Knuckling is a growth disorder in giant breed dogs that causes the legs to become weak and bowed out over the ankles. It is believed to be caused by bad nutrition. Learn how to fix puppy knuckling with the right food and exercise!
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 Some information available about puppy knuckling is outdated, confusing, or misleading.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.
Dogs, especially giant breed puppies such as Great Danes, are susceptible to growing pains, just like humans.
In this blog post, we will discuss the symptoms of growing pains in dogs, how to treat them, and how to prevent Panosteitis from happening in the first place!
Growing Pains in Dogs Overview
What is Panosteitis in Dogs?
Panosteitis, aka “growing pain” or “pano” affects puppies of all sizes, however giant breed dogs such as Great Danes are particularly susceptible.
Pano is an often painful condition where the long bones of the legs become inflamed, causing lameness.
This inflammation can happen on one or multiple legs, and can even move from leg to leg as the condition progresses.
Panosteitis typically begins when puppies are between five and eighteen months old, however, it can be seen in puppies that are younger, too. Sudden onset may be common, and the symptoms will come and go.
If you are concerned that your giant breed puppy has a pain of any kind, it is important to see your veterinarian. Your puppy may be experiencing the following symptoms:
Lameness
Pain that seems to move from leg to leg
Stiffness
Pain when touched
Fever
Decreased appetite
Low energy
Weight loss
It’s important to note that Panosteitis tends to be cyclical. Not only will the pain move from limb to limb, but the symptoms will also come and go.
One day your puppy may seem completely fine, while the next he may be lame on all four legs.
This can make pano frustrating to diagnose, as it can mimic other conditions such as arthritis or hip dysplasia.
Your veterinarian will likely take a complete history and perform a physical exam.
They will ask you when you first noticed the symptoms, if it happens in one or more legs, when it tends to occur, and if there is anything that seems to make them better or worse.
Your vet will also palpate your puppy’s long bones and joints to see if there is any pain or swelling, and then they will take x-rays.
It is important to note that it can take up to ten days for radiographs to indicate changes in bone density. Radiographic evidence of changes in the bone is an important component of pano diagnosis and recurring x-rays may be indicated a few weeks later.
The x-rays will further aid in addressing other bone-growth disorders such as knuckling, HOD, or dysplasia.
There may be a genetic component to Pano, so it’s important to talk to your breeder as well.
This painful growth disorder affects young, large growing dogs and tends to be self-limiting, however, it is very painful and must be treated. An affected dog will have symptoms one day that may be worse or better the next. More than one bone is often affected.
The good news is that most puppies will outgrow the condition by the time they are two years old.
There are things that you can do to help reduce the chance of Panosteitis occurring (more on this below).
Large and giant breed puppies such as Great Danes, Labrador Retrievers, German Shepherds, and Golden Retrievers are prone to growing pains because they grow so quickly as puppies.
It is believed that nutrition plays a role in Panosteitis, however, the direct cause beyond that isn’t fully understood.
It stands to reason that because these puppies are growing so rapidly, their bones and joints may not be able to keep up with the demand, leading to inflammation and pain.
This is a major reason to encourage slow, even growth when raising a large breed dog! Affected dogs have often been growing too quickly and changes must be made to properly support the growth of the long leg bones.
Excessive exercise in rapidly growing dogs may also contribute. Large and giant breed puppies should be encouraged to play and move naturally and freely on soft varied terrain.
Very long walks on pavement, slick or hard floors, sliding, and jumping off of furniture can be detrimental and cause painful lameness and permanent deformities (such as angular limb deformity, which will cover in another post).
Hard or vigorous exercise should never be encouraged.
At Hello Danes, we believe that nutrition plays a key role in the health and well-being of your giant breed puppy.
This includes the role of untested, poorly formulated, or incorrectly formulated foods, treats, and toppers in the development of growing pains. We are covering this more in-depth below, however, it is important to note the following:
Boutique diets, most grain-free kibbles, and adult or All-Life-Stages foods offer unbalanced, poorly formulated and inappropriate nutrition for Great Danes which can lead to many issues including:
Explosive growth and growing pains in giant breed puppies
Growing too fast is a significant contributor to Pano in large breed dogs.
Many people, in their desire to have the biggest puppy, will inadvertently overfeed their young dog or will feed them an incorrect diet and celebrate their incredibly fast growth.
This leads to growing pains, knuckling, flat feet, pano, HOD, and orthopedic disorders such as hip dysplasia.
It is important for owners of large breed puppies, as well as giant breed puppies, to be aware of the importance of choosing a correct diet and limiting intake to encourage slow, even growth, muscle development, and correct bone density.
It is important to seek veterinary advice if you are concerned that your puppy has pain, limping, or lameness of any kind. Below we’ve included everything you need to know for the treatment of acute lameness and growth pains in dogs.
The role of nutrition in Panosteitis pain
We believe that nutrition plays a key role. There is a lot of outdated advice floating around, telling owners of large and giant breed puppies to only feed ‘adult’ food.
“Adult food only” is dangerous advice based on outdated formulas of foods. Science and research have advanced since this time and the most appropriate nutrition is no longer what you may have heard.
If you have a puppy that is experiencing bone diseases and growth problems, including knuckling, HOD, angular limb deformity, flat feet, or too-fast growth you must switch them immediately to food that meets the following criteria:
Formulated by a board-certified veterinary nutritionist
Rigorously researched and tested
Large or giant breed PUPPY formula
AAFCO statement indicating that the food was substantiated in food trials for the growth of large breed puppies (70lbs + as an adult)
We’ve included a list of appropriate foods for Great Danes (and other large or giant pups) below.
Check out THE GIANT DOG FOOD PROJECT to compare brands and values.
Veterinary guidance for growing pains & inflammation
Your veterinarian will also prescribe pain medication to help your puppy be more comfortable when they are experiencing a painful flare-up.
Pain relief is an important component of this treatment, as it will help your puppy feel better and encourage them to move around, which is necessary for correct bone development.
How to care for a puppy with growing pains
A puppy in pain may be unwilling to move much. It is important to be patient and follow these steps for treating Panosteitis:
Encourage slow eating and avoid the use of excessive treats or food toppers (especially during flare-ups)
Talk to your veterinarian if you notice worsening symptoms
Keep in mind that this is a self-limiting disease and with proper support, you should notice positive changes! Most dogs go on to live a normal, healthy life.
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!
