Although high heels are now usually worn only by girls and women, there are shoe designs worn by both genders that have elevated heels, including cowboy boots and cuban heels. In previous ages, men also wore high heels. on murals dating from 3500 B.C. There are also some depictions of both upper-class males and females wearing heels, probably for ceremonial purposes. Egyptian butchers also wore heels, to help them walk above the blood of dead beasts. In ancient Greece and Rome, platform sandals called kothorni, later known as buskins in the Renaissance, were shoes with high wood or cork soles that were popular particularly among actors who would wear shoes of different heights to indicate varying social status or importance of characters. In ancient Rome, the sex trade was legal, and female prostitutes were readily identified by their high heels. During the Middle Ages, both men and women would wear patten, or wooden soles, that were clearly a precursor to the high heel. Pattens would attach to fragile and expensive shoes to keep them out of the mud and other street debris when walking outdoors * They can cause foot pain. * They increase likelihood of sprains and fractures. * They make calves look more rigid and sinewy. * They can create foot deformities, including hammertoes and bunions. * They can cause an unsteady gait. * They can shorten the wearer's stride. * They can render the wearer unable to run. * Altered forces at the knee caused by walking in high heels may predispose to degenerative changes in the knee joint. * Foot and tendon problems as listed below. * Women who wear high heels frequently have a higher incidence of degenerative joint disease of the knees. This is because they cause a decrease in the normal rotation of the foot, which puts more rotation stress on the knee. Reasons for wearing high heels, which are almost exclusively aesthetic reasons, include: * They change the angle of the foot with respect to the lower leg, which accentuates the appearance of calves. * They change the wearer's posture, requiring a more upright carriage and altering the gait in what is considered a seductive fashion. * They make the wearer appear taller. * They make the legs appear longer. * They make the foot appear smaller. * They make the toes appear shorter. * They make the arches of the feet higher and better defined. * They may improve the tone of a woman's pelvic floor, thus affecting female incontinence. * They may help shorter people use items that have been designed for those of a normal height, e.g. sit upright with feet on floor on chairs that would otherwise be too high, reach items on shelves, etc.