There is a solid knot at the back of the heel where they finish off the heel hole strip. This rubs on the back of the heel, which is uncomfortable even when wearing open-heeled shoes and makes wearing closed-heeled shoes generally impossible. I tried sleeping with him for support but woke up within an hour because he was pressing too hard on the band under my toes. I bought the Small/Medium which seemed to fit and should work as I have small rather narrow feet so I'm not sure why the compression became an issue after such a short time.
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