Elevated plantar pressure, a major risk factor for diabetic foot ulceration was investigated during uphill and downhill walking. The aim was to evaluate potential changes of pressure distribution with a view to improving the design of insoles. Peak pressure and contact time were analysed in 25 patients with non-insulin dependent diabetes. Fifteen with and 10 without peripheral neuropathy, and in 10 healthy control volunteers. Peak pressure (Median/Interquartil Range) at the hallux was significantly higher ( P < 0.05) in patients with neuropathy during downhill walking ( 460 110 kPa ) compared to horizontal ( 380 190 ) or uphill ( 390 170 ) walking. No such change was seen at the metatarsal head or heel level. Furthermore, there was an increase of contact time at the hallux (horizontal 73 19% vs. 72 24 vs. 78 13 ) in patients with neuropathy. These results suggest that uphill or downhill walking has no major effect on plantar pressure.