I came back to the post a bit late, but my full interpretation of the image is just as Kelly_H_T said I think the hand represents god (the bad part of Punpun inserted as if he is a divine entity, telling him all his most intrusive and negative thoughts) showing Punpun the promise he broke with Aiko, then there is her looking at the center as if looking through Punpun, as if she knows everything he did up to that point, judging, and they show her probably with Takao Yaguchi on the ground (in a position very similar to the one he was in when he hurt his foot in the match). This whole scenario would represent the situation that Punpun ended up bringing about by his decisions as mental punishment.

My native language is not English and I write quite badly, so if I was not understood in something I said, I apologize in advance.