## 4 Discussion

Table 3: Demonstration of the plantar pressure distributions of the eight sensors with maximum pressure with the TFA sound limb and the healthy subjects (mean \(\pm\) standard deviation). the foot. In transfemoral amputees, intact limb training may be a priority to reduce contraindications that may occur with gait adaptation. Plantar pressure distribution was used to detect the gait patterns of normal gaits, toe out, toe in, over supination/pronation, and heel-walking gait abnormalities [32]. Plantar pressure has been implemented in foot pathology evaluation [33] and assessments of the feet of diabetic individuals [34]. Plantar pressure data can be used as a guide for detecting gait disorders and gait training in TF prosthesis users. In this study, the forefoot activation percentage and peak plantar pressure value were higher in the sound limb than in the healthy individuals in the stance phase gait cycle. Prosthetic wearers with TF amputations can lift their bodies via the excessive plantar flexion of the intact foot using the compensatory mechanism of vaulting. According to the results, there is higher eccentric muscle work in the knee during the gait stance phase with double support at the beginning of the stance phase [35], and these changes in the knee occur before the plantar flexion of the ankle during the loading response. Higher flexion of the contralateral knee and higher eccentric work help to prepare for the vaulting movement. As previously mentioned, the purpose of gait compensation is to lift the body up to facilitate toe clearance, and thus, this could emerge as a compensatory mechanism to increase the foot clearance of the prosthetic foot and protect the amputated limb by loading it in a shorter time [8]. This decreased dorsiflexion may also be the result of decreased sound leg deceleration activity and greater hip flexion at the sound leg heel strike [36]. [PERSON] et al. demonstrated that TF amputees increase the muscle co-activation of the sound limb during walking as a compensatory/adaptive mechanism to deal with the prosthetic device. This increased co-activation probably plays a role in prosthetic gait asymmetry and energy consumption [37]. As a result of this study, the increased plantar pressure distribution seen in the intact-side forefoot may have developed for the reasons stated by [PERSON] [1], such as a lack of prosthetic knee flexion in the early stance, a lack of hip extension on the prosthetic side in the late stance, reduced anterior propulsion force on the prosthetic side in the late stance, and reduced prosthetic hip adduction moment in the early stance. [PERSON] et al. showed that unilateral transfemoral amputees experience significant kinetic asymmetries during gait movement as a result of absent loading response knee flexion, and individuals with TFA-intact limbs were shown to be excessive in this regard in comparison with a control group. The authors indicated that the provision of MPKs does not appear to improve any of these marked kinetic asymmetries; therefore, this group continues to walk with reduced energy efficiency [38]. Other studies have shown that 52-89% of unilateral lower limb amputees will frequently encounter lower back pain and that 41-63% will develop osteoarthritis in their sound limbs [39; 40]. Rehabilitation programs (during the preoperative and postoperative periods) can be proposed for TFAs in order to improve functional abilities, increase muscle strength, and limit the risk of early degeneration of the musculoskeletal system. The goal of prosthetic rehabilitation is to regain a symmetrical gait. Therapeutic exercises, gait training, and neuromuscular re-education prescribed for this purpose have been reported to be effective in reducing gait deviations and improving functional mobility [41; 42; 43]. [PERSON] et al.