• Your dog's paw skin can bleed due to damage from paw curling. Depending on the level of knuckling, this can be quite a distressing sight. Make sure you keep the paw wound clean and dry.
• Nails get shorter due to paw dragging, maybe even down to the quick.
• Knuckling can come and go, getting better or worse throughout the day.
• Knuckling paws in dogs can occur in one or all paws, most commonly in the rear.
• Dragging, weaving, or limping is common with knuckling paws.

Knuckling in dogs is actually a symptom of another medical condition.

If you become aware that your dog is paw knuckling, you must book an appointment with your vet for a diagnosis. The cause could be minor, like an injured paw, or sometimes knuckling can be because of a serious - even fatal - illness like Degenerative Myelopathy. It is possible for some of the medical conditions that cause knuckling to improve. Sadly, some are incurable.

What causes knuckling in dogs?

Several medical conditions can cause knuckling in dogs:

Neurological conditions

• Degenerative Myelopathy

Degenerative Myelopathy in dogs is a chronic disease of the spinal cord that causes progressive paralysis. The disease often starts with the back paws knuckling. It can look similar to arthritis or hip dysplasia, making it difficult to diagnose immediately. Eventually, Degenerative Myelopathy will progress, so the dog is nearly completely paralysed.

Read more about Degenerative Myelopathy here

• Pug Myelopathy

Pug Myelopathy, once a rare condition, is becoming increasingly common. It is predominantly seen in pugs but can also affect other breeds and is still not fully understood. Pug Myelopathy is the progressive but non-painful paralysis of a dog’s hind limbs. It should not be confused with Degenerative Myelopathy, as they are different medical conditions.

Read more about Pug Myelopathy here

• Nerve damage caused by an accident or injury

Dogs who are unfortunate to have a serious accident, for example, being hit by a car or have had a severe injury, can sometimes be left with nerve damage, causing knuckling in dogs. In these situations, the knuckling is unlikely to get better or improve.

Orthopedic conditions

• IVDD, spinal weakness or injury

Intervertebral Disc Disease (IVDD) is a degenerative disease that can affect your dog's spinal cord. It causes a range of painful mobility issues. IVDD includes herniated, ruptured, or bulging discs.

Read more about IVDD here

• Spinal stroke (FCE/fibrocartilaginous embolism)

Many individual bones, known as vertebrae, surround and protect the spinal cord. Cartilaginous discs sit between the vertebrae to act as shock absorbers and to give the dog’s back and neck the ability to flex, extend, and move from side to side. These discs are great when healthy but can create quite a problem if they rupture.

• Hip weakness or hip dysplasia

Dog hip weakness includes hip arthritis, hip dysplasia, or hip dislocation. Hip dysplasia is a painful condition that causes the hip joint to develop abnormally. It is an inherited condition. Some dogs respond well to non-surgical management through weight, exercise control, and a hip brace. If your dog improves with treatment, they can live a long, happy life.

Read more about hip dysplasia here

• Wobbler Syndrome (cervical spondylomyelopathy)

This condition comes from the wobbly gait most affected dogs exhibit. Dogs with wobbler syndrome typically have spinal cord compression in their neck from either an abnormally narrow spinal canal plus intervertebral disc herniation or a narrowed spinal canal due to changes to the surrounding bone.

• Carpal Flexural Deformity

Carpal flexural deformity mainly affects large and giant breed puppies, usually younger than four months. It affects the dog’s carpus - wrist - your dog may have hyperextension, hyperflexion, or general laxity (i.e., looseness) of the carpus.

• Arthritis

It doesn't matter how old your dog is, joint care and preparing for osteoarthritis and arthritis are excellent ideas. Many dogs can start showing signs of arthritis from as young as two or three years old, but most commonly in older stages for a dog.

Read more about osteoarthritis and arthritis here

If your dog’s knuckling is caused by a progressive condition, the knuckling on paws can become more severe. You will see:

• The paw is curled over and stays in this fixed position almost constantly.
• Your dog struggles to walk short distances without damaging their paws, skin, or nails.
• Your dog is weaving around and looking unsteady on their feet. This is particularly true if it is rear paw knuckling.

What is mild, moderate and severe dog knuckling?

• Mild knuckling is slight curling in the paws, where the skin and nails can be protected by boots. Knuckling paws might come and go throughout the day.
• Moderate knuckling is fixed paw curling. Your dog can walk but is limited, often falling over or needing to be consistently unsteady.
• Severe and aggressive knuckling is the completely fixed position of the paw. Your dog may not be able to walk at all as it is so painful.

Can I do anything to prevent my dog from knuckling?

If your dog knuckles, there are very few preventative measures you can take before it happens, as genetics play the leading role in dictating if your dog will have dog knuckling.

In particular, some breeds are more prone to these genetic diseases, such as IVDD and Degenerative Myelopathy. IVDD, in particular, affects short-legged breeds. If you have one of these breeds, ensure they aren’t carrying extra weight. Obesity can make a dog more susceptible to spinal injuries. Be careful about your dog jumping off the sofa or running up and down stairs. Think about putting down non-slip mats at home (see below).

If your dog might have Degenerative Myelopathy, this is an inherited genetic condition. You can't prevent it, but you can screen for it by genetically testing your dog.

Rear vs. front knuckling in dogs

Rear knuckling is the most common type of dog knuckling as most medical conditions mentioned above start or affect the hind paws, primarily Degenerative Myelopathy. Knuckling might start in one rear paw, but most commonly, it will soon affect both back paws.
If your dog knuckles with their front paw, this is rare and will likely only affect one paw. Getting a custom anti-knuckling brace for this paw is best to help correct the paw action.

What breeds and ages commonly suffer from dog knuckling?

Any breed can suffer from dog knuckling.

In terms of age - a dog walking on their knuckles can happen at any age. Paw knuckling in older dogs is more common than in younger dogs, as most knuckling medical conditions occur later in life. Knuckling in puppies is a known condition. Read more about dog knuckling in puppies here to help your puppy live a more active life.

Obesity and paw knuckling

Be careful with your dog's weight. The more weight they carry, the more damage they can cause to their rear knuckling paws, skin, and nails.

Your vet will conduct a series of diagnostic tests to determine the underlying cause of the knuckling. For example, they can conduct a Degenerative Myelopathy test. If this comes back positive, it will show that your dog likely has progressive dog knuckling. Radiographs are helpful, but a definitive diagnosis may require an MRI. Achieving a conclusive opinion may involve a referral to a veterinary neurologist.

Other tests may involve injecting dye around the spinal cord and then taking a radiograph or using an MRI or CT to find the areas of compression in the cases of IVDD. There is no definitive test with degenerative Myelopathy. However, blood testing will help determine the presence of a mutated gene believed to contribute to the condition.

Treatment Options: How can I help my dog?

Seeing your dog struggling with knuckling paws can be upsetting, particularly with a diagnosis of IVDD or Degenerative Myelopathy. Certain products will improve your dog’s quality of life if they are dog knuckling. Depending on the severity level, you can take a protective or corrective approach.

Depending on how advanced your dog's knuckling is, there are a few treatment options:

• Physical Therapy
• Anti-inflammatory Medications
• Laser Therapy
• Mobility Aids
• Help Around the House
• Surgery

Physical Therapy

There are options such as physiotherapy, hydrotherapy, and laser therapy. Some people swear by alternative therapies like acupuncture, acupressure, and massage therapy. They are all worth exploring.

Anti-inflammatory Medications

NSAID (Non-steroidal anti-inflammatory drugs) can be used with most treatment methods to manage pain.

Laser Therapy

Laser therapy is an increasingly popular option that offers pain relief, improved healing, and decreased swelling and inflammation.

Mobility Aids

For all levels of paw knuckling, helping the joints with a Joint Supplement can improve paw function.

For mild knuckling:

• Protect your dogs paw skin and nails with boots: WagWear Wellies or Walkabout Knuckling Protection Boot

For moderate knuckling:

• Correct your dog's paw knuckling with a Maximus PawsUp brace.
• Correct your dog's paw knuckling with a Bootie Splint.

For severe knuckling:

• Rear Paws: Maximus Skates is a popular route for severe cases. This allows your dog to stay mobile and keep muscle tone active while preventing damage to the paws from dragging.
• Front Paws: Order a custom knuckling paw brace made to your dog’s specific measurements to get the paw to walk flat again.
• Help support your dog when getting up from the floor or walking with a rear lift harness 

Surgery

Surgery is highly uncommon; however, if the underlying medical condition, e.g., IVDD, is diagnosed, your vet might recommend surgery to alleviate this condition, reducing the knuckling as a secondary.

Help Around the House

Putting mats down so your dog gets as much traction as possible is a good idea. Slippery wooden floorboards or smooth surfaces are best covered. Read more about non-slip dog socks and harnesses