Why Is My Pet Limping?
The Pet-owners Guide To Limping Dogs Cats And Ferrets
Ron Hines DVM PhD
Lots of my articles are plagiarized and altered on the web to market products and services. There are never ads running or anything for sale with my real articles. Try to stay with the ones with http://www.2ndchance.info/ in the URL box or find all my articles at ACC.htm.
Some of the most frequent visitors to veterinary hospitals are limping pets. Sometimes your veterinarian's initial physical examination identifies a simple cause and solution - but just as often, the cause is not that easily determined and the treatment is more complex.
More severe lamenesses - the ones that do not resolve themselves promptly or those that are accompanied by other health changes - require a trip to your veterinarian right now. You also need to schedule an appointment with your veterinarian when even minor lamenesses or limping come and go more than once.
I, like most veterinarians, perform a similar initial examination on all limping pets that are brought in for examination. The pet’s entire body needs to be examined, because sometimes the most obvious problem is not the only problem. This article discusses some of the more common causes of lameness that veterinarians see. There are many more.
How Does A Veterinarian Determining Which Area Is Causing Your Pet Pain ?
Most - but not all - leg pain is related to one or more painful joints. Determining which joint might be causing your pet’s lameness can be quite challenging. Sometimes the affected joint can be identified by noting swelling, heat or pain over that joint. But some pets are more stoic than others about telling you where they hurt. In those cases, gently over-flexing the affected joint often temporarily increases the limp. In some cases it is the owner who picks up first on subtle signs of pain this causes and informs the vet. It can be quite difficult to identify which leg is causing a pet to limp. Usually, the pet's head will rise when the sore limb bears weight and go slightly down when it isn't. It will also shift its weight slightly to the side of its body and legs that are not in pain.
Pets with rear leg pain often carry those legs farther forward than normal and their hip on the affected side a bit higher. Pets with front leg pain are often reluctant to move. When pets favors a leg over time, the toenails on that limb tend to be longer than on the others. That may be enough to identify the limb that is causing its abnormal walk.
When physical observation is not enough, when the problem might be serious, or just to gain more information, x-ray views of the suspected joints as well as the corresponding joint on the opposite leg are usually indicated. Some painful joints appear normal on x-rays. In those cases, the bone is not affected or the injury is too recent to have produced changes in the bone. The best way to decide if a joint is abnormal is to compare it to the opposite leg.
How Should My Pet's Paws Be Examined ?
Your pet’s paws need to be examined for thorns and stickers. Grass sandspurs, caught between the foot pads, are a common cause of limping in the southern United States. This is particularly true in pets that have heavy fur between their toes. Once the pesky thorn is removed, these wounds rarely becomes infected.
Paw Lacerations (cuts) are also quite common in active dogs. These are often due to treading on sharp glass or metal fragments, but they also occur when pets are bumped by cars and skid on the pavement. Paw lacerations are much less common in cats. When they occur, they are usually infected and the result of cat fights . When they occur in ferrets it is usually because they have caught their foot in their caging. Hot summer road asphalt can also burn the foot pads of dogs.
Even moderately large paw lacerations usually heal quite well without suturing. I usually recommend that cut footpads be soaked four times a day in warm hydrogen peroxide solution or tame iodine solution (Betadine). My experience has been that paw bandages and gauze tend to trap unwanted moisture, bacteria and debris in the wound and actually slow healing. When a paw is bandaged, the bandage needs to come off as soon as bleeding has stopped. Cut paws need to stay dry and clean until they heal. Injured pets usually lick hurt paws. That licking rarely if ever retards healing or contributes to infection.
Deep puncture wounds and seriously infected paws need systemic antibiotics given orally or by injection. Anything applied directly to the paw will most likely be licked off by your pet - so it is better to treat these injuries from the "inside" rather than topically.
Overgrown or overly short toenails frequently cause limping. Overly long nails are a particular problem in older, less active pets. When these nails break off, they can expose the sensitive quick. They quickly become infected and very painful due to the moisture of licking and contamination. These nails need to be cut off straight and cauterized in order for them to heal properly. This is a painful procedure. It should be done, professionally, under mild anesthesia. Breaks in long toenails are often incomplete with the most distant portion bent to one side or hanging incompletely separated. These partially-fractured toenails will not heal. The pet may go sound for a while, but pain will reoccur. Your pet's comfort requires that they be removed.
Very active dogs and dogs housed on concrete often wear their toenails down to the sensitive quick. With time, the quick on these nails will recede. Once the nails no longer bare weight, they will become pain free.
When your pet’s nails are allowed to overgrow, they also twist the joints of the foot in a way that can lead to arthritis and pain. Severely overgrown nails also need to be clipped off short and cauterized by your veterinarian under a mild anesthetic. Although there is no danger of a pet with a normal blood clotting mechanism bleeding to death from short-cut toenails, it is a procedure that should only be attempted by a veterinarian or an experienced groomer. Antibiotics are rarely required.
Dogs with canine atopy or skin allergies often lick their paws incessantly causing infections, abscesses and cysts to develop between the toes. This is very painful and can cause the pet to limp. Treating the paws with an astringents and topical steroids will give the pet temporary relief. But the pet’s general allergic condition needs to be dealt with if the problem is not to reoccur frequently. In some dogs, paw licking is more a psychological problem than an allergic one. You can read about allergic skin problems in dogs here.
Your Pet's Elbows:
Unstable elbow joints are subject to pain and eventual arthritis. If your pet shows signs of front leg limping that does not resolve promptly or returns intermittently, it needs to be taken to your veterinarian to have its forelegs evaluated. Many owners suspect that their pet has a shoulder problem when, in fact, the problems is lower down in the elbow. You can read about arthritis problems in dogs and what can be done for them here.
Pain in pets that is associated with their elbows tends to be serious and progressive. The most common causes of elbow pain in young dogs are elbow dysplasia, where fragments of bone (medial coronoid process) are present in the elbow joint and un-united anconeal process where a portion of one of the bones that forms the elbow fails to fuse. These are serious conditions that will become worse if they are left untreated. Some owners and veterinarians opt to treat these pets medically with non-steroidal anti-inflammatory medicines for a number of years. Others make immediate attempts to repair the joints surgically. Surgery offers the only hope of slowing or stopping the slow, progressive destruction of the joint that invariably occurs. Any pet with this problem needs to maintain a trim body weight because dogs and cats carry about 70% of their weight on their front legs.
These are not conditions that pet owners can diagnose or treat themselves. Specialized x-rays and knowledge are required to detect them and sophisticated surgical devices and procedures (arthroscopy) are required to correct them.
Another common problem that occurs in the elbow of dogs is osteochonritis dissecans (osteochondrosis) in which a flap of cartilage breaks loose within the joint causing pain when it is trapped between joint surfaces. Too rapid a growth rate, genetic factors and trauma to the joint can all play a part in this disease. These flaps and floaters (joint mice) need to be removed surgically.
Your Pet's Shoulders:
The shoulder joint of dogs is also subject to osteochonritis dissecans. The heavy shoulder muscles make detection of inflammation and swelling in this location difficult in pets. However, rapidly extending and contracting the shoulder joint of pets with shoulder issues often causes detectable discomfort. Not all cases are evident on x-rays and it is sometimes necessary to examine these joints with fiber-optical apparatus to identify the problem ( similar to these arthroscopes). A few cases heal without surgery when the dogs exercise is restricted and it is given anti-inflammatory medications. But since veterinarians won’t know which cases these will be, and because arthritis of the shoulder often develops when surgery is withheld; it is usually best to surgically remove these fragment(s) of cartilage.
Occasionally inflammation of the tendons (tendinitis)
that connect major muscles of the shoulder, occur after a shoulder
injury. This problem usually improves when a long-acting corticosteroid
(ref) is injected in the
affected area and the pet is given an extended period of rest.
Corticosteroids, to reduce inflammation and NSAID's
to reduce pain and inflammation will probably make your pet run
and roughhouse like it used to. But they must
not be a substitute for the extended rest your pet needs for its
joint to truly heal.
Panosteitis (“growing pains”)
This is an inflammatory disease of young dogs, which causes lameness that shifts from one leg to another. It is also called enostosis, eosinophilic panosteitis or juvenile osteomyelitis. Panosteitis is particularly common in German Shepherd dogs. Eighty percent are male less than two years of age. Firmly grasping the bones of the legs will often cause these dogs to yelp. The cause of panosteitis is unknown. Early in the lameness phase of the disease, x-rays are normal. Panosteitis is a transient disease that cures itself with "tincture of time" (patience).
Your Pet's Knee or Stifle:
Luxating Patellas – “Trick Knees” are quite common in toy breeds of dogs. They also occasionally occur in cats - particularly purebred, cattery cats. When the problem occurs in ferrets, it is usually due to having its leg stepped on or wrenched in some other manner.
In almost all cases, the kneecap pops out of its track toward the inside (medial side) of the knee joint. Patella luxation in dogs and cats is usually an inherited problem caused by poor alignment of the thigh (femur) and shin bone (tibia) as well as an abnormally shallow groove that the patella rides in. You can see that groove and the surrounding anatomy here (I circled the groove in pink). When it is an inherited problem (and it usually is) the pet may favor one leg over another, but both knees have the problem to some extent. Occasionally it will occur as a single-side problem after a severe accident that wrenches the pet’s knee. It causes intermittent, painless lameness, which locks the knee during the time the patella is out of its tract or groove. Surgery to correct this problem is straight-forward and usually very successful. You can read more about the problem and solution here.
Anterior (cranial) cruciate ligament injury
Anterior cruciate ligament tears are one of the most common knee injuries in dogs. They are also among the most difficult injuries to treat successfully. Cats that are overweight or have multiple health problems occasionally develop the problem as well. It also occurs sporadically in ferrets. You can read about this problem and its treatment in dogs here and and a review of its occurrence and treatment in cats here. (Despite what you read in that article about non-steroidal products (NSAIDs) being used to treat this problem in cats - be exceptionally careful and cautious if that is attempted !)
When a cruciate tear occurs, the pet will suddenly refuse or be reluctant to bear weight on the affected leg. Surgery to correct this problem is less successful that one might hope for. In dogs weighing less that 40 pounds, lameness generally resolves itself or becomes manageable without surgical treatment during a period of 5-10 wks with initial cage rest, later exercise restriction, medications during recovery to control pain and maintenance of a healthy, lean body weight. Hydro and physical therapy can be quite beneficial. There are a large number of surgical techniques currently used in an attempt to stabilize your pet’s knee. Surgical success rates are hard to evaluate because pets tend to get better with time even without surgery and later arthritic knee changes are not prevented by the surgery. Proponents of surgery say that these arthritic changes would be worse had the surgery not been performed. However, that is really impossible to know. At a minimum, a long period of rest, weight control in overweight pets and physical therapy are needed to get pets through this condition. Leg braces are quite helpful if pets tolerate them and if they are designed so that they do not fall off. (unless a strap goes over the back and around the unaffected leg, it will probably not stay on) Much like back problems in humans - there is no agreement among physicians or veterinarians as to what the best treatment really is.
Torn Knee Meniscus
Knee injuries to your pet can result in tears of the elastic cartilages that cushion the knee joint. Sometimes these occur in conjunction with cruciate ligament damage. Your pet’s meniscus are formed of rubbery cartilages and they are there to absorb shock.
We associate meniscal tears with large dogs, but they can occur in any type of pet subsequent to trauma. Sometimes the knees of dogs with this problem “click” as they walk. Meniscal tears rarely heal on their own because cartilage is a tissue with poor blood supply. In larger pets, the meniscus can be smoothed through arthroscopic surgery and the tags of torn tissue removed. Surgically opening the knees of small pets in older, traditional, manners requires that many important structures be cut and then replaced as best the surgeon can. I generally do not recommend that that be done in smaller pets.
Nearly all pets, like nearly all people, develop some degree of arthritis as they age. It is common to see stiffness or lameness associated with arthritis in dogs over 8, cats over 12 and ferrets over 7 years of age. Pets that are unusually large and those that do not stand vertically on their legs (bulldogs, bassets, etc. = achondroplastic/ osteochondrodysplasias) are more at risk of developing problems earlier. Signs of arthritis are usually visible on x-rays long before you notice changes in you pet. The severity of the damage your veterinarian sees on x-rays may not accurately reflect the amount of pain your pet is actually experiencing. Some pets I see with horrible x-rays do not seem to be in pain at all and some with only minimal bone changes are in obvious discomfort. Because all medications that control pain and inflammation can have significant side effects when used over long periods in your pet, do not begin your companion on anti-arthritic mediations until it is really necessary. Try to resist the pharmaceutical company ads as long as possible. That advice does not apply to the food supplements and "neutraceuticals" commonly sold or suggested by veterinarians - they do not appear to share these dangerous side effects. You will find some non-drug methods of dealing with arthritis in older pets here and here.
If your pet suffered an injury to a leg joint earlier in life, arthritis may develop in that limb years later. For example, the front left leg of racing greyhounds (the "rail side") are known to develope considerably more arthritis than their right one because the left front leg taking the most pounding as the dog runs counter-clockwise on the track. You can read about those injuries here.
There are things you can do to delay the onset off arthritic pain in your pet. Here are a few :
It is common for dogs with hip dysplasia to limp or rise with stiffness. Hip dysplasia also occurs in cats – particularly big-boned cats like Maine Coon, Persians and Chartreux. Both hips are almost always affected, but the limp is usually worse on one side. It may shift from leg to leg. The age at which hip dysplasia affects a pet depends on the severity of the inherited disease. You can read more about the problem here.
Older pets, particularly larger breeds, are susceptible to tumors of the bone called osteosarcomas. The first sign of these tumors is often limping and it is not uncommon for pets to visit the vets with a limping problem several times before the true cause is discovered. Osteosarcomas commonly occur near a leg joint. On radiographs (x-rays), these tumors often have a characteristic “star burst” appearance. When they have not spread to the lungs, and they are present on a rear leg, they can be treated successfully by amputation of the limb. But I question the humaneness of amputating the front leg of an active animal. In long-haired cats, leg tumors of this type can be difficult to see. You can see how one of these tumors might look on a typical x-ray here. I circled the cancerous area in pink.
Most myositis or chronic muscle inflammations are autoimmune diseases in which the pet’s immune system begins to attack its own muscle and connective tissues. The most common form affects the muscles of the pet's jaw, not its leg muscles (ref), but a second form that affects the legs also occurs (ref). Diagnosis of myositis is made by removing a tiny sample of your pet's muscle for microscopic evaluation (biopsy). This disease often goes through waves of activity or flare-ups during which the pet is in pain and reluctant to walk. It can be controlled with medications that suppress inflammation. Its treatment and progression in pets is the same as it is in humans.
Diseases of pets caused by organisms that are transferred through blood-sucking parasites (usually ticks) seem to be becoming more common. The first sign of these diseases is sometimes lamenesses. That is because a number of these organisms trigger a process of joint inflammation known as polyarthritis (polyarthritis has other causes as well).
These tick and parasite-borne diseases include Lyme disease, Erlichia, Babesia, Bartonella and Rocky Mountain Spotted Fever. Your veterinarian has accurate blood screening tests available to detect them. The organisms are as tough and as stubborn as the ticks that carry them and they are a real challenge to permanently cure. You can read about the blood tests used to detect them here.
Dogs and cats with autoimmune diseases sometimes develop lameness. One form of autoimmune disease in dogs and cats, pemphigus, may cause inflammation of the paws. It is common for these pets to also loose pigmentation and develop crustiness around their mouth, eyes and anus. There are medications to control this condition and bring it into remission.
Bites And Stings
Infected tick bites, bee stings, spider and snake bites on the paw and lower foot can be the cause of sudden lameness. They may not be immediately apparent when you examine your pet's leg. As with thorns and cuts, carefully clipping the fur from the leg of long haired pets is sometimes the best way to locate and treat them. These bites and stings are often accompanied by considerable swelling. The pain and swelling associated with stings generally subsides in a hour or two. When it is accompanied by facial swelling, paleness, generalized weakness or rapid respiration, the pet is experiencing an anaphylactic reaction and needs to be rushed to a veterinary hospital.
Some pets with back problems appear to their owners to have leg problems. X-rays are required to rule back problems in or out. These type of injuries and degenerative conditions are most common in dachshunds and other breeds with bizarre conformation. Occasionally, knee and back problems will occur in the same dog. You can read about this problem here.
Improperly Performed Cat Declaw Surgery
When a portion of a nail root is inadvertently left in a cat that was surgically declawed, the cat’s paw will eventually become quite painful and it will limp. All limping, declawed cats need to have their toe incisions checked carefully for nail root remnants. If present, they need to be surgically removed.
Feline calicivirus infection is usually associated with upper respiratory tract and oral symptoms. However, certain strains of the virus can also cause fever and limping. This problem, called Limping syndrome, has also occurred subsequent to vaccinating cats against calicivirus.
Heart Disease In Cats
Heart disease in cats (cardomyopathy) sometimes results in blood clots that block major arteries to the hind limbs. This can result in lameness, leg weakness or paralysis - depending on the extent of the blockages. You can read more about this problem here. These cats should also be checked for hyperthyroidism which you can read about here.
Ferret Rear Leg Weaknesses
Ferrets are amazing in that so many health issues they experience result in rear leg weakness and an unsteady gait. The problem is rarely in the legs themselves. Anemia, adrenal tumors, lymphoma, insulinoma and spinal injury have all been known to caused a wobbly gait. Articles on most of these conditions are on my website.