The high laced boots of the Victorian grande cocotte represent both a symbol of love and a symbol of aggression to the sado-masochist. In bondage, high heels act to restrain movement forming a part of the fantasy of enslaving which some people find erotic. Often the very appearance of restriction is exciting to the fetishist.
The impressions of an ankle harness for instance can to the discerning eye appear as if the beautiful is trapped and at the mercy of the merciless. Immobile fantasies are a prime turn on for acrotomophiles.
Tickling and tickling pursuit is a form of power and dominance.
Submissive foot lovers prefer psychological domination or comfortable bondage to pain. In establishments such as leather bars, there are submissive bootblacks, available to polish patron's shoes and boots. Forms of sadism run the gambit from the fairly common carefully controlled play-acting with a willing partner to the very rare open assault which may involve torture, rape and sometimes murder.
In play acting mild forms of pain such as spanking and biting are not intended to hurt or mame but to add to the eroticism. Masochistic behaviour can also range from mild to extreme. Mild forms include bondage where tight lacing excites. Much of the attraction of masochistic behaviour is not discomfort of constraint but the promise of release.
In both sadism and masochism the release of adrenaline is thought to play a key role in the cycle of orgasm. In the vast majority of cases restraint and punishment represents symbolic enactments that are done consensually, under carefully controlled conditions by trusted partners. At the other end of the spectrum genuinely painful activities such as whippings, semi strangulation, being trampled upon and self mutilation carry with its practice health risks. Most sado-masochistic acts in their extreme forms can be physically and psychologically dangerous, the majority of people engaging in these behaviours do so with the understanding of the risks and stay within carefully predetermined limits.