u/ritualofsong

Hello! Sorry for the length of this.

3 year old rescue -- breed mix is Siberian husky, GSD, Alaskan malamute. She is 52 lbs. She is DX with IBD (on prescription diet), bilateral carpal hyperextension, ligament laxity, and multiple carpal malformations.

History: When I adopted her, I was told she had a slight permanent limp.

Upon bringing her to my general vet, I learned her left front leg is ripe with issues:

1. she has axial rotation of multiple toes (2, 3 and 5) & this is probably a congenital malformation.

2. 3 and 5 also have malpositioned claws, where they unfortunately grow off from the side of the toe instead of straight forward. This causes friction problems on their neighbor toes, even with obsessive regular trimming and toe spacers. (It's an endless nail trimming battle to stop toe 2 and 4 from having cuts from the claw rubbing on the inside of that toe).

3. Toe 3 also has a chronic, permanent small wound - where a dog's actual nail bed should sit - that according to the general vet and the orthopedic vet, is unlikely to ever heal. Because of how her toe is shaped, the weight bearing part of her toe is sadly not actually the paw pad tissue itself, and this skin that does touch ground can't handle the rubbing.

4. She has severe carpal hyperextension of that left limb. This was the original reason I assumed she had a limp. General vet thought it was probably compensatory issues secondary to her toes being odd and painful, and referred us to an orthopedic vet to see if she was a surgical candidate for the hyperextension and/or the toes.

5. Orthopedic vet said that while surgery is theoretically possible, he strongly felt Mingo was likely to fail because her leg bones are very long and skinny, and the hardware size in comparison to this + her age, energy level, and crate rest requirements were a lot: but he DID think a custom orthotic AFO would help. Her did not recommend surgery for any of the toes at the time, but said it may be needed eventually.

6. She got a custom orthotic for her leg, and it helps a lot with the wrist stability! She wears it for playtime, long walks, and any high energy activity, but is boot free during rest and casual time at home.

The present quandaries:

1. The other leg

2. The chronic cuts

She now has moderate carpal hyperextension in her front other leg. It's progressed somewhat rapidly over the last few months. She does not favor the limb, or limp, and doesn't appear to be in pain from it, but that's a ticking time bomb.

To treat this and the other leg, she has done aquatic PT and although she gained some strength, her baseline ligament laxity is still off anytime she is bearing weight. There is a significant shoulder height difference when she walks again (the boot had evened it out, until the other leg went wonky).

Even with the orthotic, the 3 cuts never heal because even rubbing against the foam of her orthotic boot, or carpets, or soft surfaces) opens up the scab again. I do have a medicated prescription spray for the wound care.

The orthopedic vet was hesitant to remove any weight bearing toes considering how floppy her wrist is already, and the orthopedist has made numerous adjustments to her orthotic to accommodate the cuts and relieve pressure on them. The worse leg's joint already shows osteoarthritis. Since she is only 3 and in her orthotic mostly full time, I'm not sure what else I can do to preserve her joint efficacy?

So, the litany of questions:
Has anyone had a young dog with a similar array of confirmation issues? She has poor structural integrity and since she's so young, I want to do anything I can to preserve her joints.

Is there something I'm missing that anyone suggests looking into? Since her other leg now has carpal hyperextension, albeit more mild, she will probably need a second orthotic for her other limb... Having already done PT and regularly exercising, I think her limb is about as "strong" as it can be. Has anyone had a dog with a malformed paw or carpal hyperextension that wasn't a good candidate for surgery? What sort of things helped? I fear if she does ever need an amputation it won't be long before she is in a front support dog wheelchair... besides swimming and walking on variable surfaces, are there any activities that may help her?

She takes a joint supplement daily. She's on prescription EN Gastroenteric diet for her IBD.

(We've thankfully dogged any toe infections so far from the chronic cuts, but my general vet says she doesn't like the look of toe 3 and if it weren't for her whole constellation of symptoms, she'd recommend it being partially amputated, but given the combination of it all, she thinks managing wound care for as long as possible to delay even more stress on her joints is the best option. Which makes sense!)