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. While dismounting, the slick sole allows the boot to easily come free of the stirrup. The stiletto of certain kinds of high-heels can damage some types of floors. Early boots were plain leather, but as custom boots were made, cowboys asked for decorative stitching, cutouts in the high tops helped prevent the boot from filling with mud and water. 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. The outsole may comprise a single piece, or may comprise.

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