Puppy knuckling is when a puppy’s feet appear crooked or bowed out. It often happens due to various factors, including incorrect nutrition, genetics, and care. Some information available about puppy knuckling is outdated, confusing, or misleading. We get it!
Rather than boring you with science and research data, I will lay this out in a quick-start guide-type format. It’s 2024, and we have new information about how to prevent knuckling in puppies and how to treat it, too!
Read on if you have a large or giant breed puppy, such as a Great Dane, showing signs of puppy knuckling.
Signs of Puppy Knuckling and “Bowing Out”
Your puppy may be knuckling over if you see the following signs:
Flat or weak feet
Turned out feet (which may also be genetic)
An ankle that bows over the foot
Ankles that shake or roll over the foot on soft surfaces
Feet and limbs that don’t look right
In the image below, you will see three puppies experiencing knuckling, from severe to mild. Mild knuckling in puppies can become severe or even permanent if left untreated.
How to Treat Puppy Knuckling
Here is our easy 3-step guide for treating puppy knuckling!
STEP ONE – SEE YOUR VETERINARIAN
STEP TWO – CHANGE YOUR FOOD
STEP THREE – CHANGE YOUR ROUTINE
Step One – See Your Veterinarian
Veterinarians attend school for many years to learn about companion animal health and wellness. They see hundreds of dogs weekly in a clinical setting and will know much more about the current science and research than any other resource you may find.
Many veterinarians are highly experienced in large and giant breed dogs and will give you the best advice.
Not only that, but if your puppy has crooked feet, your veterinarian needs to rule out other health conditions that may be similar or that may be contributing to growth disorders in your puppy:
Forget everything you hear in breed groups and from pet owners. An alarming amount of it is based on anecdotes, profit-driven marketing, and other nonsense. The correctly balanced puppy foods (listed below) are necessary to fix growth disorders.
Switch foods quickly. Do not add toppers or supplements, and keep training treats to a minimum. Getting your puppy onto 100% correctly balanced nutrition will be a key to success.
We dig deeper into the science with our posts linked below. But for this quick-start guide, here is a list of dog food to feed a knuckling puppy. These are readily available at Petsmart or on Chewy.com (which we’ve linked below for your convenience).
Check out THE GIANT DOG FOOD PROJECT to compare brands and values.
It is critically important that you do not overfeed your Great Dane puppy, especially if they are knuckling. Too much food is related to growth disorders. Encourage small, frequent meals.
Step Three – Change Your Routine
Large and giant breed puppies have delicate joints. Protect the soft cartilage and help your puppy strengthen their feet by avoiding hard, slick surfaces and encouraging movement on soft, varied terrain.
Here are some movement and exercise ideas for puppies that are knuckling or that have flat feet:
Explore a natural area with small rolling hills
Play in sand or gravel
Stand on couch cushions and gym mats
Sit on a grassy lawn or at a park and watch the world go by (also great for socialization)
Put runners and mats down on slick floors in your home. Discourage your puppy from jumping.
Trim nails weekly. We recommend a DREMEL. Keeping the nails short will help protect the joints and keep unnecessary pressure off of the toes.
If you’re thinking of adding a Great Dane puppy to your family, you’ll want to make sure you’re prepared for the challenge! Learning how to care for a Great Dane puppy is easy and fun, but you must know this: Great Danes are not like other dog breeds!
These dogs are big and powerful, and they need plenty of the right kind of nutrition, exercise, and training. Today I’m going to walk you through everything you need to know about taking care of a Great Dane puppy.
What do I Need to Know About Raising A Great Dane?
Proper Great Dane care requires a little bit of research. The great news here is that you’ve made it to this blog post!
Great Danes make incredible family pets. They are gentle, loving, and protective of their people. But before you bring one home, it’s important to understand what goes into taking care of a Great Dane.
Adding toppers and bribery will only serve to unbalance their diet and encourage ‘picky eating’.
At this time your pup will be moving into the second stage of growth (the time when a well-balanced large or giant formula puppy food will be the most important thing).
If you MUST use a harness, stay away from restrictive no-pull versions that can damage movement and orthopedic health. The “Easy-Walk” harness is a common example of a bad harness that should not be used.
When your pup is ready, we recommend modern e-collar training which is incredibly freeing, positive and fun!
There are a lot of inexpensive beds on Amazon that often go flat and fall apart quickly. These beds do not support Great Dane joints and will need to be replaced often.
When choosing what kibble to feed your Great Dane, there are a few guidelines to keep in mind.
The food should be formulated by an on-staff board-certified Veterinary Nutritionist, DACVN (call the company and confirm)
It should be backed by intensive feeding trials and peer-reviewed and published scientific research, proving that they are experts in kibble formulation and puppy growth
Is manufactured by an established and reputable company, using their own facilities, and are willing to issue recalls to keep your pet safe (“No Recalls” is a red flag!)
Many enthusiastic pet parents get excited to feed their large breed puppy and start adding all manner of supplements and toppers such as raw egg, rice, sardines, bone broth, freeze-dried toppings or goat’s milk.
This practice is both largely unnecessary and may be disruptive to the nutritional balance of the food. Goat’s milk, for example, causes gastro-distress. Too many eggs can cause a biotin deficiency. Too much rice can fill the dog up so much that they don’t get the right amino acids and nutrients from other sources.
Many commercial ‘toppers’ and food items encouraged in ‘build a better bowl’ type marketing campaigns are overpriced revenue-generating nonsense.
We recommend a loose free-feeding schedule until 12 weeks of age. The trick with this is to not allow your dog to scarf food or overeat; habits that can lead to serious health problems. Offer 3 meals/day but let your pup graze on the food (or use some for training) between meals as well. Monitor intake: overfeeding is dangerous!
After that, offer 3 schedule meals each day and take the food up after 20 minutes. Don’t offer more than your dog can finish in that time, and closely monitor body condition.
Topping meals with same-brand canned food can reduce bloat risk and make meals more appetizing, without causing nutritional imbalance.
At 8-12 months of age, you can transition to 2 meals per day.
Encourage slow, stress-free eating. I like Royal Canin Giant formula food because the kibble pieces are huge to encourage chewing.
If your dog is resource-guarding their food, stop sticking your hands in the bowl. This outdated training technique encourages stressed eating and may increase bloat risk.
NEVER feed one large meal each day, as this will increase your dog’s risk of getting BLOAT, a deadly and common life-threatening condition in large dogs. Smaller more frequent meals are best.
Great Dane Puppy Food Myths
Some people are still promoting the idea that Great Dane pups should never be fed puppy food and that the food must be low in protein.
Neither of these concepts is rooted in science. They are based on anecdotal evidence from a time when well-formulated puppy foods were NOT available to correctly support the growth of giant breed dogs.
15+ years ago, adult food was the safer choice, and low protein foods generally had better calcium and phosphorus ratios. It had nothing to do with the protein itself, though, at the time nobody knew that.
These ideas, at one time, justifiably made sense. Giant puppies grow extremely fast and over-nutrition is related to knuckling, HOD, panosteitis, and other orthopedic physical health and growth disorders.
By limiting the nutrition, breeders were able to effectively limit their run-ins with painful growth problems.
The choice to feed adult food was heavily promoted despite the fact that adult foods don’t have the complete nutrition that large breeds (including Great Danes) need to support muscle development, skin, and coat health.
A sacrifice had to be made to ensure that their bones didn’t grow too quickly.
Many teenager Danes (5-24 months) on ‘adult’ foods will overeat to try and get enough protein, fat, and calories.
This often results in chronic loose stools and a lanky body condition with very little muscle tone. I believe that most adult foods starve them of the nutrition they need to thrive.
The great news here is that it’s 2022 (or beyond!) and established dog food manufacturers have used science to graciously solve this problem for us. Dane puppies can now have research-backed puppy food AND still grow slowly so their joints develop properly.
As a matter of fact, board-certified Veterinary Nutritionists believe that Great Dane dogs should be on puppy food until 18-24 months of age.
Let’s put these large breed food myths to rest.
If you planon choosing a food that is not formulated by a board-certified Veterinary Nutritionist (common examples include Fromm, Diamond, Victor, Costco, and 4Health), it may be safer to choose the adult formula for your puppy.
These foods are not backed by dedicated growth and development research or qualified formulation professionals and aren’t ideal, to begin with.
Fromm – formulated by a chemical engineer
Victor – formulated by a guy with an online certificate in dairy cattle nutrition
Diamond / 4Health / Taste of the Wild / Costco / Nutranuggets – co-packed brands under the same parent company with canned recipes that may or may not have been looked over by an off-site consultant who has marginal credentials.
Purina – multiple board-certified veterinary nutritionists, M.S. and Ph.D. professionals with advanced degrees in animal nutrition, food science, and quality control are on staff to formulate and research the foods.
Royal Canin – over 400 professionals with top degrees in nutrition, veterinary nutrition, and nutrition science
Hill’s Science Diet – same as Purina & Royal Canin (see a pattern, yet?)
If you are interested in modern health and nutrition science and want high-quality food that was formulated by qualified professionals and then proven in feeding trials for the growth of big dogs, we recommend the following brands and formulas from Purina, Hill’s, Royal Canin, Eukanuba, and Iam’s.
Notice, all of these are large or giant formula puppy foods:
Keep the puppies until at least 8 weeks of age, no matter what
Support you as the buyer for life
A good breeder will not breed aggressive or timid dogs or dogs that carry common genetic linked disorders such as bloat, DCM, wobblers, Addison’s, blood clotting, seizures, megaesophagus, IMGD, or otherwise.
The biggest step you can take towards ensuring your puppy is healthy for life is to be very choosy about your breeder.
Knuckling, HOD, and Panosteitis
As above, these painful orthopedic growth disorders are often a direct result of unbalanced, poorly formulated nutrition, overfeeding, and incorrect exercise (see ‘how to care for puppy joints’ below).
Knuckling in Great Dane puppies is when the ankles appear to “knuckle over” the foot. It is easily corrected with proper nutrition. Left untreated, it can lead to deformity and arthritis.
HOD is short for Hypertrophic Osteodystrophy, which is a disease that affects growing Dane puppies between the ages of four and eight months. It is characterized by fever, loss of appetite, stiffness, and pain. X-rays will often show a thickening of the long bones in the legs.
Panosteitis (AKA “Growing Pains”) is a condition that causes inflammation in the long bones of Dane puppies. It usually affects dogs between five and fourteen months old and manifests as lameness and pain that comes and goes.
All three of these orthopedic growth disorders are largely preventable with good breeding, feeding, and exercise practices. Additionally, they are treatable if caught in time.
Flat feet, downed pasterns, and cow hocks are other symptoms of growth, genetics, improper nutrition, or a lack of correct exercise. Make sure your pup gets plenty of off-leash play on soft, varied terrain and steer clear of breeders whose adult dogs don’t have exceptional structure.
The bottom line is that if you are feeding your puppy correctly formulated food, and exercising them properly (see below), they should not be as susceptible to these problems.
If you notice knuckling, stiffness, pain, or lethargy, talk to your veterinarian!
IS YOUR GREAT DANE PUPPY KNUCKLING?
Check out our science-based and constantly always growing knuckling resource page.
Puppy joints are very soft and susceptible to injury.
It is very important to avoid hard and slick surfaces whenever possible. Put runners down in your home, and avoid long walks on the hard pavement.
Better alternatives include free movement on grass, sand, gravel, hills, and other soft varied terrains. These things will strengthen joints, toes, and balance as well as encourage confidence.
Angular Limb Deformity is a common and painful disorder that happens when the large knobby growth plates are damaged by running, jumping, or injury. For many dogs, amputation or invasive and painful surgeries are the only way to move forward.
We know you are excited to have your new puppy as a running partner, but hold your horses!
Proper nutrition and exercise are key for taking care of your puppy’s delicate joints. Patience will pay off in the long run when your big puppy is more mature (around 18-24 months).
Great Dane grooming including nails and teeth are a few things that pet owners tend to neglect.
Teeth should be brushed daily
Nails should be trimmed weekly
Take advantage of your puppy’s enthusiasm and take the time now to make both of these things a matter of routine in your house.
Daily hair brushing can also help reduce dander, itching, and shedding in your Great Dane’s coat. We recommend using a SLEEK EZ tool. Do not use a “Furminator” as those tools cut the hair.
Practice handling your puppy all over, brushing your puppy, picking up each paw, and inspecting your puppy’s teeth. An adult Great Dane that wants to fight these things can and will, so make this a positive experience now while you can.
If you have a little bitey Great Dane gremlin on your hands, restrain the urge to use your hands to tap, shove, choke, or pinch your puppy’s mouth! These outdated training techniques are the fast track to making sure that your 140 lb adult Great Dane is resistant to handling.
For your Great Dane’s nails, use a Dremel! Tap each toe and offer a treat. Make this a fun, positive experience now while your puppy is still at a young age.
Regularly inspect your dog’s ears for signs of irritation or infection, too.
Socialization does not just mean going to the dog park or pet store or letting people squeal, hover, and handle your puppy.
As a matter of fact, these common ‘socialization’ exercises can be detrimental to their well-being and temperament!
Good socialization will be the foundation for all of your training exercises for years to come, so this is important. The single best piece of advice I can give you is this:
Make sure every experience is a good one.
That means that if you are going to introduce your puppy to new people, make sure those people know how to properly greet a puppy.
Set your pup up for success by making sure they can’t get into trouble or hurt themselves, but also have plenty of new experiences, smells, noises, and textures to explore.
Our favorite socialization exercise is the puppy playground! Grab a variety of interesting objects such as cushions, large balls, a kiddie pool, noisy toys, and household items and gather them in a large area.
Encourage your puppy to explore and play with all of the new things, and make sure to give lots of praise and treats!
This is a great way to get your pup used to different textures, smells, noises, and objects in a safe and controlled environment.
Positive reinforcement training is the best way to install new behaviors.
All puppies should be taught:
Acceptance of handling by veterinarians and groomers
Sit, down, stand
Wait
Leave it
Come
Place
Stay
Loose-leash walking/heel
We recommend finding a highly qualified trainer who uses positive + balanced training methods. Start attending classes now and continue through intermediate and advanced obedience!
The STAR Puppy and AKC Canine Good Citizen programs are fantastic ways to set goals for yourself. Consistent training will pay off in the form of calm, indifferent, friendly, and safe adult dogs in your home.
Large dogs require obedience training and lots of mental enrichment. Putting the time in beyond puppy class is a hallmark trait of responsible dog owners.
By nature, leashes and collars rely on physical restraint. This restraint can become impossible or dangerous with large adult Great Danes.
It is much safer and better for their mental and orthopedic health that they have good off-leash obedience.
Start training your large breed dog to be off-leash now!
In your living room, reward your puppy for looking at you, engaging with you, and walking next to you around obstacles in the house.
Outside, we recommend using a long Biothane leash and practicing recall in low-distraction areas such as empty lots and baseball fields.
Never scold your puppy for not coming when called. This creates superstitious dogs that do not come back.
Instead, make coming to you the most fun thing in the world!
Use praise, treats, and play to make coming back a positive experience.
A positive training program will produce positive results!
When your puppy can reliably come when called from 20 feet away in moderately distracting areas, it’s time to layer in a modern, positive e-collar so you can ditch the physical restraint.
Getting regular veterinary care for your puppy is an important part of responsible dog ownership.
In the first year, your puppy will need to see the veterinarian several times for a well-check, growth-check, vaccinations, and deworming.
After that, yearly well-visits are all that is needed!
Puppy Vaccines
It is extremely important that your puppy is vaccinated against common and often deadly dog illnesses such as Distemper, Parvo, and Rabies.
Your veterinarian will provide you with a vaccine schedule. Additionally, your breeder should have already begun the vaccination process.
Keep in mind that Rabies vaccination is legally required in many places.
Some breeders may encourage you to hold off on Rabies or Leptospirosis vaccinations until your puppy is more mature, especially if your puppy has had problems with orthopedic growth disorders. Only HEALTHY puppies should be vaccinated.
It is also very important that until your puppy is fully vaccinated, they not be exposed to places where diseases tend to be common. Positive socialization is VERY important, so we encourage you to take your puppy with you whenever you can.
However, it is smart to avoid pet stores, dog parks, and the floor of the veterinarian’s office as much as possible while your puppy is young.
Parvo, for example, is extremely contagious and deadly.
However, poor socialization can set a puppy up for a lifetime of stress, frustration, and anxiety. It’s important to find a safe, healthy balance.
Flea & Tick Prevention
Flea, tick, parasite, and heartworm prevention are important for all dogs.
Bugs and parasites bring with them diseases that can cause permanent damage to your dog.
You may have seen alarming blogs and media about dogs becoming sick and suffering seizures from flea and tick medications. While side effects are possible, it’s important to note that they are rare and often associated with other health problems. This kind of alarmist media is emotional and drives clicks and revenue, skewing our perception of the problem.
The reported side effects of veterinary flea and tick preventatives are minimal compared to the side effects associated with leaving your dog unprotected.
Parasites, including fleas and ticks, can cause devastating health problems such as Lyme’s disease, malnutrition, anemia, Rocky Mountain Spotted fever, deadly heartworms, and more. Thousands if not millions of dogs suffer from these things every year, at an astronomically higher rate than the rare dog who has a severe reaction to preventatives.
There are many products on the market that can help you keep your puppy safe from these pests. Do not be afraid of preventatives, and beware of pseudoscience and clickbait media that teaches you otherwise.
Talk to your veterinarian about deworming, as well as which flea and tick products are right for your puppy and your area.
I personally use Bravecto and Sentinal, on the recommendation of our veterinarian. My dogs have had no side effects and I like knowing that I don’t have to shelter them from fun, enriching outdoor activities.
Finding a Veterinarian
It’s important to find a veterinarian whose opinion you value and trust.
Ideally, they have experience with giant dogs and understand their unique orthopedic, nutritional, and growth needs.
I like to find veterinarians who:
Are up to date on the current research and will support delayed spay and neuter for well-tempered giant breed dogs with responsible owners
A Great Dane’s life may be short, but there are things you can do to make it as long and wonderful as possible. Enjoy your puppy!
JOIN OUR COMMUNITY
Do you like modern positive+balanced off-leash dog training, science-based information, life with Danes, educated ownership and chatting with other like-minded people?
If you are the owner of a Great Dane, it is important that you are aware of angular limb deformity. Many people mistake this more serious conditioning with simple knuckling in puppies!
Angular limb deformities result in deformed bones that can cause your dog pain and mobility problems. It may require surgery to correct.
In this article, we will discuss what angular limb deformity is, the difference between ALD and knuckling, how to spot it in your dog, and what treatment options are available.
Angular Limb Deformity in Great Danes
What does Angular Limb Deformity Look Like?
Angular limb deformity can be mild or severe and may present itself in one or both legs. The signs of ALD include:
* Lameness or stiffness in the affected limb
* Pain
* Muscle wasting
* A flat foot or feet that turn out away from the body
* Weak pasterns or ankles
* Joint deformity
* Crooked, bent or deformed feet and ankles
A dog with more advanced ALD may walk with a floppy, turned-out foot that faces outward
ALD is not to be mistaken with knuckling or Queen Anne (“Ballet”) feet.
This Great Dane below has a severe case of Angular Limb Deformity.
A dog’s legs can be bowed for a number of reasons, including Carpal Valgus or knuckling, Angular Limb deformity, poor nutrition, neglect, injury, birth defects, or congenital disorders.
If you notice anything unusual about your dog’s feet or limbs, especially while they are growing, it’s important to take them to the vet for an evaluation.
Dogs are exceptionally good at hiding pain, so don’t take ‘acting normal’ as a sign that your dog is ok. A dog with an affected limb may or may not limp.
Angular limb deformity, also known as ALD or Angular Stance Deformity, is a condition that causes the bones in a dog’s legs to grow at abnormal angles.
This can cause pain, lameness, and mobility problems.
ALD will often present initially as mild changes to the foot and ankle that may be mistaken for other things, such as knuckling.
Can a dog live with Angular Limb Deformity?
While a dog can live, move and even play with any number of odd conditions, Angular Limb Deformity should be evaluated by a board-certified veterinary orthopedic surgeon as soon as possible.
Many times, the deformity can be corrected surgically. The earlier the surgery is performed, the better the outcome for your dog.
Left untreated, Angular Limb Deformity can cause your dog a great deal of pain and will likely lead to arthritis later in life.
Your dog will walk with an altered gait, which can be hard on the healthier or more normal joints.
Severe deformities will eventually make it hard for your dog to walk at all.
Knuckling is a condition most often seen in large and giant breed puppies during their rapid growth phase.
A puppy that is knuckling will have feet that appear to bow out, up and over the top of the toes. This is caused by nutritional deficiencies but also may be the result of weak muscles and tendons in the feet.
Correct nutrition and strengthening the feet with gentle forms of exercise on soft surfaces can help puppies recover from knuckling.
Appropriate nutrition is also required. Large and giant breed dogs need correctly balanced large or giant breed puppy food.
This is a Great Dane puppy that is knuckling. This is a treatable condition that doesn’t require surgery and is NOT the same thing as angular limb deformity. Source: The Great Dane Lady. Read more about knuckling HERE.
HOD or Panosteitis
HOD or Panosteitis is a disease of the long bones that causes lameness and pain. It is seen most often in large and giant breed dogs between the ages of four and fourteen months old. A dog with HOD may limp and act painful.
The cause of HOD is unknown but it may be related to rapid growth, genetics, or nutrition.
Panosteitis (also known as growing pains) can also result in pain, lameness, and swelling.
Angular limb deformity (ALD) is the purpose of our article today. ALD is believed to be caused by damage to the immature growth plates and may be made worse by incorrect nutrition.
Many people think that their dog with Angular Limb Deformity is simply knuckling. A dog with ALD needs PROMPT treatment, as this condition cannot likely be fixed by nutrition alone.
We will dive into this condition more throughout this article.
Genetic Crooked Limbs
Some dogs just have crooked feet. If a breeder is not paying close attention to the structure of the dogs that they are breeding, they will pass these genes onto the puppies.
Queen Anne or “Ballet” feet are often seen in Dachshunds and Basset Hounds. These dogs have a genetic predisposition for this condition and it is not painful.
Other dogs who should have correct limbs will present with turned-out feet (sometimes called ‘Easty-Westy’), flat splayed toes, or chronically weak pasterns: these genetic conditions can be painful or damaging and should not be passed on through a pedigree.
Birth & Congenital Defects
Birth defects and congenital (genetic) disorders can cause limbs to be deformed in puppies. These deformities can be mild or severe and may affect one or more limbs.
Some congenital disorders that may cause crooked legs to include:
* Osteochondrodysplasia (OCD) – a disorder that affects the growth of bones and cartilage
* Elbow dysplasia – a condition that causes the bones in the elbow joint to grow abnormally
* Hip dysplasia– a condition that causes the bones in the hip joint to grow abnormally
* Patellar Luxation – a condition that causes the kneecap to slip out of place
If you suspect your puppy has a congenital disorder, it is important to take them to the vet for an evaluation.
Surgical treatment may be indicated to reduce pain and improve the quality of life.
There are several reasons why a dog may develop a limb deformity, including injury, genetics, incorrect nutrition, and rapid growth.
We will cover them in more depth below.
Growth Plate Injuries in Dogs
Young puppies have very delicate growth plates in both the front and hind limbs. These are areas of cartilage near the ends of the long bones that turn into bone as the puppy grows.
Growth plate injury is a leading cause of angular limb deformities in dogs, especially in dogs with significant remaining growth potential.
If these growth plates are damaged, it can cause the bone to grow at an abnormal angle. This can happen if the puppy has a fall, is hit by a car, or sustained any other type of trauma.
For some puppies, jumping or sliding on slick floors is enough to cause damage to this sensitive area. In other words, a traumatic injury is not necessarily required to cause enough damage.
To protect the growth plates, we do not recommend letting your puppy play excessively on concrete, asphalt, hardwood, or tile floors until they are fully grown and their bones are no longer at risk for injury.
Additionally, growing puppies should never be subjected to on-leash running, treadmills, or forced exercise on hard surfaces (including the pavement) until they are fully grown.
Nutrition plays a key role in your dog’s health, especially when it comes to puppies who are rapidly growing.
Poor nutrition can ultimately lead to an angular limb deformity and bowed limbs.
Large and Giant Breed dogs have different nutritional needs than smaller breeds. They need precisely balanced calcium and phosphorus ratios, as well as the correct levels of amino acids, nutrients, and fats.
Puppies who grow too quickly are at risk of developing joint problems and limb deformities, including ALD. We see this often in the Great Dane community.
These foods have now been formulated correctly for slow, even bone growth, while still providing the dog with enough nutrition to support building muscle and nice, tight feet.
It’s important to choose a food with Meat meal and meat by-product meals as the first ingredients. These are high-quality protein sources that contain biologically appropriate meat, bone, and organ.
If you are unsure about what type of food to feed your large or giant breed puppy, we recommend speaking to your veterinarian and referencing our articles on nutrition.
The addition of supplements, toppers, and training treats can throw off the balance of these nutrients, so keep that in mind as you are building your dog’s food bowl!
Getting a diagnosis of Angular Limb Deformity can be devastating, however, it’s important to take action quickly.
In growing dogs, Angular Limb Deformity can be progressive, and the sooner you take care of it, the better.
Depending on the complexity of surgical correction required, your dog may need to be on crate rest for weeks at a time. Restricting movement while bone healing and fusion of the bone plates take place is important.
We recommend preparing yourself financially and emotionally for this.
There are two bones inside the front limbs of your dog. The Ulna, and the Radius.
The radius is the large weight-bearing bone. This bone is often the one that becomes deformed.
The ulna may have stopped growing (as a result of growth plate damage) and will restrict the radius from growing normally.
Orthopedic Surgery Options
There are three types of surgery offered for dogs suffering from angular deformity. The earlier it’s caught and diagnosed, the better, especially in growing puppies.
Any visible limb deformity should be evaluated by a board-certified orthopedic surgeon.
First, the surgeon will rule out other causes of bowed legs. Radiographs will be used to confirm if the deformed bones are in fact Angular Limb Deformity.
They will also evaluate how much further growth is expected, before making a recommendation. A severe deformity may result in the recommendation to amputate, rather than attempt to fix the bones of the affected forelimb.
The four types of surgical correction for limb deformities include Ulnar Ostectomy, Osteotomy, Arthrodesis, and Amputation. Read more about each option below.
This is the most common type of surgery and is recommended for puppies under one year of age, especially for dogs that have significant remaining growth potential in the affected and normal limbs.
This procedure involves cutting and removing a portion of the deformed bone (the ulna) in the forearm or affected joint.
The radius is then allowed to rotate into its new position as the puppy finishes growing.
With this option, the ulna bone will be ‘free-floating’ from that point forward, and can no longer restrict the growth of the radius bone as it was before.
Compared to other options, this is the least-invasive choice.
However, it will be ineffective if the puppy is nearly fully grown.
With the Ulnar Ostectomy, time is of the essence.
Some dogs who undergo this procedure will still have a valgus deformity and may need additional surgeries.
This orthopedic surgery involves cutting, realigning, resetting, and pinning the bone. Metal plates and screws are commonly used to connect bone segments and joints adjacent to the deformity.
Corrective osteotomy is a more involved surgery, but it often results in a better long-term outcome for your dog.
This type of surgery is recommended for dogs over one year of age and may be necessary if the Ulnar Ostectomy (the cutting of the ulna bone) performed previously didn’t provide satisfactory results.
Many surgeons will place an external skeletal fixation device following the procedure. These look scary and can be alarming to pet parents, but will help with stabilizing the bone while it heals from surgery.
An external skeletal fixator is similar to a cast in how it functions, while still allowing the skin to breathe and heal. It is removed once the bones have fully set.
It is not uncommon for dogs with ALD to need both surgeries in the journey to restore acceptable limb function, especially for those with more severe deformities. The adjacent joints may also undergo arthrodesis (see below).
Expect your dog to need 6-8 weeks or more of crate rest, followed by physical therapy.
This is a newer technique that fuses the bones together using bone grafts in the affected forelimb.
Many orthopedic surgeons will choose to pair Osteotomy with Arthrodesis.
While this option may ultimately restrict some movement of the bones and joints, it can also provide a lifetime of support and pain-free living for a dog with angular deformities.
No matter which type of surgery your dog needs, it’s important to discuss all pros and cons with a board-certified Veterinary Orthopedic Surgeon.
The opposite limb can be affected in some ways, too, because of how angular limb deformities affect gait and movement.
Orthopedic limb-sparing surgery of any kind will require diligent crate rest and low activity for several weeks.
For some dogs with a severe deformity, or dogs with small, weak or brittle bones, amputation may be advised.
This is considered a last-resort effort as it will permanently remove the use of the affected limb.
Dogs typically do very well on three legs and can lead long, happy lives, however!
Unlike the other orthopedic surgeries mentioned above, amputation has a relatively short recovery time.
It will only require crate rest for 10-14 days while the sutures heal, followed by physical therapy so your dog can build strength and balance in the remaining limbs.
A three-legged Great Dane
Living with Angular Limb Deformities
A dog that has an Angular Limb Deformity, whether it has been amputated, surgically corrected, or not treated at all, will have special considerations when it comes to joint care, diet, and body condition.
Nutrition Support for Angular Limb Deformity
Dogs who have angular limb deformities will benefit from a correctly balanced diet.
It may be tempting to seek out holistic and natural alternatives such as home cooking, however, we advise doing so with caution.
Home-cooked diets are rarely if ever balanced correctly. They are dangerous at best.
A dog with any kind of orthopedic issue or limb deformity, especially while growing, needs a scientifically-backed balance of calcium, phosphorus, fats, and amino acids to support bone growth and healing.
It’s important to note that many ‘super-premium’ boutique dog foods that you find in the pet store or online are formulated by people with nominal, if any, nutrition or veterinary credentials. They often use ingredient splitting to trick you and may make things worse for your dog.
Make sure you are choosing dry kibble food that is formulated by veterinary nutritionists. The food you choose should have also been subjected to legitimate research and feeding trials.
We recommend choosing a kibble that is appropriate for your dog’s size and age and then using toppers (see below) to add fresh and whole foods nutrition.
Make sure that toppers comprise 10% or less of your dog’s overall food intake when choosing unbalanced options such as fruit and veggies (which can fill your dog up and make them less interested in their balanced nutrition). Don’t overdo fish oil or bone broth. Less is more!
Conditioning for dogs with Angular Limb Deformities
It is extremely important to keep a dog with any kind of limb deformity strong and lean.
Extra weight puts unnecessary stress on joints, ligaments, and bones and can worsen the effects of angular limb deformity.
We recommend a combination of moderate exercise and a correctly balanced diet to help your dog maintain an ideal body condition.
The safest and most natural form of movement for a dog will be off-leash on soft, varied outdoor terrain.
For this reason, we recommend that all dogs are E-Collar trained so they can benefit from unrestricted movement and enrichment.
The soft, varied terrain will keep their muscles and feet strong, without causing additional damage to the joints.
Pavement, pulling, harnesses, head collars, hard surfaces, jumping, and sliding around can be painful and damaging to dogs with healthy joints.
Therefore, dogs with any kind of deformity or orthopedic challenge will require additional attention to their joint and muscle health and should be allowed to move as naturally as possible.
Joint Support for dogs with Angular Limb Deformity
Dogs with Angular Limb Deformity often require joint supplements and pain medication to help them stay comfortable.
Your veterinarian or orthopedic surgeon may prescribe muscle relaxers, anti-inflammatories, pain medications, and joint support.
If you choose a correctly balanced kibble with meat meal and meat by-product meal in the ingredients, Glucosamine (a joint support supplement that is naturally occurring in nutritious by-products such as chicken feet, tracheas, and cartilage) should already be naturally included in the diet.
We also recommend the following products, however, be careful not to overdo it! Too much joint support can actually be detrimental.
Talk to your veterinarian about an appropriate diet and supplements for your dog.
My Story of Angular Limb Deformity
We have a small terrier who, at 14 weeks of age had a very tiny ‘greenstick’ fracture in his front limb.
The injury was very mild and required a cast and crate rest. Our veterinarian said it was fairly common and not concerning.
His final x-ray showed that he had healed perfectly, and there was no apparent damage left. It was as if it had never happened!
After having been in a cast, however, his leg was pretty weak. Our veterinarian said this was normal and that it would quickly become stronger as he was able to move, play and be a puppy.
Two days after his cast was removed, we attended (with veterinary permission) a puppy 101 training class.
The instructor, who promoted herself as a ‘positive’ dog trainer, didn’t like how he was getting excited and biting his leash.
To fix it, she spun his collar around her finger until he was choking. Then she grabbed his scruff in the same hand, picked him up off the ground, shook him, and then slammed him onto a concrete floor. She held him there until he stopped screaming.
Doing this, she caused irreparable damage to his soft growth plate and to the tendons in his leg, which just days before had been considered healed. Her training method is a form of abuse.
Within weeks, he began to show signs of Angular Limb Deformity. I had to advocate for him; I didn’t know what ALD was but I knew something was wrong with the foot. His symptoms were very mild at first. By the time he was 6 months of age, I was alarmed.
We saw three different veterinarians in our journey to find out what was happening.
What started as a very mild deformity quickly become worse, almost overnight.
At that point, we were referred to an orthopedic surgeon, who diagnosed him with Angular Limb Deformity. He said that his tendons had also likely been stretched beyond repair by the dog trainer.
He was a candidate for Orthopedic Osteotomy (plates and screws) paired with Arthrodesis (bone fusion) to support the tendons in his foot.
We were told that because his bones were so small, there was a 40% chance these surgeries would fail, leading us to additional surgeries or amputation.
The estimated costs were running upwards of $8000-$10,000, and we were prepped to anticipate 6-8 months of crate rest and rehabilitation if we wanted our best chance at success.
We we also told that the risks associated with orthopedic surgery included bone fractures, cold intolerance (in the affected limb), and early onset arthritis.
Jackson was also a candidate for amputation of his affected limb.
He is an extremely agile and athletic dog; for this reason, we chose (under the advisement of both our veterinarian and our orthopedic surgeon) amputation.
This isn’t the correct choice for all dogs, but it was for ours.
He is fast, strong, fit, balanced, and incredibly happy. Amputating his painful, damaged leg was a gift.
If you are facing an angular limb deformity diagnosis, don’t be afraid to ask questions and advocate for your pet!
Read on for our tips for preventing knuckling in Great Danes!
HOW TO PREVENT KNUCKLING IN GREAT DANES
1. Avoid hard and slick surfaces.
This includes wood, tile, and yes, concrete! Puppies need soft places to rest their joints, walk, and exercise. Do not allow your puppy to slide around on floors or jump off furniture. Healthy play on soft, varied terrain is appropriate and will help strengthen joints!
Put down lots of area rugs to keep joints safe and cushioned. We love washable rugs from Ruggable; they are perfect for homes with puppies, look beautiful, and offer just enough softness and traction.
2. Strengthen Toes and Feet
Strong feet are important to ensure that your puppy has a solid foundation to grow on. Walk and play on soft surfaces such as bedding, gym mats, sand, gravel, dirt, and grass.
By allowing your puppy to play on a variety of terrain, you are building muscles and strength that will help their feet grow correctly.
Choose a large or giant breed puppy formula with meat and meat meals in the first ingredients, calcium at or below 1.2%, and phosphorus close behind. The food must also contain the AAFCO large breed growth statement.
Do NOT mix kibble brands. Choose one and stick with it. The following foods meet the criteria:
Check out THE GIANT DOG FOOD PROJECT to compare brands and values.
5. Watch the Treats
Do not let supplements, toppers, or treats make up more than 10% of the intake. Excess nutrition is harmful for Dane pups!
6. Minimize Crate Time
Crates are important for training, however, Great Dane puppies need the freedom to move naturally to develop joints, tendons, and bones. Limit crate time, especially if your puppy is in a crate overnight.
Great Dane puppy joints are fragile and need to be cared for.
With proper care, knuckling over is preventable and treatable. Without care, knuckled limbs may become painful and permanently deformed.
All these things we listed work together to help prevent and treat knuckling in Great Dane puppies. Protect the joints, strengthen the joints, and lastly, provide the correct nutrition.
Today we are sharing five ways to strengthen your Great Dane’s feet! Weak feet that knuckle, bobble, flop, and turn out are a common problem with fast-growing giant breed dogs.
The feet are the foundation for the whole body, and these dogs have HUGE bodies. So yes, this matters.
When their feet are weak or flat, it’s not only an aesthetic problem; it’s a functional one.
The development of the feet is especially important in growing puppies (read our article on puppy knuckling here). However, in adolescent and adult dogs, poor structure and weak joints could lead to pain, early arthritis, and permanent joint damage.
How Genetics Affect Foot Structure in Dogs
Genetics play some role in the overall structure, shape, and direction of the feet on your Great Dane.
The written standard for Danes states that the feet should be straight and parallel when viewed from the front. The feet should be ‘well knuckled’ and the pastern should have an 8 degree bend.
Deviations from this, including ‘East-West’ feet, splayed toes, bone deformities and otherwise are considered faults. These faults are often genetic and can be made worse by environmental factors such as nutrition.
The written standard is based on building an appropriate structure for such giant dogs, which must be built correctly for longevity, movement, and overall comfort.
Angular Limb Deformities (caused by damage to the growth plate) are another form of incorrect feet and joints that typically requires surgical intervention.
If you are concerned, always ask your veterinarian first!
From the written standard, this illustration outlines common feet in Great Danes. Hare foot, flat/down in pasterns and splayed feet are unacceptable.
“The strong pasterns should slope slightly. The feet should be round and compact with well-arched toes, neither toeing in, toeing out, nor rolling to the inside or outside. The nails should be short.”
We cannot stress this enough. Overgrown nails are extremely common and a major reason so many Great Danes have splayed toes, weak knuckles, and flat pasterns.
Nails that are allowed to grow too long (touch the ground, click on the floor) alter the shape of the foot and how your dog walks.
With time, it leads to pain, arthritis, and irreversible joint damage.
Start trimming nails the first week you bring your puppy or dog home, and make it a weekly or bi-weekly habit! If your dog is resistant, work with a trainer and learn how to condition your dog.
The Millers Forge cut through nails like butter, eliminating much of the pressure into the nail that many dogs find uncomfortable. They also stay sharp FOREVER! The Dremel is fantastic for rounding the nail off and helping the quick to shorten (which will be important if you need to shorten the nails a lot).
Need to learn how? The Facebook group ‘Nail Maintenance for Dogs’ is a fantastic resource. Getting nails trimmed back to an appropriate length may take time and dedication. Be patient.
Think your dog’s nails are ok? Here is an example of overgrown nails:
2 – Play on Soft, Varied Terrain
Great Danes and especially puppies benefit greatly from lots of free-play and exploration on soft, varied terrain. This movement strengthens the tiny muscles and tendons in the feet.
Structured walks on hard surfaces are hard on the joints and should be limited, especially if the nails are overgrown.
Slick surfaces in the home (tile, hardwood, laminate) are also hard on the joints. Use runners and yoga mats.
Purposefully seek out hills, grass, dirt piles, sand, soft pea gravel, and even the trampoline! Use a long leash so that your dog can move and explore safely and supervised without restriction.
We highly recommend that puppies be exposed to various surfaces and textures and encouraged and challenged to explore and use their bodies safely. Ramps, tunnels, and even splashing in a pool are all great for building confidence AND making those feet extra strong!
AVOID INJURY! It’s important that your puppy or adult dog not make a habit of jumping off things (beds, furniture, etc.). Damage to the growth plates is serious and may be expensive and painful to address properly.
3- Canine Fitness to Strengthen Puppy Feet
Dogs are no different than humans! They require movement and exercise to stay strong.
Find a dog trainer who offers a Canine Fitness or ‘Fit Paws’ class, and learn how to use balls, peanuts, and teeter boards to help your dog develop balance and strength.
This is an inexpensive knockoff of the popular Fit Paws balance disk. Choose the Fit Paws version if you have the budget; it will be more stable and last longer. Otherwise, this is a great alternative for home use!
Put this flat on a surface and ensure that it won’t slide. Lure your dog to put both front feet onto it.
The disk will wobble, and your dog will balance.
If you do this right, your dog will quickly learn that standing with two front feet on the wobble disk is SUPER fun! Gently lure your dog to the treat so that he stands up tall on the knuckles of the feet.
Don’t spend too much time on this, and don’t ask. your dog to stretch super far. You don’t want your dog sore or injured. It is helpful to work with a Physical Therapist or qualified fitness trainer.
4- Other Balance Games
Balancing requires humans (and dogs) to activate our tiny muscles tendons and ligaments.
To help your dog strengthen these muscles, encourage activities that require balance!
Be safe, and chat with a veterinarian and Canine Physical Therapist for help.
For puppies especially, we love the ‘puppy playground’. Use tunnels, ramps, gym mats, couch cushions and more to encourage exploration, body awareness and confidence building.
Remember, supervise and keep your dog safe! NEVER force a dog into an activity or pick them up and place them on an unstable surface. Encourage your dog to use their choices and body to do these activities, and reward them with praise and treats.
5 – Nutrition + Foot Structure
Nutrition plays a key role in developing sound orthopedic health in puppies, especially large and giant breed ones that grow quickly.
Many believe big puppies should be fed a nutrient-dense “holistic” adult or puppy diet with lots of protein and calcium. This is the worst thing a puppy owner can do!
Puppies that receive too much nutrition will grow too fast and can develop major problems with their bones, ligaments, and tendons, affecting them in adulthood.
DO NOT:
Feed nutrient-dense “holistic” diets.
Give adult food to a large or giant breed puppy.
Choose regular “puppy food” that contains extra nutrients.
Offer a diet with more than 1.5% calcium (ideally, 1.2% or less).
Add vitamin or mineral supplements.
Top the food with too many goodies, which unbalance the diet.
DO:
Feed a well-formulated large or giant breed PUPPY or all-life stages formula with 1.2% or less calcium.
Verify that the food meets AAFCO guidelines for large-breed growth
Monitor intake and don’t overfeed.
Tread cautiously with outdated information encouraging you to feed adult or nutrient-dense “holistic” foods.
Ask your veterinarian for advice.
Contrary to popular old beliefs, adult food is NOT the correct choice for growing giant breed puppies!
We only recommend research-backed large and giant breed foods from Royal Canin, Purina, Hill’s Science Diet, and Eukanuba. They have been heavily tested, researched, and formulated correctly for the growth of large and giant breed dogs, then subjected to further peer-reviewed science as we learn more.
A dog struggling with food may have excess gas, loose stools, a dull coat, poor muscle tone, inappropriate weight (over or under), and/or low energy.
Inappropriate nutrition for growing Great Danes can lead to knuckling, hip dysplasia, heart disease, and more.
Chat with a Giant Breed experienced veterinarian to find a diet appropriate for your Great Dane. Here is our list of recommended foods:
I’m taking a wild guess here that you found this post because you are concerned about your Great Dane puppy knuckling over. We have many resources on this topic, and are here to help!
Great Dane puppies have HUGE knobby knees. Their limbs look so chunky when they are young that many people, even some veterinarians (who aren’t used to seeing giant breed dogs) are initially alarmed. Knuckling Over (medically known as “carpal laxity”) is a condition where the puppy’s front legs bow out over the tops of the feet.
This reversible problem is believed to be the result of excessively fast growth, environment, genetics, and incorrect nutrition. We will touch on all of these factors below!
What causes puppy knuckling over?
Are flat feet and knuckling the same thing?
How to treat puppy knuckling and carpal laxity
This is a photo of a Great Dane puppy with severe carpal laxity “knuckling“
Great Dane Puppy Knuckling Photos
Here are some photos of Great Dane puppies who are experiencing severe carpal laxity (“knuckling”). Your puppy may have only mild knuckling that could progress quickly if left untreated and may not yet look like the puppies below.
Any kind of bowing out, flat toes, or crooked appearance is cause for concern. While carpal laxity knuckling is the most common growth disorder, it’s also the most benign!
Other problems related to bone growth in Great Danes include HOD, Panosteitis, Angular Limb Deformity, and Osteochondrosis. If you see ANY kind of abnormality in your puppy’s feet, you must visit your veterinarian to rule out more serious conditions.
Normal Great Dane Puppy Legs
For reference, the image below is a young Great Dane puppy with normal legs. Notice the growth plates; those bumps are normal. The feet are nice and tall, and the limbs appear to hold the puppy up without any struggle or bowing out.
Having solid feet and good foundations are so important for growing giant breed dogs. At this age, the joints and growth plates are very soft and susceptible to damage.
The bump above the patella (or, the ‘ankle’) may be alarmingly large! Many people mistake this for knuckling in Great Dane puppies. If that bump is swollen and warm, that is concerning. However, it’s not unusual for them to be knobby in substantial, well-boned Great Dane puppies.
Great Dane Health Issues & Orthopedic Growth Disorders
It is super important to note that while it may be normal for Great Dane puppies to have large growth plates, they should still be strictly monitored.
Excessive swelling of the growth plates and obvious signs of pain are red flags and warrant a visit to the veterinarian. A struggling Great Dane puppy may limp, appear weak or lame, wobble, whine, chew on their feet and/or have a strange gait when they walk.
Warm growth plates and flat or turned-out feet or limbs are another sign that something is wrong.
Some common Great Dane growth disorders include:
HOD – Hypertrophic Osteodystrophy is a painful disorder in growing large and giant breed puppies that can cause swelling and abnormally large limbs and joints.
PANO – PANOSTEITIS is also known as growing pains, and can cause swelling and pain.
OSTEOCHONDROSIS
INJURY – Injury to the growth plate may be serious and can cause swelling and permanent damage (that may develop into angular limb deformity or similar).
As before, consult with your veterinarian if you are unsure! Even severe cases start with a mild version, so keep an eye on your puppy and take day-to-day photos if you are concerned.
A double-merle Great Dane puppy with normal knobby knees and Growth Plates
What Causes Knuckling in Giant Breed Dogs
While the exact cause is unknown, it is believed that knuckling (carpal laxity), and all other orthopedic growth disorders are related largely to diet and an imbalance of important minerals and nutrients.
Excess intake of calcium has been shown in studies to contribute to improper growth. Osteochondrosis, HOD, Panosteitis, and even angular limb deformities are commonly associated with too much calcium.
Great Dane puppies utilize nearly EVERY bit of the calcium they receive in their diets. Adult dogs are better able to regulate this and discard what they don’t need. This makes it very important that we control the amount of calcium our puppies (under the age of 2) are receiving.
Never feed a diet with more than 1.2% calcium to a Great Dane puppy! If it’s not listed on the bag, contact the company.
In addition to excess calcium intake, excess food intake (overfeeding) results in obesity and rapid growth. This creates a perfect storm that results in all kinds of deformities and disorders.
So what is the trick to reducing the risk of orthopedic growth disorders and bone problems?
Less calcium, less food. I’ll dig into this below!
The Best Food to Treat Knuckling in Puppies
Many foods on the market are NOT safe to feed giant breed puppies. I believe there are only a handful of truly nutritious and correctly balanced choices.
When choosing food for a Great Dane puppy, especially if they have any kind of carpal laxity or painful growth disorder, you need to check the values.
The calcium content MUST meet the following guidelines:
1.2% or less calcium 3.5g or less calcium per 1000kCal A ratio of calcium to phosphorus of as close to 1 : 1 as possible
These factors alone don’t eliminate all possible options, so to narrow it down even further, choose as follows:
Labeled as a large or giant breed PUPPY formula or a large breed ALL LIFE STAGES formula
Must have the “formulated for the growth of 70+ lb as adult dogs” AAFCO statement
Includes grains (NO “grain-free”)
Made by a company that does research and feeding trials
Formulated by a highly qualified on-staff nutritionist (either a PhD in Animal Nutrition or a Board Certified Veterinary Nutritionist
You may have heard that Great Dane puppies should never have puppy food. This is an OUTDATED MYTH. I cannot say this loud enough. Adult maintenance diets were used in the past but they are no longer the best choice.
If you want more information on values associated with different food brands, check out the new Giant Dog Food Project website. www.thegiantdogfoodproject.com
Great Danes need food that is formulated specifically for slow, even growth.
It is also very important, when treating growth disorders, that food intake is limited and monitored. Do NOT overfeed or free feed. Eliminate all toppers, treats, and supplements.
We highly recommend a highly researched, extensively tested and scientifically formulated large or giant breed puppy kibble with balanced calcium and phosphorus levels. Our favorites are listed below.
Check out THE GIANT DOG FOOD PROJECT to compare brands and values.
Great Dane Puppy Knuckling and Breeders
Another contributor to growth problems and bowing legs in Great Danes may be poor breeding and health practices; young puppies that are kept primarily on hard surfaces and fed an improper first diet may be more susceptible.
Great Dane puppy Knuckling occasionally goes hand in hand with flat feet (weak knuckles and toes). Poor overall foot structure has a genetic component.
Many breeders still subscribe to outdated ideas about feeding adult foods and low-protein foods; however, these may not prevent growth disorders and often do more harm than good!
A Great Dane puppy knuckling before and after photo series
Puppies that aren’t offered adequate free-play on soft, varied terrain (think grass, sand, dirt, and gravel) or that live in homes with a lot of hard, slick floors may be more prone to knuckling, flat feet, and other orthopedic issues.
In the early stages of knuckling, you may notice:
Weak feet (flat toes/knuckles)
Weak ankles
Shaking limbs when on soft surfaces
What looks like severe knuckling when standing on a softer surface, but may correct and look ‘normal’ when back on the floor
Ankles that appear to be moving up and over the foot, even slightly
Legs that occasionally ‘bow out’
Limbs that look crooked in some way
Knuckling Before and After
The great news is that knuckling (carpal laxity) is treatable and can be corrected!
The treatment for knuckling is also helpful for treating flat feet, which are another symptom of improper flooring, inadequate exercise, poor nutrition, and poor breeding practices.
BEFORE:
AFTER:
How to treat Great Dane puppy knuckling
There are five big changes to make when treating knuckling.
Change Food Immediately
Supplements
Nail Maintenance
Flooring
Exercise
We are going to use the space below to outline each one, including the best foods to offer when correcting knuckling in addition to information on supplements that we recommend.
As always, consult your veterinarian.
Of course, we say to consult your veterinarian often because we really do think that you should.
However, it is extremely important to note that you find a veterinarian with giant breed experience, who is well studied in the latest research when it comes to nutrition and more. Ask questions!
When you notice the early signs of knuckling, it is imperative that you change foods immediately.
Knuckling is largely related to nutrition.
The food you choose for your Great Dane puppy MUST have the correct calcium, and phosphorus ratios.
More research is needed into the exact mechanisms behind nutrition and knuckling, but it is believed that an imbalance of amino acids and meat proteins may also contribute. For this reason, we only recommend research-backed brands for Great Dane Puppies. These brands include Purina, Royal Canin, Iam’s, Hill’s Science Diet, and Eukanuba.
A food with the ‘correct’ calcium and phosphorus ratios may still cause knuckling if it is overfed or not professionally formulated by a veterinary nutritionist!
The best Great Dane puppy foods to treat knuckling
We like to see:
Calcium at or below 1.2%
Phosphorus close behind
Calcium and Phosphorus should be balanced together as closely as possible, with phosphorus being the lower value. Calcium values of 1.2% or lower are ideal.
Science-based formulation from a company that follows WSAVA Guidelines and utilizes research and science, not marketing buzzwords (Purina, Iams, Eukanuba, Hills, Royal Canin)
If possible, look for an AAFCO statement on the bag with information about the formula being correct for the “growth of large-size dogs (70 lbs. or more as an adult)”.
Better yet, the AAFCO statement should indicate that the food was substantiated in food trials.
Ingredients: Science-backed formulation with meat, meat, and/or meat by-product meals in the first ingredients. Be wary of any food that uses an excessive amount of legumes or pea protein instead of real meat protein (which may also be linked to heart problems).
Added probiotics and ingredients such as DHA and fish oil that promote healthy brain development and a shiny coat are recommended.
NOTE: It used to be said that ‘adult food’ was the only choice for Dane puppies. Formulations and science have been updated. Puppy food may help ensure that your puppy is receiving enough of the right protein and fat for brain development and growing muscles.
Formulations, research, science and kibble diets have changed for the better in the last 10 years.
You can now choose a puppy OR an adult formula, as long as it’s formulated correctly for the growth of giant breed dogs and from a science-backed, heavily researched brand such as Purina.
Great Dane puppy foods that we recommend
Always consult with your veterinarian before a diet change or adding supplements! The brands listed below are heavily tested and researched by Veterinary Nutritionists and are thus formulated with up-to-date information about the growth of large and giant breed dogs.
These brands are recommended by veterinarians and many of the Top Breeders in the U.S.
Check out THE GIANT DOG FOOD PROJECT to compare brands and values.
Whatever you do, do NOT give your Great Dane puppy a calcium supplement or multivitamin!
Nail trimming to prevent knuckling in Great Dane Puppies
Overgrown nails lead to:
Flat feet
Weak pasterns
Unnecessary pressure on the toes and joints
Altered gait/walking
Pain
Damage to the skin, furniture, and hardwood
Temporary or permanent deformity of the feet & ankles
Eventually: joint damage and arthritis
Nails must be kept short and round, not long and sharp. If they touch the ground, they are too long. If you have a puppy that is knuckling, has flat feet, or has another bone growth disorder, nail maintenance is even more important.
Discourage your puppy from jumping, especially if the landing is on a hard or slick surface. Use a washable, tough bed in the crate to keep feet off the hard crate pan when crating for extended periods.
Do not allow your puppy to zoomie and slide all over the hardwood and tile floors in your home.
It is important to help your puppy strengthen those feet, tendons, and muscles.
Great Dane puppies should have large, well-knuckled feet. The toes should not be flat. We’ve included more information below on what good foot structure and strong feet should look like!
Check out THE GIANT DOG FOOD PROJECT to compare brands and values.
How to strengthen weak Great Dane puppy feet
Exercise ideas for strengthening Great Dane puppy feet and pasterns:
Lots and LOTS of free play on varied terrains such as grass, sand, and pea gravel.
Walking up and down gently rolling hills.
Have the puppy stand on the bed or the couch, and gently touch each side with a flat palm to encourage the puppy to ‘balance’.
Use a stability disk or cushion. Encourage the puppy to stand with both front feet on the disk.
When indoors, keep the puppy only on soft surfaces.
Limit time spent walking on concrete and in the ‘heel’ position.
Create a puppy playground and encourage your puppy to safely explore ramps, tunnels, and things that wobble a bit.
Be careful about over-using a crate (restricted movement all day and all night) or keeping your puppy on a tile or linoleum floor all day long. This practice can contribute to weak feet, knees and hips.
Make sure that your puppy receives plenty of time to move outside of the crate or X-pen when you are home.
If your puppy has a severe case of knuckling, consult with a veterinarian and certified canine physical therapist before adding any additional exercise!
Some cases of knuckling benefit from wraps to support the limbs; a professional can help you. We do NOT Recommend wrapping without professional guidance.
This puppy has weak flat feet, and weak pasterns, and shows what may be early signs of knuckling.
Around 5-7 weeks puppies can appear to have flat feet and early knuckling, which will correct itself if the puppy is given the correct food.
Feet and pasterns may ‘fall’ a bit following surgery (ear cropping, for example) and during teething.
It’s easy to become alarmed each time this happens, but it’s important to monitor progress toward the end goal: tight knuckles and straight limbs!
A young Great Dane puppy with slightly flat feet
Great Dane puppy knuckling can look much worse than it is, but it’s still essential to immediately begin correcting the problem.
Failure to correct knuckling could lead to permanent deformities of the limbs that may become painful and may eventually lead to arthritis or require surgery.
Have you had a puppy knuckling? What did you do to treat it? How quickly did it resolve?
Use the comment section below to tell us about it!
If you are concerned because you have a Great Dane puppy with knuckling, crooked paws, bowed-out legs, or bumps on the front legs, you’ve come to the right place. It is important to understand what causes knuckling over, and how to quickly fix knuckling in Great Dane puppies.
Knuckling over, better known as “Carpal Laxity” is one of the challenges that may arise during the explosive puppy growth phase.
As you are now aware, giant breed puppies, known for their rapid growth, can sometimes face orthopedic concerns that affect their front legs. This post is a big one, and in it, we are providing the most up-to-date information based on science & research! Use our table of contents to navigate.
In this post we will discuss:
How to determine if your Great Dane puppy is knuckling
What causes knuckling in giant breed puppies
How to fix knuckling over, flat feet, and carpal laxity in Great Danes
A Great Dane puppy knuckling over, with carpal laxity
What is Knuckling Over in Puppies?
Knuckling, or Knuckling over is the layman’s term for a large or giant breed puppy when their front limbs collapse. You can see in the image above that the knuckle joint is bowed over the foot.
This condition is a result of fast growth and while it looks alarming, it is one of the least concerning growth disorders that big puppies can face!
Is Puppy Knuckling & Carpal Laxity the Same Thing?
The WORD “knuckling” and carpal laxity go hand in hand. However, the word “knuckling” is medically incorrect for this condition.
In other words, the use of the word ‘knuckling’ is actually a misnomer!
When people say ‘knuckling’ in reference to bowed legs on a giant breed puppy, what they really mean is “Carpal Laxity”.
True knuckling is actually a neurological condition, usually associated with more serious disorders in older dogs. To be clear, the use of the word ‘knuckling’ in reference to Great Dane puppy feet is basically slang.
Now that that is out of the way, it’s important to note that I will be using the terms “Carpal Laxity” and “Knuckling” interchangeably in this post.
When you speak to your vet, mention that you have concerns about carpal laxity. This will make much more sense to them, and their diagnosis will make much more sense to you, too!
Is Knuckling Over in Great Danes Serious?
Knuckling over is one of the most common growth complications in Great Danes and other giant breed puppies.
With carpal laxity, the dogs weight becomes too much for the quickly developing bone and cartilage, and the legs ‘buckle’ or go flat in response to the stress.
Some puppies have a mild case of knuckling over, others have a more severe case. Either way, this is a notable (and reversible) condition that requires treatment.
It often pops up with very little warning, and puppies can be normal and then wake up from a nap buckling over. Other puppies show early signs, such as having shaky legs and flat feet.
While the exact cause of knuckling is unknown, it is believed to be related to dysfunctional (too fast) growth, often brought on by improper nutrition. Excessive or improper exercise and slippery or hard surfaces can cause further damage to the lax joints.
It is a condition that requires swift action and treatment, however, it is NOT a serious condition requiring life-saving measures. Don’t stress! With the right treatment, this problem resolves quickly.
This photo above is of an 8-week-old Great Dane puppy who was diagnosed with HOD and knuckling. This is a severe case. Knuckling can look more mild or more severe than this.
Normal Great Dane Puppy Growth vs. Knuckling
Many people mistake normal, knobby growth plates, flat feet, or angular limb deformities with knuckling!
Healthy Great Dane puppies will often have large, knobby growth plates on their front paws. These growth plates may swell a little bit before a growth spurt; this is normal!
However, excessive swelling is indicative of problems such as HOD and PANO which are much more serious than carpal laxity. Always monitor the condition of your puppy’s growth plates and report to your veterinarian; if there seems to be pain, limping, and/or a lot of swelling.
What are the Signs & Symptoms of Puppy Knuckling?
This photo above is a fairly severe case: notice the bowed appearance and toes.
It’s important to understand the warning signs that may indicate early or developing bone growth problems in your puppy, and see a giant-breed-knowledgeable veterinarian ASAP. Left untreated, puppy knuckling can lead to permanent damage and deformity.
Symptoms of puppy knuckling over and carpal laxity include:
Weak limbs that ‘shake’ on soft surfaces
Flat toes/splayed feet
Ankles that rest over the top of the foot
Bowing out
Flat feet (another form of carpal laxity)
Crooked front limbs or ‘ballet feet’ (which may also indicate growth plate damage and angular limb deformity, more serious than knuckling)
We’re going to dig more into how diet affects bone growth in large and giant breed puppies below, but before we get there, check your food! If the calcium level is above 1.2% it should NOT be fed.
How to Quickly Fix Puppy Knuckling in Great Danes
I’m going to deep dive into the nutritional and environmental issues related to knuckling below, but if you are reading this article you may be looking for a quick fix.
Here is the long and the short of how to QUICKLY fix puppy knuckling:
Encourage lots of free play on soft, varied terrain such as grass, sand, and gravel
Do NOT use a harness, which can restrict natural movement
Put runners and rugs down in your home
Avoid slick or hard surfaces and jumping
Utilize orthopedic bedding
See your veterinarian for further instruction and monitoring
Here is our heavily researched list of the best foods for Great Dane puppies, especially if they are suffering from any kind of growth or orthopedic disorder:
Check out THE GIANT DOG FOOD PROJECT to compare brands and values.
What Causes Knuckling in Giant Breed Dogs?
While the exact mechanism behind the cause of knuckling still needs more research, there are strong correlations to diet and exercise practices. If you have a puppy that is knuckling over, you MUST immediately address the diet.
A proper diet for a giant breed puppy should be like this:
Large or Giant Breed Puppy OR All Life Stages Formula, NEVER adult-only foods
AAFCO Large Breed Growth Statement – this is a MUST-have
1.2% or less calcium, no exceptions
3.5g of calcium or less per 1000kCal
We’ve partnered with the Giant Dog Food Project to develop a search tool that allows pet owners to sort through nearly 700 brands and formulas, and find the ones that match those values. Visit the Giant Dog Food Project Pet Food Search Tool HERE.
Feeding an unbalanced diet can cause knuckling over
Feeding an unbalanced, nutrient-dense fussy diet is thought to be the leading cause of knuckling. Too much calcium and feeding too much food or too many toppers, treats, and supplements cause the puppy to grow unevenly.
Here is a list of things that cause a diet to be unbalanced:
Poorly formulated kibble (see our recommendations)
Regular puppy foods that were not designed for large+ breed growth
Adding supplements such as calcium or multivitamins
Adding too many unbalanced toppers such as yogurt, cottage cheese, eggs, and meat
Offering too many treats and training treats
Feeding a food that was not formulated for large or giant breed dogs (the ratios are different)
Mixing two or more types of kibble
Home-cooked or homemade raw diets (which are rarely formulated correctly)
Switching diets, especially when doing so often
Feeding a kibble that is not formulated by a veterinary nutritionist or Ph.D. in Animal Nutrition
Do any of the things on the list above apply to you? We will outline them in detail below.
Feeding the wrong kibble
We believe in science.
Science tells us that the only appropriate kibble for a Great Dane puppy is a LARGE or GIANT breed puppy or “All Life Stages” formula from a brand that meets veterinary guidelines for ethics, sourcing, testing, research and responsibility.
You may have heard that Great Dane puppies should “only have adult food”. This information is outdated in 2022 and may actually be dangerous. We’re digging more into the science of this below!
Choosing an appropriate food for your Great Dane puppy means that it should be:
Ideally be formulated by an on-staff, full-time, board-certified Veterinary Nutritionist
A large or giant breed puppy or “all life stages” formulation that was created to support slow, even growth of large and giant breed puppies
Be rigorously tested, researched and subjected to feeding trials
Come from an established brand with lots of peer-reviewed research behind it
Meet nutritional guidelines through feed trials and testing, not just be ‘formulated to meet minimums’ on paper
Less than 3.5g of calcium per 1000kCal
1.2% or less calcium
Calcium to Phosphorus ratio of as close to 1 : 1 as possible
AAFCO’s statement that the food was formulated for the growth of (70+lbs) large breed dogs <—important, although not, AAFCO sets minimums. A food can ‘meet the minimum’ and still not be the healthiest choice.
The following brands and formulations are the only ones that meet the requirements listed above. We do not recommend feeding any other food brands to Great Dane puppies, though many people recommend other foods.
Many pet parents will switch their puppy’s food often in an attempt to resolve chronic loose stools, itching, or ‘pickiness’.
All this does is create a puppy who will refuse to eat until toppers or a different food is offered.Picky dogs are created by, you guessed it, US!
This practice also contributes to poor overall gut health, itching, and loose poop.
People mistake these health issues with ‘allergies’ when really, their pup just needs the right amount of correctly balanced food and some time for their gut to adjust.
Choose a proper science-backed food, measure it with a scale, don’t overfeed, and stick with it.
No matter how ‘healthy’ it may seem to offer ground meat, rice, and veggies in lieu of kibble, home-cooked dog food is rarely balanced correctly. Imagine if you ate that kind of diet every day for breakfast, lunch, and dinner. It wouldn’t take long before you started to suffer from malnutrition!
Dogs need correctly balanced meat, bone, and organs in their diet in addition the the right ratios of protein, carbs, fiber, amino acids, nutrients, and minerals.
The website www.balanceit.com allows you to plug in your home-cooked food recipe and see what it’s deficient in. Even recipes made by “canine nutritionists” and celebrity veterinarians are often wildly incorrect.
Homemade diets should only be made under the guidance of a board-certified veterinary nutritionist and NEVER for growing giant breed dogs.
Overfeeding Great Dane Puppies is Bad for Growth
Feeding too much food to a puppy can cause uneven, fast growth, loose stools, and knuckling.
Your puppy does need to eat a LOT of food. But too much is a problem.
Puppies that are offered poorly balanced puppy or adult foods, who then overeat to try and get the nutrition they need, can suffer from chronic loose stools, knuckling, HOD, growing pains, and permanent joint deformities.
Great Dane puppies that are offered ‘adult only’ food in particular may need to eat much more than necessary.
Adult food doesn’t provide them with enough nutrition for their energy levels and muscle development.This is one reason why we see so many teenage Danes with ongoing loose stools that look like walking skeletons with no muscle: they are literally starved for nutrients and will over-eat to try and compensate.
We no longer recommend choosing adult formulas. All Life Stages Large and Giant Breed Formulas are ok.
A science-backed large or giant breed puppy food from Purina, Royal Canin, Hill’s, Eukanuba, or Iam’s are excellent choices.
Puppy kibbles have more nutrition in the form of calories, fat, and protein. This can make it easy to overfeed, especially if you are used to seeing your Dane pups have to gorge themselves on adult formulas.
Watch your puppy’s body condition and adjust accordingly.
Poor nail maintenance and slick floors
Great Dane puppy nails should be trimmed weekly. Do not ever let them get so long that they touch, scrape or click on the ground.
Hard, slick surfaces contribute to early joint damage.
Encourage your puppy to play freely on soft, varied terrain in lieu of walks on hard pavement. Use runners and throw rugs to eliminate slipping and sliding in your home.
Nutrition & Knuckling in Giant Breeds
It is believed that nutrition is a key factor in bone and growth disorders in giant breed dogs. Current research shows that excess calcium is among the most damaging nutritional problems. Because giant breed puppies utilize every bit of calcium offered to them in their diet (they are unable to get rid of it), their bones take all of it in. That would seem like a good thing, except it’s not!
Excessive calcium is linked to a whole slew of bone growth issues including osteochondrosis, hip and elbow dysplasia, angular limb deformities, retained cartilage cores, and more. Some researchers understandably also speculate that these damaged bones are more susceptible to developing things such as Osteosarcoma (bone cancer) and Wobbler disease later in life.
It is extremely important to find and stick to an appropriate balanced diet for your puppy! Unfortunately, the giant breed community still promotes many myths. These myths are NOT rooted in current research and science.
Common Great Dane puppy food myths include:
“Great Dane puppies should never have puppy food”
“Purina, Royal Canin, and Hill’s Dog foods are trash”
“Protein levels MUST be below 24%!”
“Fresh roasted deboned meat, fruits, and veggies are healthy and more nutritious for dogs than meat meals made of muscle, bone, organ, and cartilage”
We recommend:
Protein – ignore this number if you are choosing a professionally balanced food recommended on this page. This is a myth that was disproven by peer-reviewed research. The protein level does not matter. The bioavailability of amino acids, as well as calcium and phosphorus levels, DO matter.
Fat – ignore this number as well, for the same reason as above
Calcium 1.2% or lower (1.3 – 1.4 can also be okay if you do not add any toppers or supplements). Overall calcium intake should never exceed 3.5g per 1000kCal.
Phosphorus is close behind calcium.
The following brands are correctly formulated and tested for the growth of our gentle giants.
There are 300-400 new boutique food brands offered each year in the U.S. When you choose science instead of fancy bags and marketing, it’s easy to narrow the options down.
Foods with fresh ‘deboned meat’ paired with peas, potatoes, fruit and veggies. These foods sound nice but in reality are likely to be heavy in starch and low in meat.
Choosing the correct food for your Great Dane puppy is extremely important! Chat with your breeder and a giant-breed knowledgeable veterinarian for more advice.
Vitamin C for Treating Puppy Knuckling
Many people swear by Vitamin C to aid in the treatment of knuckling in Great Danes. Vitamin C is a known antioxidant that is important in bone formation. However, some researchers say that adding too much to the diet can have the opposite effect.
In addition to addressing the nutritional aspect of knuckling (we recommend switching food immediately with a short transition period), there are other things you can do!
Change the diet ASAP. This is the MOST important step you can take. Stick with what you choose.
Put runners down, everywhere. Your puppy should not be jumping, sliding, running or walking anywhere with a slick surface, especially while treating knuckling.
Do not allow your puppy to jump up or to launch themselves off of furniture. Use ramps, training, crates, and gates to prevent this behavior.
Avoid hard pavement and leashed walks, which are hard on joints and don’t allow the puppy to move naturally.
Don’t run or bike jor with your Dane puppy until they are age 2+, have good hips and feet and are well conditioned to exercise.
Avoid training methods that use physical force and pressure for down/sit, alpha rolls/pinning, extended down-stay or long ‘pack/structure walks’. None of that is healthy, natural or necessary, especially for giant breed puppies.
Limit crate time, which can lead to weakness and poor orthopedic development.
Unless your veterinarian prescribes rest, allow your puppy to freely walk, move, run and explore varied terrain every single day. Grass, sand, gravel, hills, and dirt are great examples. As a bonus, this is great for socialization! Use a long leash or a fenced yard.
Work with a certified Canine physical therapist to strengthen the feet, toes, ankles, shoulders and core.
Choose orthopedic beds, like the BIG BARKER (our personal favorite).
TALK TO YOUR BREEDER! They can be the best resource, especially if you’ve done your research and chosen an ethical breeder that supports your puppy for life.
We always believe that you should also work with a giant-breed experienced veterinarian!
Some bone growth issues are much more serious than knuckling (angular limb deformity, HOD, and Wobblers for example) and it’s important to rule them out.
Have more questions about knuckling or want to share your experience? Leave a comment below!
