Abstract:
An injured musculoskeletal structure is mobilized relative to a juxtaposing support structure surface to isolate the injured musculoskeletal structure from forces transferred from adjoining musculoskeletal structures in order to alleviate pain, discomfort, inflammation, and further injury associated with such transferred forces.

Description:
RELATED APPLICATION 
       [0001]    This application is related to, and claims priority to, U.S. Provisional application No. 61/050,928, filed on May 6, 2008, and entitled “Musculoskeletal Disorder Support Devices and Methods of Their Use,” which is incorporated herein in its entirety. 
     
    
     TECHNICAL FIELD 
       [0002]    This disclosure relates to mobilizing musculoskeletal structures, including injured musculoskeletal structures. 
       BACKGROUND 
       [0003]    Casts, splints, bandages, and braces are used to stabilize, immobilize, or otherwise protect or support, musculoskeletal disorders such as traumatic injuries, e.g., fractures, deformities, and other problems of bones, joints, and connective tissues of the body (“injury sites”). Protecting and supporting the injury site can assist in reducing pain or discomfort, reducing inflammation, providing physical support, promoting healing, and protecting from further damage or injury. Supporting and protecting an injury site typically involves immobilizing the injury site. For example, one treatment for fractures of the bones of the toes (the phalanges) includes taping the injured toe to an adjacent toe to limit independent movement of the injured toe. Additionally or alternatively, a splint is sometimes attached to an injured toe in an attempt to immobilize and protect the injured toe. 
       SUMMARY 
       [0004]    An injured musculoskeletal structure, such as a broken toe or finger bone, is also susceptible to painful and potentially damaging forces. Particularly, normal use of interconnected musculoskeletal structures can transfer forces to the injury site, potentially causing pain and inflammation, and potentially hindering healing of the injury. For example, when a person steps down on the foot, the metatarsals normally move down and forward in relation to the heel, and they also spread to the sides in relation to one another. Thus, mobilizing an injured musculoskeletal structure relative to a support device can allow natural movement of the injured musculoskeletal structure, and can reduce undesired transfer of forces to the injured musculoskeletal structure during healing. 
         [0005]    In one general aspect, a device includes a shell member sized and shaped to juxtapose an injured digit of a limb during healing. The shell member has a digit-facing surface formed of a slippery material to mobilize the injured digit relative to the shell member. The device also includes means for limiting movement of the shell member relative to an adjacent healthy musculoskeletal structure of the limb. 
         [0006]    Some implementations may include one or more of the following features. The device includes an interface member disposed between the injured digit and the shell member to facilitate movement of the injured digit relative to the shell member. The means for limiting movement of the shell member relative to an adjacent healthy musculoskeletal structure includes a slip-resistant body-facing surface juxtaposing the adjacent healthy musculoskeletal structure of the limb. The means for limiting movement of the shell member relative to an adjacent healthy musculoskeletal structure includes a hook-and-loop fastener. 
         [0007]    The shell member is formed as a shoe insole. The device includes an upstanding deflection member configured to at least partially cover an injured toe. The digit-facing surface includes an upper surface portion of the shell member on which a wearer&#39;s foot rests during use, and the means for limiting movement includes an upper surface portion of the shell member on which the wearer&#39;s heel or instep rests during use. The shell member defines a space in which the wearer&#39;s heel does not rest on the shell during use, and the means for limiting movement of the shell member relative to an adjacent healthy musculoskeletal structure of the limb includes the space. 
         [0008]    The device includes an interface member formed as a sock configured to cover a wearer&#39;s foot, and the sock is configured for sliding engagement with the digit-facing surface and substantially non-sliding engagement with the upper surface portion of the shell member on which the wearer&#39;s heel or instep rests. 
         [0009]    The shell member defines an interior cavity configured to receive at least a portion of the injured digit, and the digit-facing surface includes an inner surface of the shell member. The device further includes an interface member including a splint or a sleeve. The device includes a deflection member configured to at least partially enclose the injured digit to protect the injured digit from damaging contact. 
         [0010]    The device includes a shoe member that is configured to receive the shell member. The shoe member includes the means for limiting movement of the shell member relative to an adjacent healthy musculoskeletal structure of the limb. 
         [0011]    In another general aspect, a splint for supporting an injured musculoskeletal structure includes a rigid supportive shell configured to cradle an injured musculoskeletal structure. The supportive shell limits bending of the injured musculoskeletal structure in a first direction. An interface member is disposed between a portion of a wearer&#39;s body and at least a portion of the supportive shell to mobilize at least one of the injured musculoskeletal structure and a musculoskeletal structure adjacent to the injured musculoskeletal structure relative to the supportive shell. 
         [0012]    In another general aspect, a process includes providing a device for mobilizing an injured musculoskeletal structure to slide relative to an orthotic member juxtaposing the injured musculoskeletal structure to support the injured musculoskeletal structure during healing. 
         [0013]    In another general aspect, supporting an injured musculoskeletal structure during healing includes mobilizing the injured musculoskeletal structure to slide relative to an orthotic member juxtaposing the injured musculoskeletal structure. 
         [0014]    Some implementations may include one or more of the following features. Supporting an injured musculoskeletal structure includes isolating the injured musculoskeletal structure from the orthotic member such that the orthotic member limits the transfer of a force to the injured musculoskeletal structure when moving with a body portion to which the orthotic member is attached. The method includes retaining the orthotic member to a healthy musculoskeletal structure during use, substantially limiting bending of the injured musculoskeletal structure in a first direction, or at least partially enclosing the injured musculoskeletal structure to protect against damaging contact. 
         [0015]    In another general aspect, supporting an injured musculoskeletal structure includes placing an interface member on an exterior skin surface juxtaposing the injured musculoskeletal structure and placing a shell member in a position juxtaposing the injured musculoskeletal structure. The interface member facilitates sliding movement of the injured musculoskeletal structure and/or an adjacent musculoskeletal structure relative to the shell member during support. 
         [0016]    In another general aspect, a device includes a shell member sized and shaped to juxtapose an injured toe during healing. The shell member includes a first, foot-facing surface portion formed of a slippery material to mobilize the injured toe relative to the first surface portion, and a second, foot-facing surface portion having a higher coefficient of friction than the first surface portion and arranged relative to the first surface portion to support a healthy musculoskeletal structure adjacent the injured toe and to limit sliding between the second surface and the healthy musculoskeletal structure. 
         [0017]    In another general aspect, a device includes a shell member sized and shaped to juxtapose a foot sole at a location proximate an injured toe while not juxtaposing adjacent portions of the sole. The shell member includes a foot-facing surface formed of a slippery material to mobilize the injured toe relative to the foot-facing surface. 
         [0018]    In another general aspect, a device includes a shell member sized and shaped to juxtapose an injured finger or thumb during healing. The shell member includes a first digit-facing surface portion formed from a slippery material to mobilize the injured finger or thumb relative to the first surface portion and a second surface portion configured to immobilize the shell member relative to healthy musculoskeletal structure adjacent the injured finger or thumb. 
         [0019]    In another general aspect, a device includes a shell member sized and shaped to juxtapose an injured metacarpal structure during healing. The shell member includes a first surface portion configured to immobilize the shell member relative to the injured metacarpal structure and a second digit-facing surface portion formed from a slippery material to mobilize a finger or thumb adjacent the injured metacarpal structure relative to the second surface portion. 
         [0020]    In one general aspect, a device includes a shell member sized and shaped to juxtapose an injured musculoskeletal structure of a limb during healing. The shell member has a surface configured to face the injured musculoskeletal structure and/or an adjacent musculoskeletal structure. The surface is formed of a slippery material to mobilize the injured musculoskeletal structure and/or the adjacent musculoskeletal structure relative to the shell member. The device also includes means for limiting movement of the shell member relative to an adjacent healthy musculoskeletal structure of the limb. 
         [0021]    In some implementations, musculoskeletal structures adjacent to an injured musculoskeletal structure are mobilized. For example, other bones, skeletal muscles, cartilage, and/or tendons in the forefoot, in addition to the injured musculoskeletal structure, can be mobilized relative to a support device to limit painful and/or injurious forces from being transferred to an injured toe during standing or walking. In other implementations, the musculoskeletal structures adjacent to, and/or adjoining an injured musculoskeletal structure are mobilized instead of the injured musculoskeletal structure. Additionally, the mobilized adjacent and/or adjoining musculoskeletal structures include those structures distal to the injured musculoskeletal structure. For example, a healthy toe can be mobilized relative to a support device to protect a connected metatarsal bone or joint such that when the metatarsal bone pushes forward or outward against the toe during walking, the mobilized toe moves with the internal motion of the connected metatarsal bone. Mobilizing the toe minimizes resistance against such internal movements of the metatarsal bone, and reducing painful and/or injurious forces transferred to the injury site. 
         [0022]    The details of various implementations set forth in the accompanying drawings and description. Other features and advantages will be apparent from the description and drawings, and from the claims. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0023]      FIG. 1  is a top view of an orthotic support device according to one implementation. 
           [0024]      FIG. 2  is a perspective view of the orthotic support device shown in  FIG. 1 , with the low friction liner removed. 
           [0025]      FIG. 2A  is a plan view of the low friction liner of the orthotic support device shown in  FIG. 1 . 
           [0026]      FIG. 3  is a side view of the orthotic support device shown in  FIG. 1  with the low friction liner removed. 
           [0027]      FIGS. 4 and 4A  are diagrammatic views of socks according to two implementations. 
           [0028]      FIG. 5  is a side view of an orthotic support device in which an open area of the shoe portion of the device is replaced by an enlarged protective area. 
           [0029]      FIG. 6  is a partial cut-away side view of the orthotic support device of  FIG. 1  in use with a toe splint. 
           [0030]      FIG. 7  is an exploded view of another orthotic support device. 
           [0031]      FIG. 8  is a perspective view of the orthotic support device of  FIG. 7  in use. 
           [0032]      FIG. 9  is an exploded view of another orthotic support device. 
           [0033]      FIGS. 9A and 9B  are perspective views of the orthotic support device of  FIG. 9 . 
           [0034]      FIG. 10  is an exploded view of another orthotic support device. 
           [0035]      FIGS. 10A and 10B  are perspective views of the orthotic support device of  FIG. 10  in use. 
           [0036]      FIG. 11  is an exploded view of another orthotic support device. 
           [0037]      FIG. 11A  is a perspective views of the orthotic support device of  FIG. 11  in use. 
       
    
    
       [0038]    Like reference symbols in the various drawings indicate like elements. 
       DETAILED DESCRIPTION 
       [0039]    An injured musculoskeletal structure is mobilized relative to a juxtaposing support device by a low friction interface provided where the support device contacts the injury site. For example, as will be discussed in further detail below, in the case of a toe fracture the support device provides a slippery surface located on a surface facing the injured toe such that a very low friction interface is provided between the injured toe and the support device. This allows the injured toe to move relative to the support device when pressure is applied to the foot, e.g., when the patient stands or walks, causing the metatarsal bones to spread and push forward in relation to the heel of the foot and in relation to the support device. Because the toe can slide over the slippery surface to accommodate these movements of the musculoskeletal structure of the foot, pressure and stress on the toe are reduced, thereby reducing pain and inflammation, and reducing the likelihood of further damage to the injured toe. 
         [0040]    Referring to  FIGS. 1-3 , a mobilizing support device  10  for supporting an injured foot, e.g., having a toe fracture, a deformed toe, or other musculoskeletal injury, includes a shoe portion  12  having an open area  14  surrounding the injury site. The open area  14  is arranged such that contact between the injured musculoskeletal structure of the foot and the shoe portion  12  is reduced or eliminated. Thus, during walking or standing, the shoe portion  12  does not contact the top, end, or sides of the injured musculoskeletal structure. The shoe portion  12  includes a sole  16 , an upper  18 , a lacing system  20 , and a toe cover  22  positioned adjacent the open area  14  to protect uninjured toes from impact with external objects. 
         [0041]    In an alternative embodiment, shown in  FIG. 5 , the open area  14  and toe cover  22  are replaced, at least in part, by an enlarged, protective area  23 . Protective area  23  has sufficient dimensions to provide clearance around the injured musculoskeletal structure. For example, the protective area  23  provides a clearance distance of from about 0.125″ to about 1.0″ around the top, end, and sides of the injured toe(s), and is formed of a material that is sufficiently stiff to provide a desired degree of protection to the toes from an impact from the front or above, e.g., an object being dropped on the foot. The protective area  23  can include perforations or other ventilation structure, and can be lined with a low friction material to provide a low friction sliding interface with the toes in case the toes contact the inner surface of the enlarged protective area  23 . Ideally, the open area or enlarged area is configured to allow the injury site to slide relative to the insole, as will be discussed further below, without contact of the upper part of the injured area with the device  10 . 
         [0042]    The lacing system  20  holds in place a portion of the limb that is adjacent to the injury site, such as the heel, ankle, and/or calf, relative to the shoe portion  12  and allows adjustment of the size of the shoe, e.g., to accommodate swelling and to allow the wearer to easily don and remove the shoe. For example, the lacing system can retain musculoskeletal structures of the heel and/or ankle in generally slip-free communication with the upper  18 . The lacing system can be replaced by, and/or supplemented with, any suitable attachment device, for example hook and loop fastener strips such as those available commercially under the tradename Velcro®, or other adjustable straps. Snaps, clips, buckles, and other latching and/or cinching devices can also be used. In some implementations, the upper  18  extends over the ankle area, to provide additional support and immobilization of selected musculoskeletal structures of the foot relative to the shoe portion  12 . For example, the upper  18  may be similar to that of a high top sneaker, a hiking shoe, or boot. 
         [0043]    Referring to  FIG. 2 , a liner  24  is disposed inside the shoe  12 , and functions both as an insole and as a low-friction sliding surface. As shown in  FIG. 1 , the liner  24  is sized such that it extends beyond the position of the toes when weight is carried by the foot, so that there is room for the toes to slide forward and outward when the wearer steps or stands on the foot. For example, the liner  24  extends horizontally a distance of approximately 0.25″ or more beyond the perimeter of expected movements of the forefoot when walking or standing, in order to ensure adequate space for unimpeded movement of the toes and to provide protection from side impacts. In some embodiments, this side protection can be enhanced by including an upstanding protective portion  25  that extends upward slightly and curves, forming a cavity to partially enclose one or more toes. 
         [0044]    In use, and as shown in  FIG. 6 , the liner  24  is disposed juxtaposing an injured musculoskeletal structure and healthy musculoskeletal structures adjacent to the injured musculoskeletal structure. The liner  24  includes a slippery surface  26  that provides an interface having a low coefficient of friction and can be formed of any material that, with the shoe, provides the necessary support for the particular application. The support device  10  additionally includes an interface member  27  that covers at least a portion of the wearer&#39;s skin to cooperate with the slippery surface  26 . As illustrated in  FIG. 4 , the interface member  27  can be a sock  28  to cover a foot having an injured musculoskeletal structure. Depending on the material of the interface member  27 , suitable materials for the slippery surface  26  can include polytetrafluoroethylene, polyethylene, polypropylene, nylon, or the like. In some cases, the liner  24  may be formed of a heat moldable material, to allow the liner to be shaped to portions of the wearer&#39;s foot if desired. For example, the liner can be molded to serve as a supportive footbed, providing arch support and/or other ergonomic or therapeutic support to the foot while walking, in addition to providing a slippery surface for mobilization of injured musculoskeletal structures and/or adjacent musculoskeletal structures. One suitable material for use as the liner  24  is commercially available from Sammons Preston (www.sammonspreston.com) under the tradename Aquaplast®. 
         [0045]    The stiffness or flexibility of all, or parts of, the support device  10  can be achieved by varying the flexibility of the shoe portion  12  and/or of the liner  24 , and can be varied as may be required for treating different conditions. The support device can be or can include portions that are rigid, semi-rigid, or flexible, as appropriate for a given implementation. In most cases, it will be desirable for the support device  10  to be rigid enough to minimize bending motion around the injury site. In some cases, the support device  10  can be supplied to a healthcare provider, or to the end user, with a set of liners  24  having different thicknesses, or other characteristics, to allow the shoe portion  12  to be easily adapted to treat a variety of different injuries or conditions. Similarly, the healthcare provider can be supplied with a plurality of shoe portions  12  having different sizes and/or performance characteristics, to allow the healthcare provider to select a shoe portion  12  to meet a particular patient&#39;s needs. 
         [0046]    If desired, the liner  24  can include multiple layers, e.g., an upper layer to provide the slippery surface  26  and a lower layer to provide other properties such as cushioning or shock absorption. In such cases one of the layers, e.g., the upper layer, can provide the desired level of stiffness and support. Alternatively, the shoe portion  12  may include a layer of foam or other cushioning material disposed under the liner  24 , for example the sole  16  can provide cushioning. 
         [0047]    As discussed above, interface member  27  can be formed as a sock  28  of conventional design, and should generally have elastic properties that allow the sock  28  to expand and contract along with the skin of the foot with minimal restriction of the natural expansion or contraction of the foot during standing or walking. In the area A of the injury site ( FIG. 6 ) where unrestrained sliding movement is desired, the fabric of the sock  28  should slide freely and readily on the liner  24 , with the interface therebetween having a low coefficient of friction to mobilize the injured toe. Additionally, musculoskeletal structures surrounding the injured toe, such as healthy musculoskeletal structures of the forefoot, including metatarsal structures, are mobilized. Preferably, the sock  28  includes materials or fibers that allow the foot to breathe and allow perspiration to be vented for general health as well as to minimize the possibility of moisture altering the coefficient of friction at the slippery surface  26 . Other physical properties, e.g.; elasticity or padding, of one or more areas of the sock  28 , or of any interface member  27 , can be varied as may be appropriate for differing health conditions. 
         [0048]    In some implementations, the liner  24  has one or more slippery areas  26 A having a relatively low coefficient of friction, which are disposed juxtaposing the injury site(s), and one or more non-slip areas  29  having a relatively higher coefficient of friction, which are disposed away from the injury site, juxtaposing musculoskeletal structures of the foot that are adjacent to the injury site. For example, the liner can be sized and shaped to juxtapose substantially the entire bottom surface of the wearer&#39;s foot. An area  29  of the liner  24  that juxtaposes the wearer&#39;s heel has a relatively high coefficient of friction to limit the foot sliding forward in the shoe for limiting movement of the liner  24  relative to the heel or other adjacent healthy musculoskeletal structure of the limb. The area  26 A of the liner  24  that juxtaposes the toes is slippery and has a relatively low coefficient of friction to allow the toes to move as the foot spreads. In some implementations, the liner  24  can be formed by comolding two different polymeric compositions. Additionally, a separate insole portion can be disposed on the liner to limit sliding of the foot. In other implementations, the liner  24  is sized and shaped such that it does not juxtapose the heel and/or instep of the wearer&#39;s foot during use, and sliding between the wearer&#39;s heel and/or instep can be limited by the shoe portion  12 , as discussed above. 
         [0049]    Referring to  FIG. 4 , a sock  28  has a first region  30  juxtaposing the injury site having a low coefficient of friction, e.g., formed of a synthetic fiber or a combination of fibers or yarns, such as nylon and rayon, such as to provide a low friction interface with the slippery surface  26 . A second region  32 , e.g., in the heel area, has a relatively higher coefficient of friction. The second region  32  may be formed using a rougher texture knit, and/or using fibers or yarns having a higher coefficient of friction. This sock construction allows the toes to slide freely relative to the liner  24  as the foot spreads, while helping to keep the rest of the foot in place within the shoe. 
         [0050]    Referring to  FIG. 4A , a sock  34  may have two or more layers, to provide desired comfort characteristics. For example, in the embodiment shown the sock includes an inner, moisture wicking layer  36 , e.g., of cotton, a cotton blend, or a hydrophilic synthetic material. Also, in some implementations, the sock  28  or the sock  34  can be constructed of the same material, or combination of materials, throughout. In such embodiments, the variations of coefficient of friction are accomplished by variation of portions of the chosen interfacing surfaces. 
         [0051]    Now referring to  FIG. 6 , the interface member  27  can include, integrally or in combination, a splint  40 , or other device configured to support an injured musculoskeletal structure, such as a broken phalange of a toe. The splint  40  can be used for localized support, such as to support a joint or to maintain desired alignment of bone portions of the fracture bone, and can be used with or without a fabric covering the splint  40 , such as the sock  28 . While the splint  40  can be considered an immobilizing device, the slippery surface  26  of the liner  24  still allows the splint  40  to slide freely thereover during standing or walking. Additionally, even when the splint  40  is used, phalanges or metacarpals, can be mobilized relative to the slippery surface  26  of the liner  24 . The slippery surface  26  can be selected from a material that creates a low friction interface with an external surface of the splint  40 , including tape or the like that may be used to attach the splint  40  to the injured musculoskeletal structure. This splint can be rigid, semi-rigid or flexible, and can be formed from any combination of fabrics, foams, suitable metals and/or plastics, such as elastic sleeves, elastic or inelastic bandaging, or conventional splints for digits. To provide sliding interaction, the slippery surface  26  can be formed from polytetrafluoroethylene, polypropylene, or polyethylene, among other materials. 
         [0052]    While the support device  10  of  FIGS. 1-6  is suitable for mobilizing support of an injured musculoskeletal structure in the foot, including toes and joints, other support devices can be used to mobilize injured musculoskeletal structures of the foot, or of other parts of the body. Referring to  FIG. 7 , a mobilizing support device  50  includes a rigid digit-receiving support shell  60  and a digit-covering interface member  70  for use in supporting an injured musculoskeletal structure of injured finger I, including injured interphalangeal joints and/or injured metacarpophalangeal joints. As illustrated in  FIG. 8 , the support shell  60  juxtaposes the phalanges of the injured finger I to reduce injurious contact with foreign objects and undesired bending of the injured finger I. Particularly, the support shell  60  includes a tubular wall  61  having a slippery interior surface  65  and an exterior surface  66 . The tubular wall  61  defines a central cavity  69  accessible from at least one open end of the support shell  60 . The interface member  70  covers the injured finger I and includes a slippery external surface  75  that slides freely against the interior surface  65  of the support shell  60 . The support shell  60  can be formed from any suitable material, including plastics, metals, composite materials, and other materials used for splinting and casting. 
         [0053]    In use, and as illustrated in  FIG. 8 , a wearer, or a nurse, physician, or other caregiver, places the interface member  70  over the injured finger I. As discussed above with respect to the interface member  27 , the interface member  70  can include a sock and/or an elastic support material, or other flexible, rigid, or semi-rigid support devices. The wearer or caregiver also places the support shell  60  juxtaposing the injured musculoskeletal structure of the injured finger I. For example, the wearer or caregiver inserts the injured finger I into the support shell  60  such that the support shell partially or fully encloses the injured finger I to protect against injury and to support the injured finger I using an attachment device  80 . The wearer or caregiver secures the support shell  60  to an adjacent healthy finger H, or another adjacent healthy musculoskeletal structure of the limb, such as the hand, wrist, or forearm. The support shell  60  can be attached to a contiguous adjacent musculoskeletal structure, such as the palm, that is adjacent to the injured finger, using the attachment device  80 . For example, tape, ties, straps, or the like, are used to secure the shell  60  to the healthy finger H for limiting movement of the support shell  60  relative to an adjacent healthy musculoskeletal structure of the limb. Additionally, the interior cavity of the support shell  60  is large enough to provide clearance space between the support shell  60  and the interface member  70  to allow for radial movement of the enclosed interface member  70 . The space provided may be from about 0.1″ to about 0.3″ around the circumference of the interface member. Thus, as the healthy finger H moves, and as the support shell  60  moves with the healthy finger H, the injured finger I is mobilized to move freely within the support shell  60 . For additional protection, the distal end of the injured finger I should not extend beyond the distal end of the support shell  60  when in use. The distal end of the support shell  60  can be open, closed, or partially open for ventilation. 
         [0054]    Instead of placing the interface member  70  on the injured finger I, the interface member  70  can be attached to the support shell  60  such that the interior surface  65  is covered by the interface member  70 . The interface member can be formed from an elastic tubular material such that the interface member  70  narrows within the support shell  60  to cushion the injured finger I during use. For example, the ends of the elastic tubular interface member  70  can be attached to the ends  61  and  62  of the support shell  60  such that the middle portion of the tubular elastic interface member  70  is free to slide over and move within the interior surface  65  of the support shell  60 . Thus, the support shell  60  and the interface member  70  in such a configuration can mobilize the injured finger by suspending, cushioning, and sliding. Furthermore, the support shell  60  can be sized such that the injured finger I can move with minimized contact with the interior surface  65  of the support shell  60 . For additional protection, the distal end of the injured finger I should not extend beyond the distal end of the support shell  60  when in use. The distal end of the support shell  60  can be open, closed, or partially open for ventilation. 
         [0055]    As illustrated in  FIGS. 9-9B , a support device  50 A includes a tab  90 A included with the support shell  60 A. The tab  90 A provides secure attachment to the wearer&#39;s hand H using the attachment device  80 . The tab  90 A can be rigid or resilient to limit or inhibit bending of the injured finger I. Alternatively, the tab  90 A can be flexible such that the tab  90 A does not inhibit bending of the injured finger I at the metacarpophalangeal joint. Support devices with different characteristics may be indicated for different applications. For example, the tab  90 A can be shaped to extend beneath one or more metacarpal heads depending on the circumstances. 
         [0056]    As illustrated in  FIGS. 10-10B , a support device  50 B supports an injured thumb T. The tab  90 B is configured as a body-engaging clip with arms  91 . The arms  91  are resilient and deformable to fit over the wearer&#39;s hand H. The arms  91  exert a retaining force, such as by spring action, to secure the support device  50 B to the wearer&#39;s hand H, as shown in  FIG. 10A . Additionally or alternatively, as shown in  FIG. 10B , the support device  50 B can be retained in a position juxtaposing the injured musculoskeletal structure of the thumb T using the attachment device  80  wrapped around and/or adhered to the hand H. The tab  90 B can be modified or extended to provide varying engagement or attachment with the hand, wrist or arm as deemed appropriate for a particular condition. 
         [0057]    Referring now to  FIGS. 11 and 11A , a support device  100  includes a contoured support shell  110  that, in use and as illustrated in  FIG. 11A , juxtaposes musculoskeletal structures in the wearer&#39;s arm, wrist, and hand, including fingers. The support shell  110  can be used to support, for example, a fractured metacarpal bone adjacent to the arm, wrist and hand. Thus, the support shell  110  is sufficiently rigid to protect the fracture site. The support device  100  also includes an interface member  120  for covering the finger adjoining the fractured bone, and one or more fingers adjacent thereto. The support shell  110  includes a slippery interior surface  115  to allow the interface member  120  to slide freely thereover to mobilize the fingers adjoining the fractured bone relative to the support shell  110 . Thus, when the interface member  120  is placed over the finger adjoining the fracture and over the adjacent finger and when the support shell  110  is placed juxtaposing the fracture site, as illustrated in  FIG. 11A , the interface member  120  mobilizes the fingers to slide freely over the slippery interior surface  115  to reduce forces applied to the fractured metacarpal bone as the fingers are flexed, or as the hand or arm pushes forward or pulls rearward in the support shell. For additional protection, the distal end of the interface member  120  does not extend beyond the distal end of the support shell  110  during use. The distal end of the support shell  110  can be open, closed, or partially open, such as including perforations or other ventilating structure. 
         [0058]    The support shell  110  also includes a tab  117  that retains the support device  110  in position on the wearer&#39;s hand and arm. For example, the tab  117  can press inward against the wearer&#39;s hand to apply a retaining force. Alternatively, the tab  117 , and/or other portions of the support shell  110  can include a tacky surface that adheres to the wearer&#39;s skin. Alternatively, the support device  100  can be secured using a strap, tape, or other attachment device. 
         [0059]    A number of implementations have been described, and share many features. For example, the various support shell implementations described above each extends a distance beyond an anticipated range of motion of an injured musculoskeletal structure, or a musculoskeletal structure adjacent thereto, in order to reduce the opportunity for contact with foreign objects. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention. 
         [0060]    For example, a low friction interface can be created between a surface of any type of support or brace and the wearer&#39;s skin. As one example, a soft, elastomeric knee brace can be provided with a low friction surface facing the wearer&#39;s skin in the area of the kneecap, and can be worn with a thin liner, e.g., of fabric, that provides a low coefficient of friction interface where it contacts the low friction surface. 
         [0061]    Moreover, in the context of the toe support device discussed above, other areas of the shoe portion  12  can be provided with a sliding surface, in addition to the footbed. For example, if the wearer has an injury to another part of the foot, or if a particular musculoskeletal condition requires additional controlled restraint of motion around the injury site, a sliding surface can be provided on the interior of the shoe upper in the area of that injury. 
         [0062]    Additionally, injured musculoskeletal structures that can be supported and/or protected as described above include broken or bruised bones, torn or strained ligaments, torn or bruised cartilage, or torn or strained muscles. Similarly, malformed structures, and diseased structures, such as musculoskeletal structures affected by rheumatory diseases, can be supported and/or protected as described above. Moreover, while mobilization of musculoskeletal structures has been described above with respect to support and/or protection during healing of an injury, the musculoskeletal structures can be mobilized in many situations, which, for the purpose of this disclosure, are considered to be included in the term healing. For example, an injured musculoskeletal structure can be mobilized during support and/or protection thereof while more critical injuries are addressed. Additionally, in situations involving chronic diseases, pain management or other maintenance procedures are considered to be included in the term healing as used herein. 
         [0063]    Accordingly, other embodiments are within the scope of the following claims.