Tuesday, September 16, 2014

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

by  Krista Magnifico, DVM

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.

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?

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 dog who presents for "lameness."

When I am trying to determine the cause of a limp or lameness I always start with watching the dog 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 dog on the floor and calmly walk over to me as they coax the dog to follow. The dog 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.
I corrected his cruciate rupture a week ago, on the other side.
Time for this one to be done is now ASAP.
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 dog. 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 dog in innumerable ways. When a client calls me at 10  pm wondering whether their dog 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 dog walking, I warn the parent that I am probably going to have to muzzle their dog. 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 dog 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 dog 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 dog 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 dog is trying to tell you something.
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'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 dogs 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.

My point is that limping dogs 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 dogs can be treated quickly, easily, and alleviated of their discomfort.

Most limping dogs are not an emergency. 

But the identification of the root cause, and a plan to assist the dog 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 dog 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, concerns, or just want to share your pet knowledge with our pet enthusiasts please visit Pawbly.com. We are a free pet community with a big heart.

***

Krista Magnifico, DVM owns a small animal hospital in northern Maryland, where she practices everyday. She wants to make quality veterinary care available to everyone, everywhere at any time; trying to save the world 1 wet nose @ a time.  Her blog is a diary of he day-to-day life & the animals and people she meets. 

Dr. Krista is also the founder of pawbly.com, free pet advice and assistance.

To contact her, you may leave a comment on her blog, email her or catch her on Twitter or Facebook.

Articles by Dr. Magnifico:
Don't Make This Mistake: Ruby's Death To Heat Stroke 
Parvo: Cora's Story 
Jake's Laryngeal Paralysis
The Tip Of The Iceberg: The Unexpected Dental Dilemma
The Ear Ache That Wasn't Going Away: Tottsie's Story
Cody's Eyelid Tumor
Ruger's Mysterious Illness
The Day The Heart Stood Still: Timber's Story 
Different Definition Of Comfort Food: Levi's Story 
Savannah's Pancreatitis  
Histiocytoma: Rio's Mysterious Bump
Von Willebrand's Disease: Greta's Story 
Alice's Heart Murmur  
Jekyll Loses His Tail Mo-Jo 
Pale Gums Are An Emergency: Bailey's Story 
To Amputate Or Not To Amputate: Heidi's Story
Lessons From A Real-Life Veterinarian 
Charlie's Life Saving Lipoma Surgery  

Related articles:
Symptoms To Watch For In Your Dog: What Is That Limp?
Common Misdiagnoses (Part 2) 


Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!

9 comments

  1. This is a really helpful post. Thank you. Rodrigo is our dog with paw issues. He's always stepping on something, but he comes to me and lifts his paw for help. I've gotten used to examining his paws weekly.

    ReplyDelete
    Replies
    1. It's great when they learn to communicate where the problem is.

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  2. One of the dogs I take running regularly started limping today, very unusual for her. Normally if this happens with the dogs I know, it's because there is a thorn in their paw and I can usually just pull it out. Today, I couldn't see anything in Nina's paw and didn't notice anything different as far as color or tenderness, but I still took her home. She did not want to put any weight on that paw, and she kept trying to bite and lick it. Luckily, her owner was home and will take her to the vet if necessary.

    You just never know what the cause is!

    ReplyDelete
  3. Hi! I need help. I came to this post thru google... my dog currently has paws irritated and brown nails. Exactly like the picture you have here from the dog with allergies. I have tried so many treatments to help her allergies i was wondering if you could suggest something for us to try. Nothing seems to work on her long term.

    ReplyDelete
    Replies
    1. Brown nails - what color are they normally supposed to be? If skin AND nails changed color I'd suspect something beyond allergies. Possibly fungal infection, whether primary or secondary.

      Delete
    2. Her paws are identical to the ones posted here for Ellie Mae.

      Delete
    3. What about the nails? Are they the color they're supposed to be or did they change color?

      Either way you should work with your vet. If it is "just" allergies, then rinsing feet after every time outside, potentially using socks or booties, as well as supplements helps.

      If it is fungal, though, that it needs to be treated.

      Delete
    4. Her nails are not as brown like that. I was looking for alternatives because our vet just wants us to have her get cortisone shots every month. I have read alot of terrible things and dont think thats agood idea. We have tried changing her diet and i give her greek yogurt with apple cider vinegar everyday to help but nothing seems to really work.

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    5. I agree regarding the steroids. While very useful for severe cases, for me only Hail Mary solution.

      The earlier recommendations still stand. Rinsing feet after every time outside. Plenty of rinsing. Betadine solution will rinse as well as help protecting from infections. Dry well. Or add a bit of rubbing alcohol to the solution, helps it dry faster.

      Omega-3 fatty acids if not using yet. Probiotics. Quercetin. Try looking up an integrative vet in your area. Also look into immunotherapy.

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