Knuckling in Dogs: What It Means and When to See a Neurologist | Southeast Veterinary Neurology

Knuckling in dogs occurs when the paw curls under, so that the top of the paw (instead of the pad) touches the ground while standing or walking. Dogs are often unaware that the paw isn’t in the right position, but even if your dog isn’t acting painful, paw knuckling is not normal. In fact, it’s a sign that the brain, spinal cord, or nerves aren’t working properly and is commonly associated with neurological disorders.

What Does Knuckling in Dogs Look Like?

The most obvious sign of knuckling in dogs is when the paw turns over and drags along the ground. Early signs may look like a slight curling of the toes, but in more severe cases, the entire paw flips over, leading to scraping of the nails or even wounds on the top of the foot.

Knuckling can affect the front or back paws, and it can affect multiple paws or just one. It may be constant, or it may come and go - for example, worsening after increased activity.

Here are some signs it’s time to consult a veterinary neurologist:

• Paw curling under
• Dragging paws on the ground as they walk
• Weakness or incoordination in the legs
• Frequent stumbling or difficulty standing
• Less active or reluctant to go on walks

Causes of Knuckling in Dogs

Paw knuckling is a typical sign of an underlying neurological issue. It indicates a disruption in communication between the brain and the limb - either the brain is sending signals that aren’t reaching the paw, or the limb is sending sensory information that isn’t making it back to the brain. This breakdown can result from problems in the brain, nerves, or most frequently, the spinal cord.

Common causes of knuckling in dogs include:

• Brain Disease such as brain tumors, inflammation (meningitis), strokes, and congenital malformations
• Peripheral Nerve Disease such as nerve tumors, inflammation (neuritis), traumatic injuries, degenerative conditions, and metabolic conditions that can affect the nerves like diabetes
• Spinal Cord Disease such as IVDD, spinal cord tumors, inflammation (myelitis), traumatic injuries, infections, spinal cord strokes (FCE), congenital malformations, and degenerative conditions like degenerative myelopathy

How Vets Diagnose Knuckling in Dogs

The simplest test for knuckling in dogs is the proprioception test. Your vet will gently place your dog’s paw upside down so that the top of the paw touches the ground. In a healthy dog, the paw should immediately flip back to a normal position. But if your dog leaves the paw flipped over, or seems slow to correct it, this is a sign of a neurological problem.If your dog shows signs of knuckling, a neurologist may recommend the following:

• Physical: The diagnostic process typically begins with a full-body examination to check your dog’s general health and to look for any physical injuries or outward signs that may point to a neurological problem.
• Neurological Exam: Your neurologist will then perform specific tests to evaluate how well your dog’s nervous system is functioning. This includes checking things like balance, cranial nerve function, spatial awareness, and reflex responses to help locate where the issue may be occurring.
• Advanced Diagnostics: Advanced diagnostic tools like MRI and a cerebrospinal fluid analysis can provide detailed images of your dog’s brain and spine to identify any lesions and evaluate for evidence of inflammation.
• Labs: Bloodwork may also be run to screen for systemic diseases or infections that could be affecting your dog’s nervous system.

Treatment Options for Knuckling in Dogs

Treatment for knuckling in dogs depends on the underlying cause, but early intervention typically improves outcomes, especially if the issue involves the spinal cord.

Common treatment options include:

• Physical Rehabilitation: Exercises to strengthen muscles and improve coordination are often essential no matter the diagnosis. Rehab may also include laser therapy, underwater treadmill work, or assisted walking devices to help with recovery.
• Medication: Anti-inflammatory drugs, pain relief medications, or drugs that support nerve function may be prescribed, depending on the diagnosis.
• Surgery: In cases where something is physically pressing on the spinal cord, surgical intervention may be needed to relieve pressure and restore function.

With the right diagnosis and treatment, many dogs will improve - often dramatically. But the key is catching it early and getting the right help.

What Can You Do If Your Dog Is Knuckling?

Knuckling in dogs, even just now and then, isn’t something to ignore. It might seem like a subtle change in your dog’s walk, but it often points to a significant neurological issue that may worsen without treatment. If you’re seeing signs of paw knuckling in your dog, or you’re just unsure what you’re seeing, don’t wait to seek help. Early action can make all the difference in many neurological cases.

As specialists in veterinary neurology, Southeast Veterinary Neurology is here to help you uncover the cause and build a treatment plan tailored to your dog’s specific needs. Reach out to one of our locations today in Miami, Boynton Beach, Jupiter, or Virginia Beach.