Treating a Rare Case of Flat Puppy Syndrome (Swimmer Pups)

A puppy came in with what looked like a fatal deformation. I was surprised to find that he had this rare — but treatable — condition.

By: elvissa
No one is sure why dogs develop flat puppy syndrome. By: elvissa

The stakes were high, and the outlook was poor. With all my heart, I longed to give the family good news, but my head said differently. This pup, splayed before me on the X-ray table, wasn’t going to make it.

Apart from the distress of losing a home-reared puppy, the stakes were especially high with this dog. His mom, a yellow Lab, originally belonged to the client’s son, who had died under tragic circumstances. The son had always wanted to breed from his dog, and so this litter was the fulfillment of a promise by his parents.

However, the mother dog had a rough pregnancy and a difficult whelping, and was unlikely to withstand another pregnancy. Of her litter, only this one precious puppy remained. And he wasn’t well.

Unable to Walk

His problem became obvious when he started to learn to walk — or rather, when he didn’t.

He struggled to get his legs underneath him, and one back leg stuck out at an odd angle. I checked him over, but there was no obvious physical problem. No broken bones and no dislocations. Because he was only 3 weeks old, we decided to wait and see.

With the passing weeks, our unease grew. The only remaining pup of a mom with lots of milk, he was a sturdy and rotund, but even though he was thriving in one way, his mobility got worse.

At 5 weeks, when he should have been running around, he was more seal than Labrador — at best worming himself along. Now, with both back and front legs splayed out to either side, he was unable to stand.

Distraught Family

His distraught caregivers were worried that he had dislocated hips, so we X-rayed him.

His hips were fine, but a new problem became evident: His chest was flattened, top to bottom. Think of squashing a ball of dough, and you start to get the picture.

In 25 years of practice, I’d never seen a case like this. The condition is also known by these names:

Pizza Pups

These dogs have legs that stick out at the corners (like a turtle’s would).

Because the limbs can’t support them in a standing position, the dogs try to move with swimming motions. In this pup’s case, all the other tests came back normal or negative, so being a pizza pup looked even more likely.

No one is sure why puppies develop this condition, but some feel it’s because of delayed myelination of the motor nerves (a delay in the nerves becoming insulated). However, whether this is significant or not, it tends to occur where there is only 1 puppy (or kitten) in a litter, and that puppy feeds well and is quite heavy considering the age.

Righting Reflex

Typically, these puppies rest all the time on their sternum (breast bone).

If made to lie on their side, their righting-reflex forces them back onto their sternum. As they grow, their chest becomes flattened — and much like trying to balance a pizza on its edge, they can no longer lie on their side.

Treatment is a matter of physiotherapy and slowly training the legs to go under the body. This involves 4 or 5 physio sessions of 10 minutes each, every day. In addition, slowing up the weight gain is a good idea so the puppy slims down.

In this video, Sue Rogers shares about Mick, a Boston Terrier with splayed legs:

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A Glimmer of Hope

For once I was able to call and say there was hope. Fortunately, this puppy had an extremely dedicated family who was prepared to do whatever it took to get him back on his paws.

Their exercises included hydrotherapy to encourage him to move his limbs and swim to strengthen the muscles. They also applied the dog equivalent of padded handcuffs to keep his legs underneath him.

They stimulated his nerves by regularly tickling his paw pads with a toothbrush. They changed his bed so he could lie supported on his side rather than on his sternum.

Finally, they spent hours each day making walking movements with his legs.

A Happy Ending

I’m delighted to stay their efforts were rewarded. We knew things were going well at a follow-up appointment when the puppy wouldn’t stay in his cardboard box.

Best of all, 1 month later he had to be carried in because because he wanted to run around.

It was a learning curve for me and, thanks to the couple’s dedication to their special pup, a happy ending.


This pet health content was written by a veterinarian, Dr. Pippa Elliott, BVMS, MRCVS. It was last reviewed Dec. 17, 2018.