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Hock injury: more than a pain in the rear!

Caroline Zambrano Pet Journalist knows full well how distressing and challenging a major hock injury can be, especially if you're mum to a supersized senior dog like her Anatolian Shepherd Dog, Cruz. 

She shares her story - warts and all - hoping this will help other dog owners put things into perspective, should they face a similar crisis.

"The accident occurred the night before we moved house mid December 2022. Cruz, our 8-year-old Anatolian Shepherd, was in the backyard for most of the evening while we finished packing the remaining few boxes. When we called him in for the night, we noticed him limping on his back leg.

It wasn’t the first time our ‘livestock guardian’ hurt himself chasing birds and other wildlife that dared to enter his outdoor space, so I thought, as I felt around his leg, that he probably sprained a muscle.

By morning the lower hock area was a little swollen and we left Cruz on his bed out on the deck to keep him safely out of the way of the movers while they loaded furniture and boxes into the truck. In the meantime, I could see him running around the deck, barking at magpies and dogs passing by, so I thought it couldn’t be anything serious, otherwise he wouldn’t be acting like a clown.

Cruz waiting to see Dr Rob Zammit
after his hock injury for diagnosis
I was so wrong! Our Vet
Dr Rob Zammit at Vineyard Vet Hospital (Vineyard NSW) took one look at Cruz’s leg and said, “it is an orthopaedic catastrophe!” My heart sunk.

I asked him about our treatment options, and he said “surgery or worst-case scenario... euthanasia” because there’s a chance the surgery may not work! Cruz is a 63kg senior dog with medical issues, including hypothyroidism and arthritis, and would live the rest of his life in pain. “Let’s see what the X-rays show, and we go from there,” advised Dr Rob.

It wasn’t the kind of conversation I was expecting to have, especially during the holiday season, and was in disbelief and scared to think of the excruciating decision we may need to make as a family in the coming weeks.

A few days later, I brought Cruz back to Vineyard Vet Hospital to get the X-rays done. I stood by Dr Rob to keep Cruz calm as he manipulated Cruz’s leg under the machine to get images of different angles.

Dr Rob was right – it was an orthopaedic catastrophe; his hock was dislocated with a fracture that would require a large plate to be screwed in.

Different types of canine hock injuries and their causes

Dr Rob sent the X-rays to his colleague, a “superbly skilled surgeon” named Dr Andrew Levien, for his opinion about surgery. A couple days later I got a call from Dr Andrew, who I learned to be also the director of 24-hour emergency hospital Veterinary Specialists of Sydney (VSOS)

He wasn’t concerned about Cruz’s X-rays, explaining that it was a common injury and he’d performed this type of surgery countless times with great success.
“There are two main types of injuries to the hock - degenerative and traumatic," he said.
“I generally see cases that are more of a degenerative type issue of the ligaments supporting the ankle – much like a cruciate ligament in the knee – and for that reason we see it more in middle age or older dogs.”

“Also, hock injuries are seen more in athletic animals than sedentary ones, more common in large dogs and working dogs because they put strain on that ligament that support the ankle.”

Certain breeds, like Shetland Sheepdogs and Border Collies, are also predisposed to hock injuries that are more degenerative in nature.

Occasionally hock injuries occur due to a traumatic accident, caused for instance by jumping off the deck or getting hit by a car. It’s not related to cancer, said Dr Andrew.

In Cruz’ case, it was a traumatic accident (a break) caused most likely when he was running in the backyard and his foot got caught in a pothole and twisted.


His official diagnosis was: left tarsometatarsal subluxation – a fancy name for the metatarsal bones becoming disconnected from the tarsus or ‘ankle’ of the dog.

The recommended treatment was a partial tarsal arthrodesis – in other words, a surgery used to fuse the leg and foot bones together to salvage some joint function.

VSOS Dr Andrew with an X-ray of Cruz showing where his hock is dislocated

“Cruz’s surgery is pretty standard from the point of view of a repair. But he’s an exceptionally large dog compared to your average Border Collie that weighs only 18-24 kgs; Cruz is three times that size!” said Dr Andrew.

“For that reason, we need to beef up the hardware in his leg to account for that. He’ll get a strong plate in there to make it stronger and we’ll meticulously close the soft tissue to avoid complications.”

The cost would be around $7,000 – thank goodness for our pet insurance (personally, a must for big dogs)! We’ve had cover with Pet Insurance Australia since the day we got Cruz and have saved many, many thousands of dollars over the years with 80% money back for claims. (And he’s not even a working dog!!)

When Cruz’s insurance renewed in December last year, we decided to lower the cover to 60% to save money on the increased monthly premium due to his age. It was a good deal, we thought, and hoped he'd stay out of trouble! A few days later, Cruz went and fractured his leg!

The risks of this type of surgery

There are few risks involved in this surgery if done by a competent trained surgeon, explained Dr Andrew.

The main risks everybody should be educated on are infection,” he warned. “There’s not a lot of tissue coverage over the hardware. So, it’s not difficult for bacteria to work their way through the skin and towards the plate.

 "Sores caused by the bandaging on Cruz' leg look worse than they actually are" said Dr Andrew

Other risks are antigen (markers that tell your body that something is foreign) complications and pressure sores from bandaging problems that can be very nasty and take weeks to get better!

“Tendons and bones can be exposed from bandaging complications. That’s why I’m protective over my cases and make sure they get the appropriate bandaging after surgery to avoid complications,” he added.

Dr Andrew with Vet Nurse changing Cruz' bandage for the third time after his hock surgery

Other risks, theoretically, can be the fusion of the ankle doesn’t occur for one reason or another and the hardware got removed, causing an infection in the surgical area and required another surgery.”

Then there’s breeds like Anatolian Shepherd Dogs being at increased risk for anaesthetic complications, such as hypotension, hypothermia, abnormal heart rate, hypoventilation, and difficult recovery (eg, prolonged duration, dysphoria, pain).

Post operative care is the most important!

It was good to be informed of the risks of this major surgery. But what Dr Andrew was most concerned about was the post operative care – the surgery can be for nothing if we don’t provide him the proper care and time for his leg to heal properly.

“Dogs can walk on the leg relatively early, four to six weeks after the surgery. However, fusions are inherently a slow process, taking weeks and months to happen. So, we don’t want dogs running around on the repair until some sort of fusion has happened,” he said.

“In Cruz’s case, we can expect full recovery to take four to five months before fusion is strong. Otherwise, the implant can take all the load and the metal could snap. That would be uncommon. But I’ve heard of bones breaking around the metal object.”

So general recovery is eight to ten weeks, followed by an X-ray to see where we’re at with the fusion. I would have to restrict Cruz’s movements to a small area of the house and take him to see Dr Andrew at VSOS (65km from my home) once a week for a check-up and bandage change.

When Cruz has to do his doggy business in the backyard, we need to support him with a sling. I thought, how complicated can it be to manoeuvre a huge limo of a dog forward whilst simultaneously hold a sling to support his back?

Also, he’ll have a fibreglass cast on and I would need to keep the bandaging dry at all times. No worries, I should be able to do that whilst manoeuvring and supporting his back end with a sling when he‘s pooing in the rain. I got this .. I think?

Patient-proofing the house

The date was set for his surgery in a week’s time and in preparation, my family and I started patient-proofing the house to make it safe and comfortable for Cruz during his long and risky recovery.

1. Choose a safe, quiet space. We decided to set Cruz up in the family ‘movie room’ downstairs; it’s a small room beside the sliding door to the backyard so he didn’t have to walk far for toileting. Any movie watching would be done on low volume and turn the captions on!

2. Cosy bed. We dragged in Cruz’s new giant orthopaedic bed that we got him for Christmas, and placed his soft bed as back-up in case he didn’t feel comfortable.

3. Containment. We ordered a mesh gate for the doorway so he could see through it into the living room and not feel isolated.

4. Safety. We placed a large rug in the room and more rugs in the living area to prevent slipping and piled large pillows on the movie room pull-out couch to prevent him from climb it. We also connected the Furbo Camera in the room so I could check on him throughout the night.

5. Food and water. We placed his elevated water and food bowl stand near his bed.

The surgery!

The surgery went well; the procedure taking a couple hours and no complications to report. Cruz would stay for a couple days at Vineyard Vets for monitoring, confined to a crate to keep him quiet and off his paws.

It wasn’t long before we got a call from Dr Rob that Cruz was okay to go home. My teen daughter Isabel and I arrived at Vineyard with great excitement and were certainly not prepared for what we saw when Cruz walked out of the recovery room.

His left side had been shaved from the stomach all the way down his leg and a blue bandage was wrapped tightly around the hock joint, down to the paw. A nurse was supporting Cruz’s backside with a large sling and he was walking like a drunk.

I felt the anxiety rising in my chest and wanted to cry. Dr Rob walked into the consult room at that moment and braced himself for the zillion questions I started blurting out. Eventually he and Isabel calmed me down, assuring me everything would be ok and we could handle this.

Cruz, a few days after the surgery with
his back supported by a sling
Isabel guided Cruz out of the consult room with a lead and I shuffled behind, supporting him with the sling. To my horror, it began raining … hard! 

I remembered Dr Andrew’s advice to 
use a plastic cover to protect the bandage. A nurse brought out a modified, disposable, plastic blood collection bag that was cut across the top so I could simply slip Cruz’s paw into the hard, thick plastic and protect the bandage. Genius!

As for the rest of the bandage poking out from the top of the plastic, we put his leg into a large supermarket bag and tied the handles around the top of his thigh, then used bandage tape to seal off any openings.

We shuffled out of the building – Isabel guiding Cruz with one hand and a large umbrella in the other, and me supporting his back end with the sling. Cruz made a beeline to the closest tree for a wee and walked under a bushy branch, releasing over a dozen stink bugs on top of us!

A nurse came running to help as we desperately tried to flick the stink bugs off Cruz and from inside our shirts while balancing the sling, umbrella and bag of meds. We couldn’t stop laughing all the way home, soaked to the bone! It was a miracle Cruz’s bandage stayed dry!

At home recovering

Cruz is a very chilled dog by nature – hence his name – but keeping him calm and restricting his movements was a bit more challenging than we expected. The mesh gate we ordered didn’t arrive on time, so we blocked the entryway to the movie room with heavy wooden kitchen chairs.

In the middle of the night, we heard a loud noise. I checked our Furbo dog camera and saw he had pushed the chairs away to get out of the room! 

The next night, we reinforced the chairs with a box of books which we placed on the floor. It worked …until the following night when he managed to push passed the heavy barricade and even jumped over the box!

The daytime wasn’t any easier – he wanted out all the time. I found Dog TV on YouTube – 8 hours of ducks by a stream. Yeah, nah, this wasn’t going to work. (Frankly, I’d go a bit bonkers, too!)

Cruz won – we placed his bed in the living area, moved rugs around and blocked the stairs with the dog gate mesh that had finally arrived. 

I moved my office to the kitchen table where I could keep an eye on him and went through the daily cycle of covering his bandage with the plastic blood collection bag and supporting him with a sling when he needed to go out to do his toileting.

By around Week 3, he could walk much better on his own so we stopped using the sling. His leg trembled a little as he put pressure on it, but that was expected.

As we couldn’t play any activity games, we spent time cuddling on his bed and playing hide and seek with treats in my hand. We had to be careful not to feed him too much as he wasn’t getting any exercise.

Cruz recovering at home post surgery and contemplating the meaning of life!
I felt bad leaving him at home when I went out for my morning exercise. He sat by the front window, like a cat, watching the world pass by and occasionally barking at people – I swear he loves to make them jump! (Don’t get me started about the neighbour’s cat!) I was happy to see Cruz was making friends with the neighbourhood kids who came to play basketball with Isabel outside our house.

One day I caught up on a video call with Andre Cato, founder of Presents for Paws, and introduced him to Cruz and how he’s home recovering from a major surgery. 

A happy Cruz discovers a box full of toys, courtesy of Presents for Paws

A few days later, we got a lovely surprise in the mail – a personalised box with wonderful toys to keep him entertained! Cruz chose his favourite – a red, cuddly dinosaur that we named Dinosaur – which become a permanent fixture on his orthopaedic bed.

During the initial six weeks of recovery, we made weekly trips to see Dr Andrew at VSOS for Cruz’s bandage change and check-up, and lots of pats and cuddles from the staff. (Cruz was milking it bigtime!)

“So far it’s healing well,” said Dr Andrew in week 2, “Albeit a bit slower than expected but it could be because of his age.”

Let’s fast forward to week 6 when he finally got his bandage off and Dr Andrew was very happy with the result, despite observing a couple of pressure sores around the paw.

He said, “The difference with Cruz compared to other dogs is the bandaging situation (with pressure sores) has been a lot better. He’s a quiet dog, not boisterous and bouncy. For that reason, he laid about and rested more compared to an active dog.”

X-ray results are in!

Finally, the date arrived in Week 8 for Cruz’s follow-up x-rays at Vineyard Vet Hospital. Dr Rob called me into the imaging room and showed me the X-ray of Cruz’s leg. He pointed to the computer screen showing Cruz’s leg held together by a large metal plate and several screws.

Dr Robert Zammit sharing the X-ray results

I held my breath for a moment, not quite sure what he was going to say, and saw a big smile grow on his face. “It looks amazing!” he said.

Cruz puts his paw up in the air!
Sores nearly all gone (21/03/23) 
Dr Andrew certainly did a brilliant job with the surgery, and we were very strict with his recovery which made the difference in the end. 

But we won’t be running anytime soon. Frankly, I’m too scared to ever let him off the leash!

“You can go for walks but take it easy, maybe start with 10 minutes around the block and gradually increase over time,” advised Dr Rob.

Sounds good to me! We just need to get to the car without releasing any stink bugs!

written by Caroline Zambrano, Pet Journo, March 2023 for Australian Dog Lover (all rights reserved).

About the writer

Caroline Zambrano is a Sydney-based pet writer with nearly 20 years of experience in journalism and public relations specialising in the Australian pet industry.  Her qualifications include a Bachelor of Arts in Journalism and a Master of Arts in Journalism and Mass Communications in the United States.
Caroline is a PR & clinic volunteer for Pets in the Park, a national charity that cares for pets owned by people who are homeless or at risk of becoming homeless, and is a rescue volunteer for Sydney Metropolitan Wildlife Services Inc.  She is also a member of the Australian Canine Scent Work Association.

You can contact her at and follow her & Cruz on Instagram @petjourno
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