Despite its close association with US culture, the cowboy boot is originally Mexican and traditionally part of the shoe is covered with a perforated panel, the wing-tip, which extends down either side of the shoe. The altered forces at the knee caused by walking in high heels, may predispose to degenerative changes in the knee joint. Shoe materials include leather or canvas. Often the heel of the sole is rubber for durability and traction, while the front is leather for style. Specialized shoes will often have modifications on this design: athletic cleats have spikes embedded in the outsole to grip the ground; many kinds of dancing shoes have much softer or harder soles. Cap-toes - has an extra layer of leather that 'caps' the toe. This is possibly the most popular decoration If it is not possible to avoid high heels altogether, some doctors suggest that.

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