Narrator (Zachary Crockett)]

Jordan Beckwith is in her early 30s.

[Narrator/Reporter]

She lives on her own just outside of Denver, Colorado.

[Narrator (Zachary Crockett)]

She's got an apartment, a car, two big dogs named Sophie and Leo, and

[Narrator/Reporter]

a YouTube channel with a million subscribers.

[Jordan Beckwith (Footless Jo)]

My name's Jordan Beckwith, but online my handle's Footless Jo.

[Narrator (Zachary Crockett)]

Footless Joe's origin story goes like this.

[Jordan Beckwith (Footless Jo)]

When I was 13, I took a very bad fall off of a horse, shattered my ankle, my tibia broke off and then was shoved up into my legs. It was a really bad break, caused a lot of complications and healing. It was about 14 years of surgeries and trying to walk, trying to be active and be a kid. By the time I was 27 and still dealing with all of that, I knew that I was at the point to make the right decision. And five years ago, in 2018, I had my below the knee amputation. From the time that I sent the email in, being like, yes, let's go ahead and do this. I think it was three weeks from then. And it's funny, I mean, the process is like minor knee surgery or wrist surgery. It's all the same. When they're also removing a limb, they come in smiling. They're like, this is the one we're taking off today, right? As soon as pain was under control, they keep you there for like three days and then they send you home.

[Narrator (Zachary Crockett)]

What came next was an intense, expensive

[Narrator/Reporter]

and important relationship with her new leg.

[Jordan Beckwith (Footless Jo)]

In general, they try to get you up and beginning to use a prosthetic within like six to eight weeks, which sounds very soon, right? Like, you just cut off my leg. And I'm supposed to start walking on that.

[Narrator (Zachary Crockett)]

For the Freakonomics radio network, this is the economics of everyday things. I'm Zachary Crockett. Today, prosthetic limbs in the US about

[Narrator/Reporter]

2000 babies a year are born missing some portion of a limb. Far more people lose arms or legs later in life as a result of vascular disease or an injury. Altogether, more than 2 million Americans today are living with the absence of a limb.

[Narrator (Zachary Crockett)]

Some amputees don't seek out a replacement

[Narrator/Reporter]

for their lost limb.

[Narrator (Zachary Crockett)]

But many patients, especially those with leg loss, use a prosthesis. And for them, the first step is

[Narrator/Reporter]

finding a good prosthetist.

[Narrator (Zachary Crockett)]

Joe Beckwith loves hers.

[Jordan Beckwith (Footless Jo)]

He's fantastic. He's goofy, and he does a great job making legs. Right now, he works with Hanger Prosthetics.

[Narrator/Reporter]

Hanger has about 900 clinics nationwide.

[Narrator (Zachary Crockett)]

It provides prosthetics, which are devices meant to replace limbs and orthotics, things like knee braces and shoe inserts that support an existing body part from the outside.

[Narrator/Reporter]

Hanger does brisk business.

[Narrator (Zachary Crockett)]

Before it was taken private in 2022,

[Narrator/Reporter]

it reported annual net revenues of over a billion dollars.

[Jordan Beckwith (Footless Jo)]

They are the biggest. I had a lot of hesitations about Hanger kind of just being like big box prosthetics, but I've had a great experience there, actually.

[Narrator/Reporter]

How did you know you had found the right person?

[Jordan Beckwith (Footless Jo)]

There's a lot of time that you spend with them, a lot of like, all right, let's try this and see how it works. The relationship that you have with your prosthetist as an amputee is really important. There's a lot of trust that's placed in them.

[Eric Neufeld]

Yeah, it's a very intimate relationship.

[Narrator (Zachary Crockett)]

That's Eric Neufeld. He's the owner and medical director of Agile Orthopedics, which is also in Colorado.

[Eric Neufeld]

We're among the smaller size in our industry. We see about 200, 225 prosthetic patients a year.

[Narrator/Reporter]

What would you major in if you wanted to do this?

[Eric Neufeld]

Well, a variety of things. People major in engineering and then go for this master's program. It's called an mpo, which is a master's of prosthetics and orthotics. You need to go through a formal certification process, taking a series of exams, and going through a residency program. At the end of it, then you are certified, and that's your badge.

[Narrator/Reporter]

What was it about it that really hooked you?

[Eric Neufeld]

I think it was just the ability to make stuff and solve problems, but with a real purpose. You know, when we meet somebody, that's the line of questions that we go through. What's important to you? What do you like to do? What do you need to do? What's your job? It's in most cases, ideally a lifelong relationship. Periodically maintaining the device, replacing parts, keeping in touch with the patients. And your limbs change over a lifetime too. You gain and lose weight, you gain and lose muscle. Things happen. We've got to keep up with that with their devices. So these are people we get to know very, very well.

[Narrator (Zachary Crockett)]

But unlike a doctor or a physical therapist, Neufeld is not paid by appointment.

[Eric Neufeld]

We get reimbursed by insurance companies or Medicare or Medicaid when the device is delivered, not from the hours and hours of services provided leading up to that or even after that, it's a real nuance. But prosthetics and orthotics as a combined field is looped into durable medical equipment. So DME picture wheelchairs, crutches, beds, oxygen, things like that. Whether it's one of those walking boots you get after you fracture your ankle or a very complex above knee prosthesis, it's all considered the same financial model that's based on a single item, and all the services associated with it is tied into that payment for that device.

[Narrator (Zachary Crockett)]

It takes a lot of consultation and

[Narrator/Reporter]

time to get these highly customized products

[Narrator (Zachary Crockett)]

right, especially the socket where the prosthesis

[Narrator/Reporter]

will connect to its future owner.

[Eric Neufeld]

That's the cup that the residual limb goes into. Custom, you know, unique to that person on the socket is an attachment point at the bottom of it where you put on the componentry. And those components could be the knee, the shin section, the ankle portion, and then the foot and any other features that we're adding to it for, you know, suspension methods. Then a dynamic alignment is performed so each person walks just a little differently based on their strength, based on compensatory mechanisms they're using because of the weakness or the loss of that limb. And so it's aligned through some adjustability that's built into the components until it feels safe and performs all that work.

[Narrator (Zachary Crockett)]

Means that prosthetics are not cheap

[Eric Neufeld]

prosthetic limbs. You know, the cost for a below knee prosthesis, it's around 15 to 20 thousand dollars.

[Jordan Beckwith (Footless Jo)]

My first ankle was an oser ankle. That was the brand, I believe, when I got the bill for it. Not the socket, just the ankle itself was about $16,000.

[Narrator (Zachary Crockett)]

Looking through the manufacturer's catalogs, you can see which ankles are rated higher for

[Narrator/Reporter]

shock absorption or are waterproof. But it's hard to find prices on these individual components.

[Narrator (Zachary Crockett)]

They're not generally published online. So before a prosthetist can buy a particular model to use in a patient's device, their clinic needs to negotiate a

[Narrator/Reporter]

rate with the distributor or with the manufacturer themselves.

[Jordan Beckwith (Footless Jo)]

Either way, you tie that together with the sockets. That whole process was right around 30,000. You're talking large dollar signs when it comes to anything prosthetics related.

[Narrator/Reporter]

That's just for standard mechanical devices, which Beckwith uses.

[Jordan Beckwith (Footless Jo)]

None of them have to be charged. There's no computerized parts or pieces.

[Eric Neufeld]

You're controlling it just by your body movement and your muscle activity.

[Narrator (Zachary Crockett)]

But there are also knees and ankles

[Narrator/Reporter]

that are controlled by microprocessors and powered by hydraulics and rechargeable batteries.

[Narrator (Zachary Crockett)]

These components offer a responsive range of

[Narrator/Reporter]

stability and support, whether you're standing still or playing basketball.

[Narrator (Zachary Crockett)]

The software in these devices has to

[Narrator/Reporter]

learn how their owner moves over time.

[Eric Neufeld]

The microprocessor controlled knee, for instance, is reading your speed, your slope, how you're walking. If there's been an interruption and you're about to stumble, it knows that because it's taking these readings, however many times per second above knee, with the use of microprocessor componentry, can get into the 70, $80,000 range. And then similarly, if somebody you know is missing above the elbow and you're using myoelectrics and externally powered devices that can actually cross the $100,000 threshold.

[Narrator (Zachary Crockett)]

Myoelectric devices use signals from the arm's remaining muscles to help direct the movements

[Narrator/Reporter]

of a prosthetic elbow, wrist, or hand.

[Narrator (Zachary Crockett)]

The most deluxe models can even provide the sensation of touch. Think of reaching into your back pocket for your id the way we use our hands depends heavily on the information

[Narrator/Reporter]

we receive from the nerves in our skin.

[Narrator (Zachary Crockett)]

But there's also the challenge of proprioception, which is the body's sense of where all its parts are in balance, in

[Narrator/Reporter]

motion, and in relation to one another.

[Narrator (Zachary Crockett)]

It's a vital part of our neural

[Narrator/Reporter]

system when it comes to motor control.

[Narrator (Zachary Crockett)]

And engineers in the field called biomechatronics are making headway. But more bells and whistles make a

[Narrator/Reporter]

device more expensive and harder to learn.

[Narrator (Zachary Crockett)]

So sometimes simpler is better.

[Eric Neufeld]

Somebody who had lost her arm above the elbow, you know, we had gone through all these different iterations with complex arms to achieve a variety of things. But ultimately, all she wanted to do was hold a carrot on a cutting board. That was it. And so she helped design something called the carrot arm, which was a very simple socket with a fork just coming out of the end of it. No wrist, no hand, no elbow, nothing. This became more functional to her.

[Narrator (Zachary Crockett)]

Basic or advanced prosthetics still remain out

[Narrator/Reporter]

of reach for some patients.

[Jordan Beckwith (Footless Jo)]

I've certainly talked to people in some pretty rough situations where getting a prosthetic is not possible for them for one of many reasons that's coming up America's

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[Narrator (Zachary Crockett)]

If you need a prosthetic and you want your insurance to pay for it,

[Narrator/Reporter]

it'll have to be approved as medically necessary.

[Narrator (Zachary Crockett)]

Providers coverage guidelines often refer to a patient's function level and their potential for Rehabilitation. A patient's physician and prosthetist have to make a case involving their physical ability, their life expectancy, their home and work environment, even their grit. Eric Neufeld of Agile Orthopedics says, it can be an ordeal.

[Eric Neufeld]

Quite a bit of documentation is required both from the prosthetist and the physician who's collaborating and prescribing the device. We have a staff of administrative people fighting with insurance companies, chasing down documentation, you know, the billing, collecting all that stuff.

[Narrator (Zachary Crockett)]

If the request gets approved, then Medicare and many private insurance plans will cover

[Narrator/Reporter]

80% of the cost of a new prosthetic device.

[Jordan Beckwith (Footless Jo)]

But then there are pieces that wear out before they're going to be covered again.

[Narrator (Zachary Crockett)]

That's Jordan Beckwith, AKA Footless Joe.

[Jordan Beckwith (Footless Jo)]

So that's an out of pocket expense that either I have to pay myself or I have to deal with a part of my leg not working. Generally speaking, every three years, insurance will consider covering a new ankle.

[Narrator (Zachary Crockett)]

A lot of the components can wear out much faster.

[Jordan Beckwith (Footless Jo)]

There's a liner, which is the thing that's directly in contact with your skin. It's $1,000 each. I can make it last for six months, but that is a stretch. There's something called a sleeve, which is if you're using a suction based form of a prosthetic, which a lot of people do, those things wear out after like two months if you're an active person. But Those are like $300 to $400 each, and I couldn't really walk without it. Then there's like the foot shell, which is the thing that kind of looks like a foot that actually goes into the shoe. I was walking on one that had a lot of holes in it for a long time. So there's a rationing that comes along with being an amputee for all the additional parts and pieces.

[Narrator (Zachary Crockett)]

Eric Neufeld has spent time distributing prosthetics in parts of Central and South America where many people can't afford professionally made limbs at all.

[Eric Neufeld]

People get very innovative, very creative. We've seen all kinds of stuff. People using upside down soda bottles that are reinforced in a way to become a socket and then attached to just wood, just scrap wood and twine, tying everything together. And people like pretty functional on some of these really cleverly designed and cobbled together devices. I've really come to appreciate that kind of innovation that people just from the materials around them have been able to figure something out.

[Narrator (Zachary Crockett)]

Researchers at Johns Hopkins have suggested that the number of amputees in the US

[Narrator/Reporter]

is poised to double between 2005 and 2050.

[Narrator (Zachary Crockett)]

That's mostly due to the rising rates

[Narrator/Reporter]

of diabetes and peripheral arterial disease. These often go untreated in low income and underinsured communities.

[Narrator (Zachary Crockett)]

One development that could make some prosthetics more affordable is the rise of 3D printing.

[Eric Neufeld]

As we get better and better at creating algorithms and certain ways to process scans to create the sockets through 3D printing, I do think it could drive down cost and create scalability. You know, for instance, a scan could be taken in Ecuador and I could print a socket in Denver that night from that scan. So it allows us to work together in ways that we were never able to before.

[Narrator (Zachary Crockett)]

3D printing is an efficient way to

[Narrator/Reporter]

get through the many iterations that it takes to get a socket right.

[Narrator (Zachary Crockett)]

There have been significant advances in 3D printed hands, arms, and even feet, though

[Narrator/Reporter]

certain parts are still a challenge.

[Narrator (Zachary Crockett)]

Legs, for instance, generally have to be

[Narrator/Reporter]

made from carbon fiber materials strong enough to bear a person's weight. And that material can't be 3D printed.

[Narrator (Zachary Crockett)]

Another solution to the cost and accessibility issue is to reuse prosthetic parts. Eric Neufeld founded an organization that helps

[Narrator/Reporter]

prevent expensive parts from going to waste.

[Eric Neufeld]

To just throw it away is heartbreaking. So we do accept a ton of used prosthetics from all over the country. The sockets are not really reusable. You can't refit a socket on someone else. So, you know, the recycling effort is in the componentry. And we have a process to control quality and inspection and things like that. And we're able to distribute them to manufacturing facilities and labs that are providing custom sockets on site. In Guatemala and Ecuador, they use the recycled componentry from donations that are happening here in the United States. It's going to really help someone else and change someone else's life. It's a huge win win.

[Narrator (Zachary Crockett)]

For her part, Jo Beckwith will continue sharing her triumphs and her challenges with

[Narrator/Reporter]

her subscribers on YouTube.

[Jordan Beckwith (Footless Jo)]

I think it's really about figuring out what you want your life to look like and how you want to adjust to. I consider myself extraordinarily lucky with the people that I've been able to meet with the community that I have, and a prosthetist who fights on my behalf like amazing

[Narrator (Zachary Crockett)]

for the economics of everyday things. I'm Zachary Crockett. This episode was produced by Sarah Lilly and mixed by Jeremy Johnston. We had help from Daniel Moritz rapping.

[Jordan Beckwith (Footless Jo)]

There's the assumption that it came from something military related and I have to break their little hearts and be like, no, I just fell off a horse. You know I'm not that cool.

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