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Old 03-09-2012, 08:36 PM   #1 (permalink)
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Carpal Flexural Deformity, aka knuckling over or bowed legs

I have seen several people come to DT looking for help with their pups who have carpal flexural deformity. Often people search for the phrases "knuckling over" or "bowed/bowing legs".

My puppy, Axel, had a significant case of carpal flexural deformity. At least one of his littermates did, too, but not as bad as Axel. I was told several times when it first started that he would just outgrow it and not to worry. But he didn't. He just kept getting worse and worse. I was told if I wanted, I could give him calcium supplements or Vitamin C. My vet said that calcium is an old school way of thinking and can actually be counter-productive. Vitamin C wasn't going to hurt anything if I wanted to give that.

I'll start out by showing a photo from before any signs showed. I already had him at home, and his legs were just fine.



Then 3 weeks later he looked like this:



Here he is at its worst when he was a little over 2 months old:



This is when I found DT and the other littermate who was going through the same thing. The thread for everything we went through is here: What to do about knuckling over?

My vet and I consulted 2 orthopedic specialists and saw a canine physical therapist in addition to numerous regular vets. I researched the bejeezus out of carpal flexural deformity and this is what is working for Axel, who is still healing at 22 weeks but has seen tons of progress.

1. You want to grow your puppy slowly. Get him on a lower protein food, no more than 23-24% crude protein. All dog food packaging will tell you this content. Be sure to verify any treats or snacks you give him is low protein as well.

2. Limit his food to 3 small portions throughout the day. At 14 weeks I was feeding Axel about 2 cups of food in three meals combined. You don't want to feed him so much that you get that swollen puppy belly look. You want to keep him slim. The less weight he has to support with his legs, the better. If you start to see several ribs or the bones on the top of his back start to protrude, then he definitely needs more food. You can also tell if the food is good enough if his coat is smoth and silky.

3. If your home has hard floors such as tile or hardwood floors, buy some cheap nonslip area rugs from Walmart so his paws can grip the floor for better support and strength building.

4. Do stretches on your dog's legs several times a day. Little by little you want to stretch out his legs so they will stand correctly. Take one of his front legs in your hands. Hold it as straight as possible and gently push up on his paws so they are in a position similar to how they would be if he were standing. If they're not stretching all the way now, don't worry, he can get there with diligence.

5. Most definitely get DogLeggs carpal supports for your puppy. They have made all the difference for Axel. His legs kept getting worse and worse until he started wearing these. They require a vet's prescription. Pay for the interior lining and the extra support strap for each leg. They cost me about a total of $120USD. The puppy doesn't have to wear them while he's sleeping, so that's nice. They don't cause sores from chafing, either. Plus you can machine wash them. Carpal Support | DogLeggs Theraputic and Rehabilitative Products

The DogLeggs carpal supports are custom sized to your dog. I sent the company this photo of Axel's legs when he was 10 weeks old to create the custom-made supports:



And here is a photo of him wearing them for the first time less than 2 weeks later:



Here is a photo of him after wearing them for a week:



Here is a photo of him after wearing them for 2 weeks (you can see I added the rug in the kitchen on the tile):



6. Until his legs are mostly standing straight, keep his activity to a minimum. Crate him most of the day, except for potty and food if you have to. This won't last forever, but is necessary for a little while. You might have to put up with some protesting, but it's for his own good. Once his legs are supported or mostly straight, exercise is good for him, but nothing forced, such as taking him for a long walk or run. Let him just play naturally and don't push him to run hard.

Axel is still on his road of healing, but he's seen great improvements. His legs still bend a little bit inward now but he's running and playing just fine. Whenever I know he's going to be active, I still put the supports on his legs.

Here is a photo of him at 4 months:



And here is one a couple weeks later (two weeks ago). This one he is laying down, but you can see there is still a slight bend in his legs.



If anyone ever has questions or concerns about carpal flexural deformity/knuckling over/bowed legs, please comment or PM me. I'm more than willing to share my and Axel's experiences with you in hope that it can help your puppy. If I think of anything else, I'll add it in a comment.

I put this in the Puppy Corner section since this is mostly a condition found in puppies, and this is where most people post asking for help. If a mod wants to move it to the health section, that's fine, too.
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Old 03-09-2012, 08:55 PM   #2 (permalink)
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wow, his earlier pics are tough to look at. Glad to see he's made progress. Will he always have to wear the braces?
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Old 03-09-2012, 08:57 PM   #3 (permalink)
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Yeah, my stomach still knots up whenever I look at those earlier photos. I'm just SO grateful that he has improved so much. At this point if nothing changes, he will live a completely normal life, he just won't ever be able to compete in any trials or shows, but I wasn't planning on doing that anyway.

No, he won't always have to wear them, but he probably will for a few more months. Until there's no more hope of straightening them further, he'll wear them. I believe I heard the growth plates don't close until he's around 18 months old, so I guess there's hope up until then.
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Old 03-09-2012, 08:57 PM   #4 (permalink)
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great idea for a thread..........so sorry your puppy had to go through all this. I hope all will be well.

In all my years with Dobes, until i joined DT, i had never seen this problem.

there have been quite a few posted on DT.

so sad.

Hugz to Axel!
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Old 03-09-2012, 09:02 PM   #5 (permalink)
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I'm sorry your sweet sweet boy had to go through that, but I'm so glad we have a very informative thread from it. I hope this can help some future pups. Thank you!
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Old 03-09-2012, 09:10 PM   #6 (permalink)
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A question, did you give the vitamin C? Did any of the specialists tell you to feed grain free or to stay away from carbohydrates? That is what Dr Becker says for pano, but she didnt cover knuckling over. Dang, I hate it when you get differing advice. /////// Thank you very much for posting.
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Old 03-09-2012, 09:12 PM   #7 (permalink)
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I gave some Vitamin C, but I didn't notice a difference from it. Never heard or read anything about using grain-free food or to stay away from carbohydrates. Just to use a well-balanced low protein food.
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Old 03-09-2012, 09:27 PM   #8 (permalink)
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Did you give 500 mgs twice a day and are you still giving vit c? Parkers breeder sent me home with instructions to give vit c, 500 mgs and to work up to 500 mgs twice a day. I bring it up as another recommended preventative/treatment for pano and other bone diseases. AND when I ran out of vit c and didnt get more immediately(like week or two), Parker came down with Pano during this small time frame. That always made me suspect there was a connection.////// Again, thank you and I hope your boy continues to improve.///// We ought to mention that it is ordinarily males who seem to develop these growing diseases.
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Old 03-09-2012, 09:38 PM   #9 (permalink)
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Axel never had pano, so I don't think pano is connected to the carpal flexural deformity. Vitamin C may be connected with pano, but I don't think it made a difference for Axel's legs, and the vet said he didn't think it would help either, but it wouldn't hurt to try.

I got up to 500 mgs twice a day for a while, but when I got the carpal supports, I stopped because they actually did make a difference.

Axel's littermate who also had this is a female. I later found out that the "breeder" had several pups who experienced this (he failed to mention this to me when I asked about medical conditions in his dogs.) I think it may be more strongly related to genetics than gender. Also he was feeding his brand new pups a 32% protein dog food.
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Old 03-09-2012, 09:43 PM   #10 (permalink)
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Sorry for what you are going thru and glad to see Axel is doing so much better. Thanks for sharing your experience. I am sure it will be useful to some.
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Old 03-09-2012, 09:50 PM   #11 (permalink)
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During that 3 week timeframe when the CFD started, what was his feeding/exercise routine like? What food were you using and how many times per day did he eat? (before his actual diagnosis).
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Old 03-09-2012, 09:54 PM   #12 (permalink)
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I had him on Blue Diamond large breed puppy food. The litter was eating Blue Diamond extreme athlete food, so I tried to get as close as I could find. He was eating probably about 1.5 cups a day total split into 2-3 meals.

I was giving him jerky treats, which are 60+% protein, too! Oops!

I was walking him down the street maybe 4 houses down and back once a day. And he played with my sister's GSD who lives with us. (My sister and I are roommates.)
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Old 03-28-2012, 08:16 PM   #13 (permalink)
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Hi, my pup, Blu, is having the same issue. I have followed all the suggestions here and she seems to be improving. My only question is regarding the area rugs; my entire house has hardwood/laminate floors. I bought a few rugs but not sure if this is enough as Blu is usually all over the house. How extensively should the floors be covered? Any suggestions?
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Old 03-28-2012, 08:25 PM   #14 (permalink)
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He was one lucky pup he landed with someone as tough, innovative and determined as you are!
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Old 03-28-2012, 08:49 PM   #15 (permalink)
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OP- did any of the other pups in this litter develop CFD? I *think* it was mentioned there was one other pup, if I remember correctly. Any other pups that you know of?

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Old 03-28-2012, 09:37 PM   #16 (permalink)
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Hi, my pup, Blu, is having the same issue. I have followed all the suggestions here and she seems to be improving. My only question is regarding the area rugs; my entire house has hardwood/laminate floors. I bought a few rugs but not sure if this is enough as Blu is usually all over the house. How extensively should the floors be covered? Any suggestions?
I put down runner rugs in most of the walkways in my house and as many large area rugs my space allowed. They were really cheap at walmart and only need to last until he is fully developed. Put as many as you can and that will have to be enough.
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Old 03-28-2012, 09:43 PM   #17 (permalink)
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OP- did any of the other pups in this litter develop CFD? I *think* it was mentioned there was one other pup, if I remember correctly. Any other pups that you know of?

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There was one other littermate that I know of, a female. She didn't get as bad and is looking good now, last I heard. I know of at least one other pup from the same litter that did not have this problem.

I later learned that there were pups from previous litters with this problem, but not all the previous pups. But discussing that will only raise my blood pressure!
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Old 03-28-2012, 10:02 PM   #18 (permalink)
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do you know if the same sire/dam were used? I wonder if it's more heredity or an environmental issue that dogs develop CFD.


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Apparently dogs from previous litters have had this problem, but discussing that will only raise my blood pressure!
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Old 03-28-2012, 10:22 PM   #19 (permalink)
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do you know if the same sire/dam were used? I wonder if it's more heredity or an environmental issue that dogs develop CFD.
That's tough to answer based on my experience. Where I got Axel, there was a history of this with pups by the same sire, different dams, even. Apparently the sire had it, too, and even looked as bad as Axel, and now looks great. But also, they were feeding the mother and pups an extreme athlete dog food with very high protein levels. I wonder if it might have been a combination of the two.

I've also heard it can happen if the pups are kept in a confined space where they can't stretch, but that was not the case for my dog.
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Old 03-28-2012, 10:46 PM   #20 (permalink)
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Thank you so much for sharing the information you have gained as well as Axel's struggles and progress. You will likely end up helping and/or giving hope to more folks than you know who find this thread when dealing with a similar problem.

I'm thrilled to see the progress he has made, and thank your for dedicating so much time, energy, love, and effort into rehabilitating your puppy. He is lucky to have found a home as caring as yours. He looks like he has improved tremendously, and I hope you have continued success with his legs.
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Old 03-28-2012, 11:53 PM   #21 (permalink)
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This is a great post. Thank you for taking the time to go into such detail with all the photos.

I second that Axel is so lucky to have you. What a wonderful bond I bet you have between you. He is just adorable. So glad he is getting better.

Did I understand you had him on Blue Diamond when he was being treated or was that the food you fed him initially? If that's not the correct food you gave him during treatment, what food did you feed? What treats did you give him?

Thank you again for sharing this experience.

Please hug Axel for me.

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Old 03-29-2012, 08:24 AM   #22 (permalink)
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He was only on blue diamond for a couple weeks. I switched him to a Natural Balance food for all ages with like 20% protein. It seems to have made a difference because he has grown considerably slower than my friend's GSD who is only 12 days older.
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Old 03-29-2012, 09:07 AM   #23 (permalink)
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What treats did you feed?

Thanks.
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Old 03-29-2012, 09:45 AM   #24 (permalink)
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I remember the first thread on this, I felt so bad for him... So glad to see he has made such progress!! Way to go!!
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Old 03-29-2012, 10:23 AM   #25 (permalink)
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What treats did you feed?

Thanks.
It's pretty easy to find low protein treats. He loves the Busy Bones: Chewnola and Rollhide. Both of those are 14%. Also Pedigree Dentastix and Natural Balance Tillman's training tips.
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