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The vertical forces acting on the sole of the foot in walking have been measured in 24 diabetic patients with neuropathic ulceration of the foot using a load-sensitive surface divided into 128 load cells, and compared with those in two groups of controls: (a), 21 diabetic patients with peripheral neuropathy but no ulceration and (b) 47 normal individuals. The results showed that the patients with neuropathic ulceration were significantly heavier, that diabetic patients with neuropathy, with or without ulceration, transmitted proportionally less force through the toes than normal individuals, and showed a medial shift of the force transmitted through the metatarsal heads. All plantar ulcers occurred at the site of maximum loading. The absolute force at the site of maximum loading was significantly greater in the patients with ulcers than in both control groups, through there was a considerable overlap. A significant difference remained even when the absolute force had been corrected for differences in toe loading and body weight, indicating that a further factor (or factors) must contribute to the development of these localized areas of high loading.

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suMMARY A study of peak force exerted under areas of the foot was made in 27 patients with rheumatoid disease and in 30 normal persons. Patients were found to exert considerably less force under their toes and under the first metatarsal head and more force under the 3 outer metatarsal heads. It was possible to correlate these changes with increasing clinical and radiological severity.In normal walking the centre of gravity of loading begins in the proximal part of the heel, passes over the medial side of the midfoot on to the second metatarsal head, and ends at the lateral border of the great toe (Fig. 1). Although the highest loads are exerted on the heel, it is the forefoot that is involved for the greater part of the foot contact time (Dhanendran and Hutton, in preparation). The variations in the load distribution under the normal foot are now established, and since the foot is a common site of pain and deformity in rheumatoid arthritis, we decided to try to correlate the changes in loading with clinical and radiological disease.Barrett (1976) in a qualitative study found that there was high pressure under the second and third metatarsal heads in rheumatoid arthritis. We have tried to quantify the force distribution under the feet of patients and controls of similar age and weight. We hope that the results presented here will aid in the treatment of these patients.

Measurement of the force distribution under the foot has been used to assess the effect of juvenile chronic arthritis on foot function. The results obtained from the feet of eight patients were compared with the feet of 11 normal children. The peak forces and contact times were measured for functional areas of the foot. When considered as a group, the patients had significantly reduced loading under all the toes and the two medial metatarsal heads, and increased contact time for the heel.