What are the four levels of severity for knuckling?

The sources categorize knuckling over into four progressive levels of severity:

• Level 1: This is the beginning stage of early knuckling over, typically observed when a puppy is 5 to 7 weeks old. It is considered common and not highly unusual; it often corrects itself naturally by the time the puppy is 8 to 9 weeks old, as long as the dog is provided with the correct diet.

• Level 2: At this stage (often seen around 8 weeks of age), the knuckling is more pronounced, but the puppy can regain the ability to support its own weight within a week through a combination of a diet change and having the affected legs wrapped.

• Level 3: This is a more severe degree of knuckling. To correct Level 3, it is mandatory to change the puppy’s diet, strictly control the amount of food they consume, allow free exercise, and use leg wraps.

• Level 4: This is the most extreme case, where the puppy is completely unable to stand or support its own body weight. The dog’s toes may become deformed and curl underneath the foot. In addition to a mandatory diet change and exercise control, Level 4 requires significant physical intervention, such as using a spoon splint or even bracing the entire foot to straighten the leg and toes.