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. insoles are often added for comfort or health reasons (to control the shape, moisture, or smell of the shoe). If it is not possible to avoid high heels altogether, some doctors suggest that the wearer wear high-heels no more often than twelve hours a day, and that they are spending at least a third of the time on their feet in contour-supportive "flat" shoes (such as exercise sandals), or well-cushioned "sneaker-type" shoes, saving high heels for special occasions. Plain-toes - have a sleek appearance and no extra decorations on the vamp. Extremely high-heeled shoes, such as those higher than 5", are normally worn only for aesthetic reasons and are not considered practical. When considering wearing a cowboy.

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