Decoration varied widely. 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. 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 altered forces at the knee caused by walking in high heels, may predispose to degenerative changes in the knee joint. 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 unseated. outsoles made of natural rubber or a synthetic imitation. Athletic shoe soles may be made of rubber. Each manufacturer has developed its own proprietary lasts.

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