Sore hocks in Rabbits

Pododermatitis

Also known as ulcerative pododermatitis, parakeratosis, foot abscess, sore hocks, or sole ulcer.

Sore hocks are a fairly common issue in pet rabbits kept indoors, though outdoor rabbits can also be affected. It appears to be the most common skin disease in rabbits. Unfortunately, treatment is often lengthy, and mistakes in care can worsen the condition.

When rabbits are sitting, they shift their weight onto the back of their feet. During movement, most of the weight is placed on their toes. Unlike dogs or cats, rabbits do not have paw pads, so changes in movement patterns or unsuitable flooring can have severe effects, often leading to sore hocks quite quickly.

Causes: How Do Sore Hocks Develop?

The main causes are:

• A surface that is too hard, such as PVC or other flooring, paving stones, gravel, sand, or pellet bedding without sufficient soft covering. Alternatively, a surface that is too uniform, causing the paw to be subjected to the same pressure repeatedly. On hard surfaces, the claws cannot sink in (as they would on natural ground), leading to incorrect weight distribution.

On a soft surface, the claws sink in, and the paw is supported at multiple points. On a hard surface, however, the weight is concentrated on just a few areas. This is why pododermatitis is primarily a problem in indoor housing.

In cases of chronic pododermatitis, displacement of the superficial flexor tendon (flexor digitorum superficialis) can occur, leading to persistent incorrect weight distribution. Such animals must be kept on an extremely soft surface permanently. (According to Varga, M. 2013)

• Hard carpets that generate significant heat through friction can wear down the fur and even the skin (e.g., artificial grass carpets). However, not all carpets are unsuitable—especially soft carpets that do not heat up with friction can be used. The feet should be able to „sink in“ properly. In commercial rabbit farming, animals kept on perforated flooring, wire grids, or unsuitable slatted floors that do not drain moisture properly and cause incorrect weight distribution are particularly affected.
• Wet, damp, or dirty hind legs (caused by unclean housing, poor hygiene, non-bedded areas where rabbits sit in urine, infrequent cleaning, incontinence, diarrhea…) lead to a loss of the fur’s cushioning function.
• Overgrown claws, misalignments such as bowlegs (O-legs) or knock-knees (X-legs), amputated limbs, arthritis, or other joint diseases often lead to improper strain, incorrect weight distribution, and shifting of pressure on the foot, ultimately resulting in sore hocks.
• Studies have shown that animals kept in small cages are more likely to develop pododermatitis than those with more space. A large enclosure and regular exercise reduce the risk of sore hocks. This is because, with limited space, the foot is subjected to more uneven pressure.
• The same applies to movement avoidance due to pain (e.g., joint diseases or pododermatitis). Chronic pain leads to constant misalignment, which further intensifies the inflammation and pressure, creating a vicious cycle.
• Large/heavy breeds (especially German Giants) or overweight and pregnant rabbits, as they place significant weight on their hind legs.
• According to studies, female neutered rabbits develop pododermatitis more frequently (54.7%) compared to intact females (23.4%), possibly because they move less and are often overweight. The same applies to male rabbits (neutered 54.9%, intact 39.2%).
• An improper diet, consisting of pellets instead of fiber-rich foods, along with deficiencies in vitamins, fatty acids, and amino acids, is also considered a contributing factor.
• Lack of fur on the hind legs (e.g., due to diarrhea, where the fur was cut away, or in Angora and Rex rabbits, which often have irregular fur growth). Never trim or shave the fur on the feet!
• Matting on the soles of the feet leads to improper weight distribution and should be carefully combed out. Please avoid cutting too much, as the fur is the only cushioning for the skin, which lies directly on the bone.
• Injuries to the sole of the foot can trigger pododermatitis.
• In advanced stages, fungi or parasites often infect the wound, significantly worsening the condition.
• Due to the chronic inflammation, the superficial flexor tendon can become displaced, causing the animal to be unable to stand on its toes and put even more pressure on the back part of the footsole.

Symptoms: How to Recognize Pododermatitis

Sore hocks develop gradually. Initially, there may be a bald, non-inflamed area underneath a layer of fur that can be parted. Later, the area becomes exposed, and the fur falls out. Shortly after, the area becomes inflamed, turning redder, and may even burst open, leading to severe inflammation and scabs. The rabbit will show pain reactions when pressure is applied to the affected area (e.g., head movements, defensive movements, etc.). If the rabbit is also infected with fungus, the condition often spreads up the entire leg or even to the foot. Abscess formation is also possible. The worst inflammation is often beneath the surface, sometimes involving the bone.

Caution: At the age of one to two years, most rabbits naturally develop a small, round, hairless area on the „heel“ that is not red, thickened, or inflamed, but is covered by a thick layer of fur. This does not require treatment, but it should be monitored. If the area becomes slightly flaky, it can be gently treated with a compatible cream using a cotton swab (ensure that the surrounding fur is not treated with the cream!).

There have been various attempts to determine the severity of pododermatitis. One of the most reliable classifications is the one proposed by Mancinelli (et al., 2014):

Treatment: How is Pododermatitis Treated?

Important: Consult a veterinarian who specializes in rabbits! Regular veterinarians may not have the necessary expertise in rabbit care.

Incorrect treatment methods can unfortunately worsen pododermatitis significantly. How it is treated depends on the condition of the feet. The veterinarian will assess the situation and determine which measures are appropriate for the current stage of the disease.

From Grade 1 onwards, surface adaptation, weight reduction for overweight rabbits, spray bandages, and close monitoring (see therapy) are recommended. In case of deterioration or from Grade 2 onwards, veterinary treatment is required. To diagnose Grade 3, a veterinary assessment is necessary, possibly including X-rays to distinguish between Grades 3, 4, and 5 (as the disease affects deeper tissues and may not be fully assessable from the outside). From Grade 6 onwards, limb amputation is required, or in cases of bilateral disease, euthanasia may be considered.

• For sore hocks, changing the flooring is absolutely essential; otherwise, no treatment measure will be effective. It has proven beneficial to equip the enclosure with very soft flooring. The claws and paws should be able to sink in properly. Ideally, the flooring should be covered with a thick layer of wood bedding (no pellets) or soft hay, though this is not always possible in free-range indoor housing. In such cases, soft mats (e.g., yoga mats or washable dog mats made of nylon or faux leather), carpets, vet beds, and blankets should be used and laid thick enough. In indoor housing, foam mats can be placed under PVC flooring to provide better cushioning. Alternatively, you can use rolls of material and cover the area yourself, provided your rabbits don’t chew it (see gallery below). High-quality, thick PVC is often better cushioned. Make sure that carpets do not heat up with friction (cotton instead of synthetic fibers), have a very soft and never rough surface, and offer enough cushioning (possibly lay multiple layers). You can test with your hand to see if the carpet rubs or even gets warm when you rub over it—such carpets are unsuitable. Sometimes, covering carpets with cotton towels can help. Grass is also an ideal flooring material. Walnut leaves scattered over the bedding can have a positive effect on pododermatitis. Uneven flooring can worsen sore hocks, so it’s best to offer a variety of surfaces, preferably natural materials.

• Particularly popular resting spots must be heavily cushioned (using towels, carpets, dog mats made of faux leather, vet beds, etc.).
• The flooring must never be damp; absorbent materials should be used and regularly replaced. The top layer should be moisture-wicking (such as hay or vet bed) and always kept dry and fresh.
• Keep claws trimmed very short and cut them every two weeks!
• Matting on the feet should be combed out and cared for!
• Identify and treat the underlying cause (joint diseases, obesity, incontinence, etc.).
• Veterinary treatment is largely based on the wound (where is it located? Is it open? Is there fungal or parasitic infection? Is there bone involvement?). From grade 3 onwards, intensive, specialized wound care is required. The veterinarian will decide, after a thorough examination, which wound cleaning (to remove dirt, necrosis, biofilm, debris, dressing residues, and excess exudate) and flushing are necessary, as well as which measures, medications, bandages, ointments, and wound gels are appropriate for the specific wound.
• Veterinary treatment is heavily influenced by the housing conditions. In indoor and well-covered housing, it may be possible to cushion the flooring extensively (such as with vet beds or thick layers of hay) so that the rabbit does not sit on any hard surfaces during movement or rest. This allows the padding to be spared from the bandage. The advantage is that bandage changes become quicker and easier, and the joint remains more flexible, as even the best cushioning may restrict movement. If rabbits, for example, have access to wet grass, the affected area must be protected from moisture during this time, but still remain breathable. Depending on the rabbit (does it pull off the bandage?) and the wound, waterproof bandages, water-repellent dressings, waterproof spray plasters, liquid bandages, or water-resistant baby shoes may be suitable. For Bunnywear and Gertis-Mowerband, you can have waterproof paw shoes custom-made.
• Veterinary treatment is heavily dependent on how well the rabbit tolerates the bandages and whether they remain in place. For some rabbits, simple measures are sufficient, while others may pull off even the most securely attached and complicated bandages. Tip: If a rabbit does not tolerate shoes, it can help to apply a securely fastened bandage for a few days. Afterward, shoes are usually much better tolerated.
• Bandages are only useful for open wounds (from grade 3 onwards). Rabbits have a special anatomy that must be taken into account when applying a bandage. The veterinarian will demonstrate how to apply the bandage depending on where the feet are sore, ensuring it doesn’t restrict the rabbit’s movement. The wounded area must be well cushioned. Some rabbits tend to nibble at the bandage, while most will try to remove it. Therefore, the bandage should be applied tightly and monitored closely. However, it must not constrict the foot! The bandage helps to keep the wound clean and promotes healing. Some owners also use baby socks over the wound dressing and secure them with Leucoplast tape. A wound dressing is placed over the treated wound, which may then be secured with a simple bandage. A few layers of padding should be added for cushioning. Self-adhesive bandages are ideal for properly securing the bandage. In most cases, the toes are not bandaged (if they are, they must be individually cushioned!).

• Ointments should generally only be used with a bandage for open wounds. For „just“ inflamed feet, the cream can cause the foot to soften excessively, and it can smear the fur, potentially worsening the condition. However, it is possible to apply a thin layer of zinc ointment to scaly or damaged areas, ensuring that the fur doesn’t get smeared. Depending on the wound, iodine, zinc ointment, Betaisodona ointment, and medical Manuka honey are particularly effective in healing pus-related issues, in our experience. Zinc ointment works very well for some rabbits.

• Without a bandage, aqueous solutions and protective-care sprays can be applied (for grade 1-2). This is recommended for non-open but inflamed feet. For example, Skingel and Dr. Schaette wound care spray have proven effective. Blister plasters can also help relieve pressure on the affected area and can be stabilized with spray plasters if needed. Liquid bandages are waterproof and help relieve pressure on the skin at the affected site.
• A relatively new treatment option is laser therapy, where the affected areas are treated once or twice a week until healing occurs.
• Another emerging method is cold plasma therapy (e.g., PetCellpen), which can be used to promote better healing.
• Often, a systemic antibiotic is required. Ideally, it should be bone-penetrating. For pus-related issues, penicillin has proven effective, but it should never be administered orally; it must always be injected. If necessary, a swab may need to be taken to determine which antibiotic is most effective.
• If the rabbit is in pain, the administration of pain medication (such as Metacam) is necessary. Pain leads to misloading and reduced mobility, which in turn worsens the misloading of the foot, creating a vicious cycle.
• Overweight rabbits must lose weight until they reach a healthy weight.
• If an abscess is present, it must be treated as an abscess.
• If the feet are already more severely affected, a skin sample should be taken to check for fungal infections, and a parasitic infestation should be ruled out.
• In advanced pododermatitis, the joint and bones may already be involved, so such rabbits must be X-rayed.
• It is important that affected rabbits move well. If they sit a lot, appear less mobile, relieve the foot, or if the joint becomes stiff, physiotherapy may be necessary.
• If there is an underlying condition affecting the rabbit’s mobility (e.g., joint diseases or a painful condition that causes the rabbit to participate less in daily activities and sit more withdrawn), this must be addressed and treated as well. Treating the root cause is essential for improving the rabbit’s overall health and preventing further complications, including worsening of pododermatitis.
• Through diet, oilseeds (such as sunflower seeds and flaxseeds) can help improve the skin’s flexibility and regeneration. A fresh-food-rich diet (mainly green fodder) supports the immune system. UV-B lamps are highly recommended for indoor rabbits. Fresh herbs are particularly beneficial for support. Rodicare Derma is a suitable supplement for rabbits with sore feet. Access to soil (minerals, e.g., through a planted earth dish or slightly moistened healing clay) and a Himalayan salt lick stone should be provided.
• An often underestimated factor is the influence of the immune system. We have observed that particularly weakened animals are more prone to sore feet. By strengthening the immune system, it is usually possible to have a positive impact on healing and prevent relapses.

Building a mat as a soft surface for chewing-prone rabbits:

The edges are covered with a wooden strip. The foam provides cushioning, and the faux leather is washable. Pododermatitis has healed with this measure. Previous treatment attempts showed only moderate success. In addition to the soft surface, littered trays are ideal as a substrate for chewing-prone rabbits with pododermatitis.

Example of a progression:
Treatment included the use of paw boots.

Open hind foot: It healed well with the Bunny Boots treatment.

Sources include:

Blair, J. (2013): Bumblefoot: a comparison of clinical presentation and treatment of pododermatitis in rabbits, rodents, and birds. Veterinary Clinics: Exotic Animal Practice, 16(3), 715-735.
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Drescher, B., Schlender-Böbbis, I. (1996): Pododermatitis beim Kaninchen. Kleintierpraxis
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Mancinelli, E., Keeble, E., Richardson, J., & Hedley, J. (2014): Husbandry risk factors associated with hock pododermatitis in UK pet rabbits (Oryctolagus cuniculus). Veterinary Record, vetrec-2013.
Varga, M. (2013): Textbook of Rabbit Medicine. Elsevier Health Sciences.