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What is Knuckling?

Knuckling is when the top of your dog’s paw drags along the ground as they are walking. It is generally a neurological problem. All dogs can be victims of knuckling. Common reasons for this behavior may include:

  • Sore paws
  • Intervertebral disc disease
  • Carpal flexural deformity
  • Fibrocartilaginous embolism
  • Degenerative myelopathy

These causes can range from minor to serious, and should be checked by the vet to be safe. Some of the illnesses can be serious and in some cases fatal, whereas others can improve with time. Most of these illnesses, aside from degenerative myelopathy, have positive outcomes with satisfactory recoveries, as long as they are treated promptly and properly.

Why Knuckling Occurs in Dogs

You should observe your dog while they are walking away and toward you and look out for any signs of unsteadiness or an uneven gait. You can determine if your dog is knuckling over by having them stand and one at a time lifting their paws and placing them down with the knuckle under. Your dog should immediately correct the position of their paw, and if they do not it is likely that they are, for some reason, knuckling.

Sore Paws

If the knuckling occurs suddenly, check your pet’s paws as they may have a sharp object such as a thorn embedded in their foot, which can cause pain as they are walking. Burns from hot pavement can also have the same effect. Other possible causes include bug bites on the paws or broken toes and claws. Your dog should be brought to the vet if the issue does not resolve within a day, as some objects can cause infections if not taken out and treated.

Intervertebral Disc Disease

This disease occurs when the disc in your dog’s spinal cord begin to degenerate. This is generally a factor of age, but can also occur in younger dogs due to physical trauma or strenuous activity. Accidents like getting hit by a car or fighting with another animal can also bring on IVDD. Symptoms can vary but in general the dog will begin stumbling, knuckling their paws, showing stiffness and holding their head low, sensitivity to touch and movement, arching their back, showing lameness, weakness, a reluctance to move, shaking, loss of coordination and collapsing, potentially paralysis on one or more limbs and overall walking oddly. In mild cases, steroids and anti-inflammatories can help treat it, but surgery may be needed for more severe cases. Some breeds that are predisposed due to a disorder of cartilage formation, called chondrodystrophy, are Bulldogs, Basset Hounds, Dachshunds, Corgis, Beagles, Cocker Spaniels, Shih-Tzus, Poodles and Pekingese. Other breeds that are commonly affected not due to chondrodystrophy are German Shepherds, Doberman Pinschers and Labrador Retrievers. Dogs who are of these breeds and are obese are of further risk.

Carpal Flexural Deformity

This can occur in puppies as they go through growth spurts. Any dog can develop carpal flexural deformity, although it is commonly seen in larger breeds, sometimes caused by an excess of protein. Your vet can assist you in determining the correct diet for your pet. Generally, puppies who are under 4 months of age will show signs of over flexing or bulging their wrists forward. In most cases, the dog’s wrists will straighten out on their own within a few weeks and will not require treatment, but using a splint may be wise as your dog could develop a lifelong deformity.

Fibrocartilaginous Embolism

This is a spinal condition that can be seen in any dog but is more commonly found in larger breeds. The main cause of fibrocartilaginous embolism is exercise trauma, which can cause a piece of intervertebral disc to detach and end up in a blood vessel. This can lead to a blood clot or an embolism, which cuts off the supply of blood and oxygen to the neurons in a part of the spinal cord and can cause them to die, which leads to knuckling. Dogs will usually develop fibrocartilaginous embolism while exercising. They may yelp once, but will then most likely show no further signs of pain. They will then lose functionality of one or several limbs without much warning. Dogs with this illness may or may not see improvements, but will rarely experience a worsening in the symptoms.

Degenerative Myelopathy

Older dogs who begin knuckling over can be lame, experiencing arthritis or developing degenerative myelopathy. The latter occurs when there is a loss of white matter that is sheathing the spinal cord, also known as myelin. Dogs will most likely develop this disease between the ages of 8 to 14 The signs will begin with a loss of coordination in the hind limbs. The dog will wobble, drag their feet and the rear paws will knuckle over, often noticed when they are attempting to turn. Some other symptoms of this disease will include them falling frequently and showing difficulty rising. This disease is not painful but is progressive and can continue to get worse. It can take 6 months to 1 year for the disease to progress until the point that the dog is unable to walk.

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What to do if your Dog is Knuckling

Ideally, dogs with sore paws due to cuts or scratches would rest and let it heal. However, dogs are active and will often continue to move around and therefore reopen their wound. If the cut looks deep, they should be brought to the vet. If it is a regular scratch, you should examine the paw and look out for broken nails, which can also be a source of bleeding. The wound should then be washed with warm water and any debris should be removed using tweezers or dislodged by soaking the paw in a bowl of warm water. The area should be cleaned with a diluted antiseptic and antiseptic cream should be applied. You can wrap the paw in gauze to provide soft cushioning, followed by a pressure bandage. The bandage should cover the wrist joint but should leave out the front toes, and should not be too tight. Remove the bandage after three days, but keep your dog from reopening the wound by using a dog boot when they go out. If there is excessive oozing or bleeding, sores on the pads, toenails with crusting at the base, thick callouses or deep cracks, you should contact the vet. 

Intervertebral disc disease can require treatments varying from rest and medical management to surgery, depending on the severity. The first priority will be to manage the inflammation and the pain. Your veterinarian may suggest either nonsteroidal anti-inflammatory medications, corticosteroids, narcotics, muscle relaxants or other medications along with restricted movement and rest. If these drugs do not alleviate the pain, surgery may be required. Three to six weeks of consistent cage confinement is essential for a full recovery in all cases. Your pet should be placed on a soft surface and will need to be turned every few hours in order to prevent pressure sores from developing. Overweight dogs will be put on a dietary program. Other techniques, such as massage therapy, acupressure or acupuncture, supplements and other supportive care can also be beneficial. If your puppy is knuckling, stop feeding them milk and meat as high protein can worsen the carpal flexural deformity. Fibrocartilaginous embolism will require an MRI in order to be diagnosed. CT scans and spinal radiographs can also be beneficial. FCE is not easily treated, and recovery will usually rely on time for the spinal cord to create new blood vessels or open up the ones that were affected. While recovering, dogs should be resting on a soft bed and rotated every few hours. Physical therapy can help in the recovery phase, along with acupuncture, laser therapy and hyperbaric oxygen therapy. In most cases, the patient will be able to walk in 2 to 6 weeks. Degenerative myelopathy is diagnosed by a process of elimination. Diagnostic tests and MRIs will be used to look for other sources of the symptoms, and once ruled out, it will be decided that the pet has degenerative myelopathy. Sadly, this illness does not have any known treatments or ways of slowing the progression. However, the dog’s quality of life can be improved by nursing care, prevention of pressure sores, monitoring for urinary tract infections, using carts and harnesses to facilitate mobility, and physical rehabilitation.

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Prevention of Knuckling

To keep your dog from developing IVDD, keep their activity and exercise levels under control. This means that you should not allow them to run or jump excessively. If your dog is predisposed, do not let them leap off of high surfaces, and obesity should always be avoided.

Your dog’s foot pads need protection from the heat and cold, as they can burn on hot pavement and can get irritated by the ice and salt in the wintertime. Dog boots are a good way to prevent sore paws during the hot and cold months. Special foot wax is another option. You should also keep your pet’s hair in their paws short, as it will help keep out objects like grass seeds, and will help you clearly see any objects that are stuck in the pads. If your puppy is knuckling and has carpal flexural deformity, keep them quiet and away from any activity that will challenge their mobility, including going up and down stairs frequently, until they are fully recovered. Carpal flexural deformity can be prevented by properly weaning puppies before separating them from their mothers. Let the puppies out in places that they can run, dig, and use their muscles properly. If you decide to use a splint, put it on in the afternoon or before your puppy falls asleep so that their mind won’t be on it. The best way to prevent intervertebral disk disease from becoming progressive is to treat it early on.

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Cost of Knuckling

All of these causes of knuckling can have different outcomes and different costs for treatment. Intervertebral disc disease has a treatment cost of around $9000, and curing carpal hyperextension can be $1500. Fibrocartilaginous embolic myelopathy can cost $4000 to treat, and curing degenerative myelopathy will require an average of $1800.

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Knuckling Questions and Advice from Veterinary Professionals

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French Bulldog

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Three Years

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Hunched Over, Front Paw Knuckling, Walls But Has Trouble Standing (Wobbles)

I have been to the vet 3 days ago when this all started. He is much better when he is taking the medication given. However when the pain meds and muscle relaxer wear off he’s hunched over with a tense neck barely moving. They said mri is not needed at this time. Second opinion?

Aug. 22, 2020

Owner

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Dr. Sara O. DVM

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0 Recommendations

Hello, If he is slowly improving he may not need an MRI. If he is not improving, he will need an MRI and possibly neck surgery. I hope your dog starts to improve very soon.

Aug. 22, 2020

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Willy

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Lakeland Terrier

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13 Years

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Moderate severity

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Wobbly

My 13 yr old Lakeland terrier has started having difficulty getting up, wobbles, legs shake, slides a lot (we have tile floors) and he can't "tripod," to pee; squats like a puppy now. I bought and use gripper socks for dogs, which work well on the tile floor but I've read a lot about Degenerative Myelopathy. His symptoms seem to have come on relatively quickly; within the past 6 months being really noticeable, and the symptoms seem to advance daily. Any advice?

Aug. 18, 2018

Willy's Owner

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Dr. Michele K. DVM

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1611 Recommendations

Dogs commonly develop arthritis, muscle disease, and nerve degeneration as they age. If Willy isn't on any pain medications, it would be best to have him examined by a veterinarian as soon as possible to see what the core problem is, and if there is any treatment for him. Many dogs do very well with mapin medication, and he may benefit from a safe prescription from a veterinarian.

Aug. 19, 2018

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Sasha

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Miniature Pinscher

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15 Years

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Mild severity

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1 found helpful

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Mild severity

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Knucking

My 15 year old dog tumbled off the bed last night. She did not walk last night. This morning she is walking, but her one paw is knucking. I called the vet to make appointment, but I'm thinking I should give it a day since she is walking and the vet bill would be $600 when I recently paid $3000 for cataract surgery.

June 22, 2018

Sasha's Owner

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3320 Recommendations

There are various causes for knuckling including spinal disorders, nerve damage among other causes; if Sasha was just limping I would advise to give her rest and monitor her over the weekend but since she is knuckling after this tumble I would recommend that you visit your Veterinarian for an examination regardless. Regards Dr Callum Turner DVM

June 23, 2018

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Sophia

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Chihuahua

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1 Day

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Moderate severity

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Paw Knuckiling

I have a 10 year old Chihuahua she weighs about 10 pounds. She is over weight. She has always walked with a wobble but in the last few days her front paws are knuckling under and she is having problems walking. She isn't crying or acts like she is in any pain. She is eat, drinking and going to the bathroom just fine. Any ideas what might be going on?

June 12, 2018

Sophia's Owner

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3320 Recommendations

Knuckling may occur due to nerve damage, spinal injury, arthritis among other issues; weight loss is always advisable in these types of cases to reduce any stress on the joints. You should visit your Veterinarian for an examination to determine severity, reflexes etc… Regards Dr Callum Turner DVM

June 13, 2018

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Maggie

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miniature snaucher

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10 Years

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Moderate severity

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Limping Knuckling

Dear Doctor, I have a miniature snaucher Maggie and she will be 11 this August. She has a fatty tumor under her right arm pit,it has been their for a few years. I have had four different vets evaluate her all with the same conclusion to leave it alone if it isn't bothering her. about a month ago she developed a limp in this paw x-rays blood work all ok except arthritis in the elbow. after her set of x-rays, she came home slept the rest of day. The next morning woke up with paw knuckling, back to vet 10 day anti-inflammatory seemed better then knuckling again. Could this fatty tumor be pressing on the nerves to cause the limp sorry to keep going on but at my wits end. scheduled to have this tumor removed end of June. Thank you in advance for any information

May 30, 2018

Maggie's Owner

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Dr. Michele K. DVM

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1611 Recommendations

Given the location of the fatty tumor, it may be putting pressure on the nerves in her armpit. Without seeing her or knowing more about the tumor, it's size of how quickly it is growing, it is hard for me to say what might be going on, but I think surgical removal makes sense.

May 30, 2018

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Kota

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Bullmastiff

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Nine Weeks

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Serious severity

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1 found helpful

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Serious severity

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Stumbling

we just got our bullmastiff puppy last week and we noticed the first night she was knuckling over. its been a week and it is painful to watch her walk now , its so bad. we called a vet to bring her in but the appointment is in a couple weeks. is there anything we can do to help her until then. its really bad, the morning is ok but as the day goes on she cant walk by the night time. i called the breeder and she said it is the food we are feeding her. is there really a food that can cure it?

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Latte

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Pit/rot

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12 Years

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Paw Spreading Inward

I have an almost 12 yr old Pit/Rottie mix...started last month, with her rear paw, spreading out and turning inward. At first, she didn't see to limp or lick her paw...and didn't seem to bother her..now...she is falling on our non carpeted floors, steps are impossible to go up, by herself..she can come down on her own. She sleeps 99 percent of the days...some indoor accidents have occurred, she whines when we help her onto the couch or off the floor. She is semi-overweight..still eats/drinks and takes walks. Getting inside the car, she needs assistance. She has a vet appt this Sat..hopefully, they can access her without taking xrays and all of that. I feel, with her age and weight, it is arthritis, and with the severe change in weather, she feels worse on certain days (just like me). What products have helped your dogs, keeping on budget plan. I am between jobs, with a very strict budget, but, I also want to have her pain free as much as possible. I am not ready to put her down... :(

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daisy lou

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catahoula cur/american pit

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10 Weeks

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Weak Ankles
Shakiness

my puppy Daisy is half catahoula cur and half American pit. she is ten weeks old. I noticed this afternoon that she was having a hard time putting weight on her front right paw that it was turning inward and her wrist bowed outward. and her front legs seem shaky. she's had her shots and she is on puppy chow. could this be a puppy thing or an awkward growth stage? she doesn't seem to have any tenderness just weak ankles or wrists.

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Frankie

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Pug

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3 Years

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Proprioception

I have a 3 year old overweight pug that is having issues with knuckling on his rear left paw. It happened suddenly last week when the delivery person rang the doorbell and all the dogs got all worked up. I didn't see if he tripped or got trampled over by the other same size dogs. Immediately however he was screaming in pain and his entire foot was what I though was hanging on due to being a broken leg. I rushed him to the E.R. and they did xrays and blood work all appeared normal. during the neuro exam and obviously by looking at him he had knuckling and couldn't correct his foot when it was upside down which they normally do automatically. The vet put a splint on his foot and wrapped it. We left it wrapped for 5 days and we took it off now he isn't in pain unless he gets picked up the wrong way however he still doesn't have control over that leg. He isn't walking on the entire foot the wrong way anymore but is still knuckling. I just don't understand how this could come about from an apparent acute injury and now he has some neurological deficit that I can't get a definitive answer on as to whether this will get better with meds and time or where do I go for help for him.. I feel so bad seeing him like this it breaks my heart. Please advise as best you can without seeing him. Thank you.

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Jilly

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Pomeranian

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9 Years

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Moderate severity

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Weakness
Overweight

We have a dog, Jill,9 years old. I noticed a few weeks ago she was a little wobbly on her front legs, but she is a 12.4 pound chinese crested/pom mix-a little butterball, with pancreatitis. But her nails were a bit too long, had her groomed, 4 hours at the groomer she comes home and is knuckling her front feet. Went to the vet who put her on rimadyl for 2 weeks and cage rest. Last 3 days she was getting noticeably better and then tonight we came home and she's really knuckling her left front paw. I wish I knew what was going on. Can't stop crying about this. I thought since she has horrible allergies and her feet swell from it that maybe her feet were sore from the grooming, but now that she has had a relapse, I am afraid it's worse and next step is an xray from what the vet says. Are there things that can be done to help? She eats, drinks, acts exactly the same and can't understand why we are babying her the way we are.