This study was conducted to examine the relative balance performance of cowboy boots versus tennis shoes when the subject was challenged with different accelerations. The end point was the highest acceleration at which the subject could maintain full foot contact with the platform for each footwear type, ie, break acceleration.Crossover trial.General community.Twenty-seven healthy women, 18 to 40 years old, with shoe sizes between 6 and 9, were selected in a convenience sample after their response to posted ads in a university medical center.Each subject was tested 3 times in the forward direction per acceleration on a Motionspec balance platform. A successful series was defined as keeping feet flat for 2 of 3 tests/level.The planned major outcome was the difference between the highest accelerations at which the subject was successful for each type of footwear.Subjects were found to have a highest sustainable acceleration in boots 10.66 ± 6.20cm/s 2 less than the highest acceleration in shoes. A period effect was found that improved the results of the second footwear tested by 7.2 ± 6.20cm/s 2 .Cowboy boots have a decreased balance performance compared with tennis shoes. Further study should examine the specific features in the boot that contribute to this imbalance and examine the kinematic adaptations of the body to cowboy boots.