Lameness in dogs

The following are real life cases of Lameness in Dogs that have been treated by Dr. Mike Richards, DVM.

Intermittent Limping
Limping and Possible Lyme Disease
Diagnosing limping
Limping in Rottweiler
Lameness in German Shorthair Puppy
Lameness and loss of energy
Using Vitamins to Treat Lameness
Lameness is not responding to medication
Lameness and fleas
Bicepital Tendon Bursitis
Lameness in Greyhound

Intermittent Limping

Question:

We are stumped as to what might be wrong with our dog`s (Bonnie`s) right rear leg. She started limping one day after chasing a rabbit in a field. After about 4 or 5 days she seemed to be doing OK. She then went hiking (about 9 miles) with my husband and ran around a lot and played with other dogs. Then that night we noticed her limp, but only for a few steps after she would get up from lying down for a long period of time. She also seemed to have limping problems on very stony paths. After she didn`t get much better for a week, we took her to her regular vet who thought she had a torn cranial cruciate ligament. We were surprised, since she still seemed able to run around (in grass) without any pain. We then took her to a specialist for her to be evaluated for the TPLO surgery.

The specialist was very thorough and found that she had an infection between two of her toes (on her right rear leg). The drawer test for the CCL was negative. Her x-rays showed no arthritis in her hips, knees, or feet. (Bonnie is 5 1/2 years old and a mix between an Australian Shepard and a terrrier.) Her x-rays did show signs of a slightly swollen toe on the infected paw, and they also showed a very very small amount of fluid on her right rear stifle joint, which the vet drew. However the lab analyzed the fluid and found it to be "normal". The specialist excised the infected area between her toes, but could not find any seed or sticker that might have caused the infection. He bandaged her paw, and Bonnie also took a course of antibiotics for 10 days.

Bonnie didn`t limp the entire week that she had her bandage on her paw, and she didn`t limp for about a week afterward. We started taking her on gradually longer walks. Unfortunately, one day I saw her step on a large stone with her bad leg. Immediately afterwards, she froze and looked scared. I comforted her, and then Bonnie went trotting off and started running again. She seemed to be just fine. However, that night she was back to limping for her first 5 or 6 steps after arising from lying down. After this initial "warm-up" period, she seemed to be fine and would want to run around or play.

It`s now about two weeks later after very restricted activity. Most of the time, she seems just fine and will want to run and pull on her leash. She never limps once she is up and active. She even seems to be less frequently limping for the first five steps after rising. However, every once in a while I`ll still notice her limp after she has been lying down for a while, particularly if she is outside where it`s now a little cooler.

So.... after this long story, what do you think might be causing her to limp only for a few steps after rising? She will then seem completely normal once she is moving and warmed up. Do you think it might still be a problem with her paw and the previous infection? Could she have a pulled muscle? - If she stretches her hind legs right after she rises, she doesn`t really seem to limp on her first five steps. Or could she actually have a problem with her CCL?

Answer:

In our practice we always check for interdigital pyoderma (infection between the toes) as a possible cause of lameness. We have a very high rate of allergies in our area and this often leads to itchiness of the feet, which eventually leads to infections. When the infections are located between the toes they are referred to as interdigital pyoderma. Even relatively minor infections can cause lameness and severe infections will often cause dogs to carry the affected foot, unless more than one foot is involved. So this is a strong consideration with a history of infection in this region.

Cranial cruciate ligament problems can be a long degenerative process and there are dogs who have intermittent lameness for a long time prior to the time that the ligament ruptures and a drawer movement can be detected. So I wouldn`t want to rule out the possibility that the cruciate ligament is responsible fro the lameness, even though it is not possible to confirm that problem at the present time.

There are a few dogs who injure the cartilage in the knee without damaging the ligaments. This can lead to lameness and it is often intermittent or is present in the first few minutes of using the knee but then gradually gets better with use. This problem is very hard to detect except with MRI examination or surgical exploration of the knee. I don`t think that I would want to do surgery for a problem that isn`t causing too much pain and you may or may not have access to MRI scanning and the financial means to pursue that option.

Dogs do get joint sprains and muscle, tendon or ligament strains. In addition, there are dogs who have spinal disc problems or cauda equina syndrome (pressure on the nerve roots) who are only sore in the first few steps they take.

I`d look carefully for a recurrence of the interdigital pyoderma/infection. If that isn`t present then you have to figure out how hard to pursue a diagnosis. If you want to go all out, MRI examination of the knee and back are reasonable options but if you want to be patient and see what happens that is a justifiable option, as well. Early stifle (knee) injuries might respond to administration of glucosamine and chondroitin products, such as Cosequin (tm).

There are a fair number of dogs with minor limping on a regular basis in our practice that we can`t make a definite diagnosis for. Usually, if the lameness becomes severe again it is possible to make a diagnosis at that time.

Check out more of the causes and treatments for Dog limping

Question:

We recently adopted a 5 yr old mixed Newfoundland X Chow/Lab, 71-72 lbs, male neutered, total sweetie, loves to go on long walks and chases anything that moves. Gradual increase in left rear paw limp over 2-3 weeks, then it stabilized but has not improved from that point over at least a week. Limp is worst when he gets up after resting. Holds the paw off the ground when first getting up, "toes" on that paw when walking and comes down more on the opposite rear paw - when trotting has only slight limp. Initially I thought he was limping on Rt front paw but husband and vet both think that was because of the way a left rear paw injury would affect gait.

No clear start to the limping (ie no clear injury). Thought he had a fever one night (hot nose) but was afebrile at the vet`s the next day. This is the dog with the odd flesh-colored tick 2 months ago and Lyme is endemic here but vet thinks it`s very unlikely since there is only one limb involved and no documented fever. Dog is reluctant to get up but otherwise acts normal, sleeps/ eats well. Exam at the vet - no evidence of pain anywhere (ie no flinching, whining or yelping). X-ray was clear (I assume of knee joint - don`t know if they looked at foot - bending foot both ways does not produce any reaction from the dog. I know they were looking mainly for any evidence of osteosarcoma as we just lost another dog this way). Vet thinks that the knee was slightly swollen and that he probably has a knee injury such as a meniscus or anterior cruciate tear.

We are treating by decreasing walks from 2-3 miles/ walk to about 1/2 mi and not otherwise exercising him (ie no ball-playing, etc). Vet recommended ASA but we haven`t tried it yet (I know you don`t feel pain medication increases chance of dog overdoing it and re-injury but I don`t quite trust the dog not go after a squirril or something). Vet is looking into an orthopedic referral, at least for evaluation.

Our questions:

1. Would meniscus or ligament tears produce swelling? Or, put another way, are other things more likely to cause swelling? (this is VERY mild swelling, ie vet thinks there _might_ be swelling)
2. Should we be pursuing the Lyme question more aggressively? Could Lyme cause arthritis which migrates from 1 limb to another over a couple of weeks? Or could left rear limb injury look like right front limping before it got bad enough for him to hold the paw off the ground when getting up?
3. I know you write about undiagnosed sesamoid fracture as a cause of limping - does this sound like a possiblity?
4. He has a rear-feet-close-together rolling gait when walking slowly which straightens out when he trots - could hip dysplasia produce these symptoms?
5. Can an injury appear to come on gradually and get worse rather than suddenly appear and then get better with time?
6. I know in humans the next step for a suspected knee injury would be MRI and possibly arthroscopy if indicated - what happens in dogs? Is knee surgery open or arthroscopic? How are they kept from re-injuring the knee while it heals? For how long? And what sort of $$ (ballpark) is this likely to cost if that`s what it is?

Answer:

Question:

I have a 9 yr. old Border Collie (Ben) with limping in front legs, especially after he`s been laying down. He has been on Synovicre MSM for 3 weeks and is half way through an 8 injections Adequan treatment. We are also trying to limit his exercise to easy walks. Unfortunately, he is one of 4 dogs and now that he has no sheep or cows to herd, he insists on herding one of the dogs. Question: If the Adequan does not work, what diagnostic tools such as Xray or ultrasound can help pinpoint whether this is, indeed, arthristis in the ankle joint? He has had 2 tests in the past 2 years for tick-born diseases. Should we test for that again. He has always received Frontline monthly and now also wears a Preventic collar. I am willing to consider trying acupuncture. But I think that maybe we need to rule out any other causes to the limping.

Answer:

X-rays are usually sufficient to diagnose changes in bone, such as osteoarthritis. They can often help with the diagnosis of soft tissue problems due to visible changes such as swelling in joints, but rarely is it possible to be sure of a soft tissue injury with X-rays alone. The odds of this problem being osteoarthritis are really high, though. So I would start with X-rays and then look for other problems if nothing shows up on the X-rays. If the X-rays don`t show a problem but there is joint soreness or joint swelling that seem obvious on clinical exam, it might be a good idea to have a joint tap done, in which a small amount of fluid is drawn from the joint and analyzed to determine if there is inflammation or infection in the joint. Checking for lymph node enlargement and fever can help to rule out the tick borne diseases (Lyme, ehrlichiosis, Rocky Mountain spotted fever, as can serum titer tests. The incidence of Lyme disease and ehrlichiosis varies widely from one locality to another. Your vet should have an idea how commonly these diseases are a problem in your area. In my area the incidence is low enough that we don`t worry too much about tick borne disease but we do try keep them in mind. In other areas of the country these diseases are really common. You are taking good tick control measures so that should help.

A number of our patients are on chondoitin/glucose combinations, which seem to benefit many of them. Essential fatty acid supplement might help if there is arthritis and Vitamin E is sometime reported to be helpful, too. Acupuncture might be helpful for the chronic pain and there are good medications for arthritis. I still like aspirin. Carprofen (Rimadyl Rx) and etodolac (Etogesic Rx) are good when aspirin isn`t potent enough. We use hydrocodone, codeine and occasionally morphine in combination with these medications when it seems necessary. Some vets are experimenting with tri-cyclic antidepressants for use in dogs with chronic pain since these are helpful in people.

You are correct that finding a diagnosis would be a good idea and it is worth taking X-rays and doing other testing to try to be sure of the diagnosis. If this is osteoarthritis in one or both elbows it will be chronically painful and continued efforts at pain relief should be attempted, until you find something that will make your border collie comfortable.

Question:

We purchased a German Shorthair Puppy in March. She is now almost five months old and for the past 2-3 weeks she has been limping on the right front leg. We can`t see any swelling or abnormality. She doesn`t mind us manipulating it or touching it. It seems to be getting worse as time goes on. She hasn`t injured it as far as we know. She weighs about thirty pounds and we feed her Iams Large Breed Puppy Food. She wasn`t limping when we brought her for her last puppy shots 3 weeks ago. She has an appointment Sat. for shots, should I wait until then or should I bring her before? She is even limping after rest . I appreciate any info you may have, you were very informative when I wrote to you about our dog Buck. We really miss him and loved the breed so much we just had to have another. Sincerely, JoAnne

Answer:

A lameness that persists for two to three weeks in a puppy this age does call for an examination. If nothing can be found on a physical examination, it is hard to decide whether to pursue X-rays in order to rule out things like elbow dysplasia and osteochondrosis dissecans (OCD) but I think it is better to go ahead and take these as long as anesthesia is not necessary in order to get them. If anesthesia is necessary, then I tend to be a little more conservative, as long as the lameness isn`t progressive. In your puppy`s case, it sounds like the lameness is progressive, though.

Your vet can help you decide the necessity for diagnostic procedures. Hopefully, in the time it has taken me to reply the situation has improved. If the physical exam findings were normal and X-rays showed no problems, it might be necessary to consider doing arthrocentesis (withdrawing fluid from one or more joints) to be sure that there isn`t an immune mediated disease, joint inflammation from other causes or even joint infection. Usually there would be some swelling associated with these conditions but not always.

Question:

My male sheltie is nine years old and up to a year ago was very active, in fact crazy always playing, running and having a great time. He was walked twice a day for 1 hour or more depending on the weather. Now for the past year he has seemed to lost his energy. He still has small spurts but can`t seem to keep up even for 20 mins. Of course I had him in to the vets constantly saying I knew that something just wasn`t right and he was checked over thoroughly with no apparent problem showing up. Then just before Dec 96, one evening he went to get up and his hind legs wouldn`t hold him and he kind of dragged himself. It was very frightening. So back in to the vets and another check up. There the vet thought he might have a testical tumor, so we immediately had him neutured. (She didn`t think this was the problem) At that time a full set of spinal x-rays was taken. There was no tumor and the vet said she was looking for some kind of degenerate disease of the spine and was relieved to see none and no arthritis. She determined that it may be a pinched nerve and sent us home with robaxacet. This seems to pick my sheltie right up, but he is still having the episodes of lameness. And he has never regained his old energy. I realize he is older but I sense not is all right and wondered if you have any suggestions, even another area that my vet could check. I take him in everytime that he is having problems and she stands him up and puts each foot on the tiptoe to see how he responds and everything seems fine to her. Of course she hasn`t seen him in a real episode of lameness as he always seems better the next day. Also I might mention that he does have periods of stiffness after laying down for awhile. What about treating with a low dose of aspirin on a daily basis? Thank you for your time. This is a wonderful site!!! And I did go through everything I could to see if this was addressed before. I was worried about dysplasia but would this not of shown up on the xrays?

Answer:

Hip dysplasia should show up on the X-rays if it is present and his hips were included in the area examined radiographically. That is the easy part of your letter to answer.

There are many things that could lead to the loss of energy and general lethargy. I would worry about heart disease, endocrine problems like Cushing`s disease, arthritis, organ system failures and problems like that for non-specific lethargy. The neurologic signs you reported make spinal problems more likely, as you are aware. If further signs of this develop, an MRI or myelogram might be worthwhile. Sometimes problems which affect the spinal cord itself, such as blood clots or cancer, will show up better on these tests than on plain X-rays. Basically, there are just a lot of possibilities and you will need to keep working with your vet to figure out what is going on. Your vet may wish to refer you to a specialist in internal medicine or neurology if the no specific problems can be found. It may not help but it is worth a try.

Click here for more on Hip Dysplasia and Cushing`s Disease

Question:

I have a 6 month old Rotti - I have been feeding her Science Diet for Large Breed Puppies. Literature tells me it is not necessary to give vitamin supplements as this will cancel out the benefits of this food. However - during this latest "spurt" of growth I have noticed she appears to have a problem with lameness in one hip. Should I include vitamins in her diet and would 500 u. of vit C do any harm to her? When my 10 yr. Boxer developed hip problems I gave her the C and the results were remarkable. Thanks for any thoughts on this.

Answer:

There really is no need to supplement your Rotti`s diet with vitamins while you are feeding her a good dog food. The most common cause of lameness in young, growing large breed dogs (if rough playing can be ruled out) is panosteitis or inflammation of the long bones during growth. The most common clinical signs is periodic shifting lameness. Other causes can be OCD (osteochondritis dissicans) - a cartilage flap within the joint capsule (most commonly in the shoulder joints but can be in any joint) caused by the incomplete formation of bone from cartilage. Also, hip dysplasia in any large breed dog is a possibility although six mos. is a little young for clinical signs but I have seen puppies this age with clinical and radiographic signs of hip dysplasia. If the lameness does not improve or gets worse, I would take her to your regular veterinarian for an exam and possible xrays.

Question:

I have a 5 year old pit/lab mix about 45 lb. who suddenly started dragging/lifting her left rear leg. At first it was only after long runs followed by a nap, then the it was after all naps, (maybe for an hour or so after) but now it`s almost all time except for merely standing. I took her to the vet when she was first displaying symptoms and he made a quick, rather superficial determination (no xrays taken) that it is arthritis, and that it is degenerative. He said I could give her buffered aspirin 3 times a week, and he also prescribed prednisone, which I`m leery of because frankly, the side effects of the same drug killed my mother. But when my dog seemed to get worse, I started the aspirin, then the predinisone, and see little, if any effect. I`m about to get a second opinion, but then I found you. Questions: Is this a reasonable diagnosis since by dog`s so young, so fit, so otherwise healthy, and exercised regularly but not usually to extreme? Can arthritis come on so quickly and deteriorate so quickly as well? (this is only over the past 2 MONTHS!). Any other possible diagnosis considering the symptoms? (I`m pretty sure it`s not foot or knee, and vet seemed to rule out dysplasia). He said it would get progressively worse, but I thought he implied 5 or 6 years from now, not a month later! Is this just the way it`s going to be for her for the rest of her life? I am open to nutritional or "alternative" relievers as well. She has eaten Nutro Max all her life, and the only drug she takes is Heartguard.

Answer:

Video: Lameness in Young Dogs :OCD

You either need to get a second opinion from another vet or you need to tell your vet you want to know what is wrong. In a dog this young it is best to confirm arthritis, especially when it is not responsive to medications. I strongly suspect a cruciate ligament injury or possibly even a luxating patella based on your description of the lameness but those things can only be confirmed on examination. It generally takes an examination under heavy sedation or general anesthesia to be able to definitely rule out cruciate ligament injuries. One way of getting an expert second opinion would be to request a referral to a board certified veterinary surgeon with an interest in orthopedics.

Question:

I rescued an abandoned male Staffordshire Terrier mix (Pit and Boxer mix, we think)about 8 years ago. He has been quite healthy until recently, developing lameness in his right rear leg with no apparent signs of infection or tramua. His hip joints appear normal, although he seems have lost some weight as well as his overall muscle tone. Normally , at his last Vet visit Buck`s weght was 90 lbs and solid as a rock. I would guess that he has lost 10lb. I have looked through your pages which have given me great information, but far reaching for an uneducated guess to my pets ailment. which onset of the lameness occured after having fleas. Currently I am making an appointment for him to see the Vet, although your opnion on-line would be appreciated to help with my concern. Thank you.

Answer:

Although it is impossible to tell you what might be wrong without an examination, the most common cause of persistent lameness in one rear leg in middle aged and geriatric dogs in my practice is degeneration of the cranial cruciate ligaments. This is more common in overweight dogs and the weight loss would be helpful if it isn`t from a dire illness. Curiously, there is a connection between flea infestation and the incidence of cruciate ligament injury, in my opinion -- just based on the histories clients give me. I really wonder if the persistent scratching while standing on just one leg contributes to this problem. It could just be my imagination, though. We have not kept careful statistics on this.

Question:

Video: Basset hound dog presenting sudden onset of lameness in both hind legs

I have determined that the problem is in the dog`s shoulder area. The top portion of her leg, approximately @ the shoulder joint is very sensitive. There also seems to be knotted or swollen portion. Are we still talking arthritis? My vet basically gave me the same advice as you did, although I have considered seeing an orthopedic specialist if nothing changes by Monday. Would that be pemature? Thanks for your previous reply.

Answer:

It is possible that your dog may have bicepital tendon bursitis. That would cause lameness and pain in the shoulder region. This tendon is normally pretty painful when directly palpated if that is the problem. Your vet will know how to locate this tendon and see if it may be the problem. It is also possible that there is an arthritic problem in the shoulder joint or referred pain from somewhere else. If you are concerned and wish to seek a second opinion, I see no reason not to do that, especially since you are going to a specialist. It would make sense to call your vet and discuss where you think the pain is and consider a recheck with your usual vet since you feel you can localize the pain. That helps a lot in narrowing down the diagnostic workup necessary to confirm what is going on. It is often a lot easier to make a diagnosis on a second visit when the problem has had time to develop a little.

Find out more about Bursitis

Lameness in Greyhound

Question:

We are very worried about our Lab/Greyhound Mix, Chance. Chance is about 10 years old (we rescued him as full-grown) and lately has been having severe problems with his rear legs. When we first got him in Key West, FL, we noticed that he walked a bit funny (sort of a sideways lope) and when he ran or played for a long period of time, he would often limp, usually in the rear legs. When the Vet checked him out, he didn`t think it was a major problem, and it wasn`t until recently. About a year ago, Chance started limping after a long run, and it continued for over a week. We took him in and had his lame leg x-rayed and the Vet said that he had very little cartilage in his joint areas in that leg. He did not suggest any action at the time, and the dog eventually began walking "normal" again. About a month ago, he began limping again, this time it was the other leg. His limping continued for several weeks and did not seem to be getting any better. We took him to yet another Vet and asked him to check for artheritis. The Vet did not seem to think that artheritis was present when he examined Chance but he suspected the problem was in his hips. He prescribed a "Perna Canaliculus Mussel" medication as well as Rimadyl. It is now three weeks later and Chance is not getting better, he is getting progressively worse. He rarely uses the bad leg at all when he walks, he has trouble standing and sitting, and His bad leg is noticably loosing all muscle tone. The medicine does not seem to have any effect at all. He does not seem to be in noticable pain, but we are worried nonetheless. Unfortunately, due to our living situation, stairs are a part of Chance`s life (and he is too large to carry). Is there anything (or anyone) you could suggest? We love him very much and really want to help him.

Answer:

It is not possible to diagnose a cause of limping over the computer. This is just something that has to be done in a "hands on" manner. It is possible to tell you that it seems likely that the true cause of Chance`s problems has not been discovered yet, based on the response to treatment -- or that different treatment for the diagnosis made is necessary. In either case, it is necessary to talk with one of your vets again and ask for a further work-up of Chance`s condition. It is often easier to diagnose an orthopedic condition on follow-up visits when more typical signs of a problem may be present or progression of the disease produces symptoms that are more clearly diagnostic. If your vet feels that it is necessary or if there continues to be no response to treatment, asking for referral to a veterinary orthopedic surgeon or a veterinary neurologist may be in order. I can`t tell if you are still in Florida but the veterinary school there will have both of these specialists on staff if referral is necessary.

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