Introduction: Postural changes occur when walking with high heeled shoes. Among clinicians, however, controversial discussions exist about the effect of such shoes on the postural changes of the pelvis and the lower back. The assumption that walking with high heeled shoes increases lumbar lordosis is widely believed by many clinicians - however others postulate the opposite behavior.Methods: The gait pattern of four women and four men was studied walking barefoot and with high heeled shoes (women: 7.5 cm, men 4.5 cm). Kinematic analysis was performed utilizing a VICON System. Twenty-one spherical retroreflective markers were placed over anatomical landmarks of the trunk, the upper and the lower extremities bilaterally. Pelvic position was defined by the markers on both anterior superior iliac spines and the sacrum. Marker position were not altered between measurements. Six gait cycles were analyzed for each subject in each condition. The data was processed by a biomechanical analysis package (ANALYZE 2 ) allowing for the calculation of 3d- segment positions and the individual joint angles with numerical and graphical representations. A non parametric statistical test was used to compare the two conditions.Results: Gait velocity did not differ significantly between the two conditions. Two women shortened their stride length whereas the men rather reduced their cadence and increased stride length during high heeled gait. All subjects showed a reduction of single limb stance duration while wearing high heeled shoes. The most marked joint angle changes were seen at the ankle with a very significant increase in plantarflexion throughout the gait cycle when walking with high heeled shoes. At the level of the pelvis and trunk only minor changes occurred during high heeled gait. A reduction of the trunk - pelvis angle of 2° on average (range 0.8° - 3.6°) was seen in all subjects, accompanied by a decreased anterior tilt in all women and in two men (see Fig. 1 and Table 1).Discussion: During high heeled gait the major postural adaptation is seen at the ankle, accompanied by minor changes of the pelvic and trunk position. Our results confirm other investigators findings of a reduction of lumbar lordosis and pelvic tilt during high heeled gait and dispute the beliefs of clinical folklore. This study demonstrates the importance of gait analysis in clarifying long ingrained clinical misconceptions and controversies.