Limping Dog. How to do your own at home examination.

Classic "non-weight bearing" stance of a dog with a dislocated hip.

Two weeks post-op knee surgery and a seated dog with a bent knee proves that the joint is happy and healing.

One of the most common questions we get on Pawbly.com is about the limping dog.

To help people at home understand some of the most common injuries that cause lameness in a pet I thought I would provide a very basic "How to examine your limping dog at home" instruction blog.

Remember an examination doesn't just include the affected limb, it must include the whole pet. For this reason I recommend starting at the tip of the nose and letting your hands walk slowly from the nose to the tail. Inspecting everything very closely along the way.

Then we go to the "off" leg.

In most of these cases I advise my clients to check the leg by palpating (using your fingers to be your guide) and examining very closely  everything as your fingers walk your way over the leg from the toes to the spine. Palpate and probe every inch 360 degrees around as you move gradually up the leg. I know that most dogs are not fond of the feet (toes especially) being poked and prodded but in lots of cases the answer lies somewhere around here.

It is also important to remember symmetry. Use the opposite leg as a guide for what "normal" should look like.

Here we go on our virtual tour up the leg..

1. Check toenails. Some have grown into the pad and some are broken. All are painful. Broken toenails should be trimmed or clipped back as far as possible, or even removed, if broken severely. At the clinic I use a topical numbing agent and a muzzle and a quick cut. It hurts for one second,, like pulling off a band-aid. Then the pet is pain free again and using the leg as normal.

A very sharply pointed nail had grown into the foot pad.
When trimmed the evidence of the puncture is evident.

This pups toe required twice daily soaks and an oral antibiotic.
This must be treated as a wound.

This toenail is white because it was avulsed from the toe.
Regie had pulled the nail off the tissue and every time he walked the
nail rocked on the sensitive tissue underneath.
We trimmed it back as far as possible and this stopped the pain.
It will eventually grow out enough to be easily removed.
For now foot soaks, and clotting powder are all that's needed.
Oh, and no licking!

Clipped short enough to not touch the floor and cause pain.
Yellow styptic powder was used to stop the bleeding.

The toenail was broken, removed and leaves the "quick" exposed.
But, it will no longer be painful and the limp will cease.
Keeping the nail bed clean is all that is needed,
No Licking!

2. Look for redness or swelling, or wet, moist skin in between the toes. Some dogs get allergies, infections, even splinters in between their toes.

Interdigital cysts are painful.
This causes the pet to lick, which inflames the skin and seeds infection.

Many dogs with allergies lick their feet because they itch.
The licking causes red staining, inflamed skin and infection.

3. Look for injury to the foot pads. If bleeding soak foot in warm very mildly soapy water for a few minutes, then apply direct pressure with a clean cloth for 10 minutes,, no peeking, no wiping, no tight bandages. A small laceration to the foot pad is usually just allowed to heal. A deep laceration (full skin thickness) usually requires and antibiotic and protection from further trauma ( i like a panti liner (absorbs small amounts of blood and is super cheap) and a sock.. but change at least twice a day. Please call your vet if the wound is deep.

My pup, Charlie, who found a stray surgical staple. Sorry Charlie!

4. Look for any skin damage. Areas of injury. All penetrating wounds need veterinary assistance for an antibiotic and in some cases exploration to make sure nothing internal is damaged.

5. Broken bones cause significant non-weight bearing lameness and usually have considerable swelling. I know lots of people worry about broken bones but they are not normally seen without significant trauma like hit by car, jumping off bed, etc. They are swollen, painful and the leg often looks disfigured. Do not touch a broken leg without a muzzle in place. If the bone is sticking out of the skin wrap the leg in a towel and get to a vet to help stop the bleeding.

Maci a few days after her cruciate repair surgery.

6. Joint injuries are one of the most common lameness causes we see. Most often these occur after excessive or strenuous play. Some clients report that their dog was playing and they heard a sharp "Yelp!" and since then the dog has been sporadically lame. Typically this is a cranial cruciate injury. These dog have persistent lameness that may slightly improve and then worsen but in general they do not go back to normal weight bearing until the knee is stabilized. This is usually a surgical fix.

Ella is all done with her knee surgery.

I always advise that every limping and lame dog be kept quiet and calm by leashing walking outside at all times, or crating until your vet can see you. No running, jumping or play. Rest the leg. In many cases that is the only needed treatment.

A dog in significant pain to the point of not using the leg, being reluctant to stand or walk, or not interested in play, interaction, or even eating needs a vet immediately. In general a limping dog is not an emergency unless they are bleeding excessively, progressively worsening, or having a change in attitude or behavior.

In all cases your vet should be consulted. There are lots of options available after a diagnosis is provided.

Sarge,, the big ham

As always you can ask me a question about your limping (or otherwise) pet anytime for free on Pawbly.com. Pawbly is free to use and open to anyone and everyone.

Twitter has me sporadically @FreePetAdvice, And the whole majority of the rest of my life has me at the veterinary clinic, Jarrettsville Veterinary Center in Jarrettsville Maryland. 

Understanding and Diagnosing The Limping Dog, Why To Probe The Paw

This dog was brought in for limping.
Her foot hurt so badly she refused to walk on it.
Can you see the bruise on her pad?

There are a few conditions that are relatively simple, benign and resolve quickly but often present as a dog who refuses to bear weight on the leg.

For any dog who is either lame, or worst yet, carrying a limb, the best place to start is with a calm, relaxed, slow methodical hands and eyes on 'every-tiny-inch of the leg' approach. I see a whole lot of lame dogs, and I thought it might be helpful if I explained how I approach these cases.

Here is how I approach the pet who presents for "lameness."

When I am trying to determine the cause of a limp or lameness I always start with watching the pet ambulate. The best place to do this is in a closed, quiet, open room with as little furniture or hiding places as possible. In the exam room I will stand at the far corner and ask the owner to place the pet on the floor and calmly walk over to me as they coax the pet to follow. The pet will in most cases follow their mom or dad if they and this which allows me a few moments to watch them walk.

Analyze the walk
How much weight will they put on the leg? I scale lameness out of 1 to 5. 0 being normal, 5 indicating they will not put the foot on the floor.

This is my pup Jekyll. Grade 5, yesterday.
I corrected his cruciate rupture a week ago, on the other side.
Time for this one to be done is now ASAP.
And you think your dog has bad luck?

How much do the flex or extend at the joints? I want to see a good range of motion in every joint from the top to the bottom.

There are many subtle clues to a walking pet. They give me some hints about the bones, joints, muscles, and the nerves. When it comes to getting what you pay for an experienced eye from your vet can help your pet in innumerable ways. When a client calls me at 10  pm wondering whether their pet needs to go to the ER or whether they can wait until we are open I always tell them to send me a video. I can usually tell them with 30 seconds of a good walking clip.

The Physical Exam
I then try to take an educated guess where I think the problem is. If I think it is in the toe I look at the opposite leg from the shoulder down. Then I examine the lame leg from the shoulder down. Your hands do much of the work in veterinary medicine. We palpate for muscle size, lymph node size and number, bone pain and irregularities, joint swelling and range of motion, muscle size and sensitivity, etc. I try to palpate every muscle belly, every nook and cranny, and every anatomical structure in the leg. I also have to remember that some lameness results from an injury to the spinal cord.

When I think I have found the source of pain, (remember we are lame usually because we are painful) I then focus on what the root cause is.

Here's a tip from experience; For almost every single lameness exam, after I have watched the pet walking, I warn the parent that I am probably going to have to muzzle their pet. I know that people hate muzzles, for some reason they think they are cruel punishment devices?, or that it is a reflection of their parenting skills (sometimes there is a hint of truth to this), but I am looking for clues for the source of the discomfort/pain and I am asking the pet to respond. We all respond to pain differently, and when I am restraining them prohibiting their ability to flee that only leaves them with one other option. And so, I expect that in almost all cases the pet will respond with their best defense, a snip, a bit, a growl, and a harsh warning to back my inquisitive annoying self off. I don't blame them. I would bite the hand that hurts me too!

Remember when it comes to assessing the leg for lameness you have a cheat sheet. Use the other leg/foot to help identify differences. Subtle clues like;

• How much weight is being placed on the foot (a flatter foot has more weight on it).
• How long the toe nails are. Indicates how the foot is used.
• How the toes touch the ground. Is the pet reluctant or unable to place the foot correctly.
• What is the muscle mass from one leg to the other. A loss of muscle mass indicates dis-use, and more atrophy indicates either severity or chronicity.
• Is there saliva staining. A black/rust colored foot is a clue the pet is trying to tell you something.

My other pup, Charlie, who licks between his toes on his left foot.

Can you see the difference between the two feet?
The hair on the right foot is white, on the left its brown, from saliva staining.

This is Peanut.
Her mom noticed that she was intermittently carrying her back left leg.
Can you spot her boo-boo?

Peanut has a blister between her middle two toes.
For those of us who suffer walking around in a new pair of high heels we know how painful this is!

This pup was at being watched by a relative while her family was away on vacation. They are familiar with her seasonal allergies an have learned how to best manage them at home.The pet sitter didn't recognize that her allergies were flaring up. When her parents returned they were shocked to see how itchy, painful, and discolored she was.

Ellie Mae hands me a sore foot.

Ellie Mae's feet are brown, the toenails are dark brown at the base.
She has been sitting around all week licking her paws.
They ITCH!

The last place to look is the toenails. A broken toenail can be incredibly bothersome and most pets will lick at it incessantly and limp on the foot until the nail falls off or is removed.

Lorelei's nail is almost broken off at the base of the nail.
Every time she tries to stand on the foot the raw skin and jagged nail hurts her sensitive toe.

After a topical anesthetic was applied we quickly and pain-freely removed her broken toe nail.

Even though the toe is now bloody, the nail is removed and the toe can now heal without any pain.
We gave her a pain medication, something to soak the raw foot in to keep it clean and prevent infection.
A bandage to the foot and an e-collar an she will be right as  rain in a few days.

Quik-Stop to stop the bleeding.

Another happy, pain-free, limp-free customer.

My point is that limping pets arrive for a multitude of reasons. A good exam, a thorough history, a watchful eye, adept hands, and maybe even an x-ray or two, and most of our limping pets can be treated quickly, easily, and alleviated of their discomfort. Most limping pets are not an emergency. But the identification of the root cause, and a plan to assist the pet parents in understanding the consequences of waiting, and helping them to curb it in the future all help to find a quick end to a common presenting complaint.

The Treatment Plan

This should always be tailored to the patient and should address the following items;

How do we alleviate the pain?

How much time should it take for the lameness to resolve?

When should the problem be re-checked?

What are signs of the problem not resolving?

And, one of the most important, and frequently over looked parts of the treatment pan is; 

How can we prevent it from happening again? Understanding how this occurred and how you can prevent it will hopefully keep your pet pain free and out of the vets office. (Almost ALL of the toe nail problems occur because people are not keeping them trimmed).

If you have a question about your pet, or want to share your personal pet experiences with a community of pet loving people please visit us at Pawbly.com. Pawbly is always free to use and we welcome your questions and comments.

You can also find me at the clinic, Jarrettsville Vet, in beautiful Jarrettsville Maryland, on Facebook, and on Twitter @FreePetAdvice.

This Little Piggy Cried Whaa! Whaa! Whaa!, All the Way Home.

The lifeline of equine medicine is foot problems. Actually I should re-state that the demise of racing horses are foot problems. And did you know that one of the largest chapters in the textbooks for both ruminants and equids is on foot problems? And, there are quite a few foot ailments chickens get, too. Okay, I suppose that the point is that many, many, species are afflicted with foot problems.

For a little anatomy review I will remind everyone that dogs and cats have four feet. We still call them wrists and ankles, or to be anatomically specific; meta-carpals (wrist) and meta-tarsals (ankle). Our pets fingers and toes are called phalanges. And, just in case you didn't take human anatomy there are a lot of bones in your hands and feet. (I should know how many off the top of my head, but to try to recall at this point would require a pad, pen, and stick drawings, and I would still forget a few ones in that muddle of upper wrist. Remembering those freshmen anatomy pop-quiz questions for me at this point requires walking to the shelf an opening a book).

In dog and cat veterinary medicine we see a fair share of limping pets. The first thing we try to do when we see a limping patient is to try to identify where in the leg the problem is.

We start with a general overview of the pet walking and ask ourselves the following questions;
First we decide how bad the lameness is? We grade lameness on a 1 to 5 scale. 1 being the mildest and 5 being non-weight bearing. A 5 means that the pet refuses to put the foot down to ambulate. This implies that the foot is so painful they won't use it, or so unstable (fracture) that they can't use it. Any and all grade 4 and 5 lameness's need a vet ASAP.

The second thing we do is palpate the entire leg. Here is where the experience comes into play. We all have our own methods of palpation. I tend to start in the area that I don't think has the problem. So if I think the problem is in the foot as I watch the pet walk I will start palpating high on the leg. As a good rule we also look at both legs from the back and front to check for symmetry. We look to see if the legs are different sizes/shapes and that helps us identify chronicity of the disease, or aggressiveness of the disease, if bones and/or muscles are involved, swelling of tissue. In general, there are a ton of clues very good observation will give you. And then we palpate everything.

Palpation helps to identify the source of the pain, and the source of the problem. If we feel a swelling of the bone we worry about bone cancer, or bone diseases. If we feel a incongruity of the bones we think fracture or dislocation. A loss of muscle indicates chronic disuse of the muscle to the point of atrophy. We also check for lymph node enlargement.

There is certainly an art to good palpation. Every vet has had the dog who has an obvious limp and yet refuses to show any sign of pain no matter how hard you try to identify the source of their lameness. I call these guys the "stoic" dogs. There are also many many dogs who will bite you if you even approach their feet on a good day when everything seems normal. Try to  identify a foot problem in a foot phobic fear biter..it's not fun, and it is frustrating I promise.

Oddly, (although I shouldn't say that, because "oddly = normal" in my life), I saw three foot dogs in an afternoon. 

The first was a young sweet Boston Terrier. She was an easy one because her owners had witnessed her jump on their porch and then slide across the deck where they saw and heard her drive her foot into a very long wooden splinter. She immediately yelped! and then lifted her foot. They could see the splinter in her foot so they tried to pull it out. Unfortunately only half of it could be extracted. It broke under the skin and left a large piece behind. When I say "thankfully they saw it," I say it because as big as that piece of wood was you could barely feel it, and you couldn't see it at all. If they hadn't been there to point it out I would have missed it on her physical exam. It took two vets, three technicians, and a muzzle to remove it. When we finally got a forcep on it it came out easily and measured about an inch long. OUCH!

The second was a Bernese Mountain dog. He came in limping and with a large red wound on the top part of his foot, (we call it dorsal). Where some pets who have what we call a "lick granuloma" this dog seemed to be excessively licking her foot because it hurt. It took a few minutes to find the source of her pain. She had a small black pinpoint wound between her toes. She was licking the top of her foot to try to tell us that she had a wound on the bottom of her foot. Thank goodness we didn't write her off as "another dog licking for some unknown reason" and just put an e-collar on her. I have a serious pet peeve about e-collars. They only get used when you are sure of the reason and and you are treating the cause. They are otherwise torture devices. Not being allowed to scratch or lick a boo-boo is torture if you aren't treating the boo-boo.

My last dog of the day had a laceration to her foot pad. We see this a lot. They bleed like crazy, send owners into a panic attack, and often somewhat limiting in our ability to treat. Luckily foot pads heal very quickly if kept clean, dry and protected. Often after a few hours they don't seem to hurt so bad and most pets go back to walking almost normally. The real trick is to keep them from opening back up and bleeding. Now IF you have a deep laceration to the foot pad that can be a different story. keeping a deep laceration clean and allowing it time to heal, (usually this means you try to keep the pet from walking too much on it, because all that motion on the foot means the wound can't close). Some of these deep lacerations require surgery, long term antibiotics, and strict cage rest. And another concern is that many of the foots tendons live under the foot pads, we need to insure they are still intact or the foot will not function properly.

For many of the foot pad lacerations I see they are usually just the most superficial layer of the pad, so I often place a temporary foot bandage on it with lots of antibiotic cream, (after I have soaked the foot in another antimicrobial foot bath), and then re-check them in 24 hours. Usually 24 hours later the bandage can be removed and the skin/foot pad has already started to heal.


For those limping, lame dogs that we cannot find a wound on, we try to use our hands, the history from the owner and our experience to try to identify whether an x-ray will help identify the source of the problem. I have to admit and warn you that there are times when we take an x-ray and still we don't find our answer. Without being able to identify an obvious cause we often recommend rest and an anti-inflammatory. This is also the time that I tell my clients to come back and let me re-check if the problem persists or worsens. Sometimes it takes a few visits for us to figure out the cause for lameness. But I always promise that I won't give up on you if you don't give up on me. Diagnosing and treating any disease is a process and sometimes we all get stumped. When this happens, or when we feel the problem is beyond our abilities, we will refer you to orthopedic, neurology, or radiology experts.

If your pet is lame, painful, or not getting better, keep looking for answers, and don't give up. There is always a reason, and it is very difficult to provide a treatment plan when you don't have a diagnosis.