There are many conditions that produce weakness and can lead to knuckling or dragging of the front and hind paws and limbs. Conditions that can affect the hind legs include degenerative myelopathy (DM), sciatic nerve injury, disc disease, and spinal cord injury. Brachial plexus and radial nerve injuries can cause front paw knuckling or limb dragging. A fibrocartilaginous embolism (FCE) can affect either or both the front and hind legs and paws.
Regardless of the condition that led to knuckling, it is important to remember the following when considering what device or aid is best for your pet:
- Make sure the device is lightweight - these pets are already having trouble getting around. Even a light bootie can feel very heavy and actually make them knuckle or drag more.
- It should be assistive - meaning it helps the dog to properly position the paw or bring the leg forward to help them walk.
- Always use a harness - a harness is a "must-have" because these dogs often need help getting up, standing, and/or walking. Scrap the collar and opt for a comfortable, lightweight, padded harness. The more you are able to support your dog and help them stand and walk, the less they have to struggle to move their legs and the less they will knuckle or drag.
- Pets wearing an anti-dragging device should be supervised at all times - even though your pet may be able to move around better with an assistive device, many devices include straps and fasteners that can get tangled or caught, and may even trip the pet.
- Choose the device that provides the right amount of help for the pet - if your pet only slightly knuckles or scuffs, use a device that provides a little assistance and protection for the nails or digits. Remember, these pets need to keep up their strength so applying a device that does most of the work for them actually does them a disservice.
- Keep in mind that more than one device may be best - for example, your dog may feel very energetic in the morning and might only need a little help walking. As the day continues, your dog may become tired and need extra help, at which point you may want to switch to a device that provides more assistance.
Devices and aids to reduce knuckling
For Hind Paws
The No-Knuckling Training Sock reduces knuckling of the toes. It is meant for short-term use (a few minutes at a time). Dogs should be strong enough to flex the knee and bring the hip/leg forward. This device is ultralight and the toes are not covered, which is an advantage because dogs can then "feel" the ground when they are walking and the paw pads can breathe. Dogs sweat through their paw pads and keeping them covered for periods of long time can lead to overheating and skin breakdown.
||The No Knuckling Training Sock does not cover the paw so the dog can still feel the ground and receive the necessary sensory stimulation when walking|
The Toe-Up Sciatic Sling reduces knuckling of the toes. It is similar to No-Knuckling Training Sock and allows the paw to remain uncovered. It's only meant to be worn for short periods, and make sure you check the web spaces between their digits for rubbing. For best results, use this device if your dog is strong enough to flex their knee and bring the hip/leg forward.
The Hindlimb Dorsi-Flex Assist reduces knuckling of the toes and helps to flex the ankle. This is a good alternative to the above devices if your dog is knuckling more than 50% of the time when walking. It has a boot component so the dog cannot feel the ground but it does protect the nails and toes from injury. Again, this device should only be used with dogs that are strong enough to flex the knee and bring the hip/leg forward. It is a prescription product and must be ordered by a veterinarian or physical therapist. Custom-made versions are available and have been fashioned for all kinds of pets, from guinea pigs to llamas, and even a kangaroo!
The Canine Mobility Anti-Knuckling Device is used for dogs that have trouble bringing their whole hind leg(s) forward during walking. It is a useful device for dogs that are struggling a bit more and who have weakness throughout their hind legs (including knees and/or hips). The paws remain uncovered and a nylon strap is applied in a figure "8" fashion around the toes and ankle (see diagram below).
The Biko Progressive Resistance Bands are for dogs that have trouble bringing both whole hind legs forward - so dogs with weakness throughout the hind legs. The paws remain uncovered - the ankle cuffs are attached to a harness using the elastic resistance bands. The resistance bands offer varied degrees of tension and can be easily swapped out depending on how much help the dog needs with moving their legs (see image below).
For Front Paws
Unfortunately, there are not as many options for dogs who knuckle or drag their front paw(s).
The No-Knuckling Training Sock - reduces knuckling of the front toes and is meant for short-term use. Dogs should be strong enough to extend the elbow and bring the leg forward. As with the hind paw Training Sock, this device is ultralight, and the toes remain uncovered so that the dog can feel the ground.
The Forelimb Dorsi-Flex Assist reduces knuckling of the toes and helps to extend the wrist. Because it is a prescription item, it can be customized for your pet. If your pet needs some light assistance to reduce scuffing, it can be made in a lightweight fashion, and in sizes small enough to fit a kitten. Conversely, it can be fabricated in a heavy-duty manner to fit even giant breed dogs.
||The Forelimb Dorsi-Flex Assist has a supportive cuff for the wrist and elastic toe straps that can be pulled tighter for dogs that need more help to prevent knuckling|
For pets who are unable to use their front leg in a functional manner (e.g., dragging the leg), you may want to start with a hard plastic splint and continue through rehab to determine how much function the leg can regain before deciding what device to choose.
Which one is best for your pet
To figure out what device is best for your pet, you must determine their current ability / level of function as well as their prognosis. Does your pet have an injury or condition but is currently in a rehabilitation program and expected to improve in time? Or is this a progressive condition where the pet will gradually become weaker? For pets who are improving, you may be able to get away with a device that is less "assistive". For pets with a progressive condition, like DM, then you may want a device that provides more "assistance" and that can possibly be modified to increase assistance if the pet needs more help down the road.
If unsure whether a device will provide enough help for the pet or to see if a device would even be useful or tolerated by the pet, a veterinary professional can create a rough replica of the device in the clinic to see what would work best. Many devices can be mocked-up directly in the clinic with readily-available materials. For instance, in a dog with limited hind leg function and a knuckling gait, you may not know whether to order a Hindlimb Dorsi-Flex Assist (that helps reduce knuckling and flex the ankle) or the Biko Progressive Resistance Bands (that help to bring the whole hindlimb forward). Both of these devices can be mocked-up in the veterinary clinic using cohesive bandage and elastic tubing (see image below). Taking the time to roughly duplicate a device will ensure that you order the most effective support or assist is ordered for the pet.
There are variations and modifications to the above devices - contact your veterinary rehab professional for more information.
Author: Ilaria Borghese
A Vital Vet Publication