A cross sectional survey was conducted in order to evaluate chronic knee trauma associated with occupational kneeling. A total of 432 floor layers and tile setters responded to the survey questionnaire. Of these respondents, 34 individuals having a history of athletic knee injury, and 16 persons who had moved were excluded from further consideration. The remaining 381 respondents were asked to participate in physical and X-ray examinations, with 108 individuals complying. Bricklayers and millers served as comparisons; 112 floor layers and 50 tile setters, together with 235 comparisons provided the data analyzed. A history of past skin infections in the region of the knees was found to be approximately 4 times more prevalent among floor layers than among comparisons. Unilateral or bilateral patellar skin thickening and erythema were seen to be more prevalent among persons with occupations that required kneeling than among comparisons. The authors recommend that good quality knee pads which provide high degrees of protection, durability, comfort, and ease of wear, while retaining the additional advantages of low weight and low cost, be developed for use by affected individuals.