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. The Stiletto heel is named after the Audrey Hepburn film of the same name. One accessory used with cowboy boots is a spur, which is sometimes attached to the heel of each boot for the purpose of goading the horse while riding. The altered forces at the knee caused by walking in high heels, may predispose to degenerative changes in the knee joint. Extremely high-heeled shoes, such as those higher than 5", are normally worn only for aesthetic reasons and are not considered practical. Because of this, standardization has been slow, and fitting between companies is not always consistent. The outsole is the layer in direct contact with the ground. The stiletto of certain kinds of high-heels.

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