High-heels have seen significant controversy in the medical field lately, with many podiatrists seeing patients whose severe foot problems have been caused almost exclusively by high-heel wear. Because of this, standardization has been slow, and fitting between companies is not always consistent. Shoes with uppers made high to cover the ankles are also available; a shoe with the upper rising above the ankle is usually considered a boot but certain styles may be referred to as high-topped shoes or high-tops. The insole is the interior bottom of a shoe, which sits directly beneath the foot. Many shoes have removable and replaceable insoles, and extra they can become painful or damaging for some wearers. While mounted, the tall heel prevented the foot from sliding forward through the stirrup, which could be life threatening if it happened and the rider were to be.

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