Sore Hock Severity Grades
| Grade | Description | Appearance | Treatment |
|---|---|---|---|
| 1 — Mild | Hair loss, no skin damage | Bald spots on hocks | Fix flooring + soft bedding |
| 2 — Moderate | Red, inflamed skin | Pink/red, slightly swollen | Soft bedding + vet check |
| 3 — Severe | Open sores, crusting | Visible wounds, scabs | Vet: wound care + antibiotics |
| 4 — Critical | Bone infection | Swollen, draining pus, limp | Vet: intensive treatment |
Sore Hocks Treatment Protocol
Sore Hocks Prevention Checklist
| Do | Provide solid flooring — never wire or bare concrete |
| Do | Use deep soft bedding (straw, fleece, paper) |
| Do | Maintain healthy weight — obese rabbits get sore hocks |
| Do | Trim nails regularly — long nails alter foot posture |
| Do | Check hocks weekly for early signs of hair loss |
| Avoid | Keep rabbit on wire-bottom cages |
| Avoid | Ignore early bald patches — they heal on their own |
| Avoid | Use concrete or tile as primary flooring |
Sore hocks (ulcerative pododermatitis) is a progressive inflammatory condition of the rabbit's hind feet in which the skin over the weight-bearing surface breaks down, becomes infected, and can progress to bone involvement (osteomyelitis) in severe cases. It is one of the most common and preventable rabbit health problems -- almost always caused by inappropriate housing surfaces (wire-bottom cages, hard floors) combined with predisposing factors like obesity, sedentary lifestyle, or inappropriate genetics for the body weight. Caught early, sore hocks heal with housing modification and treatment; advanced cases are serious, painful, and potentially fatal.
Why Rabbits Get Sore Hocks
Unlike many mammals, rabbits have no foot pads -- their hind feet are covered only by fur and the skin beneath it. The hind feet bear approximately 60-70% of the rabbit's body weight. When a rabbit sits on an unforgiving surface (wire-bottom cage floors, hard plastic, ceramic tile without cushioning) for extended periods, the continuous pressure compresses the vascular supply to the skin, causing ischemic (pressure-related) damage that begins with fur loss and progresses to open sores.
Risk factors include: wire-bottom cage housing (the most preventable cause); obesity (increased weight = increased pressure); large, heavy breeds (Giant breeds like Flemish Giants, Rex rabbits -- Rex fur is shorter and less protective than most breeds); reduced activity (sedentary rabbits spend more time in contact with surfaces); wet or soiled bedding (softens skin, making it more vulnerable); and genetics (some lines are predisposed).
Recognizing the Stages
Stage 1 (mild): Fur thinning or baldness on the plantar (bottom) surface of one or both hind feet. No skin break yet. The rabbit shows no obvious discomfort. This stage is easy to miss without regular foot inspections.
Stage 2 (moderate): Reddened, thickened, calloused skin visible under the thinned fur. May have small scabs. The rabbit may shift weight or show mild reluctance to move but often appears comfortable at rest.
Stage 3 (significant): Open skin lesions; possible infection (warm, swollen tissue; purulent exudate). The rabbit shows obvious pain: reluctance to move, altered sitting posture (shifting weight to front feet), thumping or vocalization when hocks are handled, reduced appetite from pain.
Stage 4 (severe): Deep infection extending to tendons or bone (osteomyelitis). Limbs may be visibly swollen, hot, and deformed. The rabbit is severely compromised; treatment is intensive and outcomes are guarded to poor.
Treatment by Stage
Stage 1-2: Remove the causative flooring immediately. Provide deep, soft bedding (fleece, hay, clean straw, or foam mats covered with fleece). Clean the foot gently with chlorhexidine 0.05% solution. Apply a thin layer of prescribed topical antibiotic ointment (mupirocin is commonly used) if there is any skin break. Recheck in 1-2 weeks. Weight reduction for obese rabbits is essential.
Stage 3: Veterinary care required. The wound should be cleaned, debrided if needed, and bandaged using non-adhesive wound dressings changed every 2-3 days. Systemic antibiotics are necessary for infected lesions -- commonly trimethoprim-sulfa or enrofloxacin in rabbits. Pain management with meloxicam (0.3-0.6 mg/kg daily) is essential. The rabbit must be kept on appropriate soft flooring throughout treatment.
Stage 4: Radiographs to assess bone involvement; possible surgical debridement; long-term systemic antibiotics based on culture and sensitivity; aggressive pain management. Some cases require euthanasia when suffering cannot be adequately managed.
Housing to Prevent Sore Hocks
The primary prevention is appropriate flooring. Rabbits should never live on wire-bottom cages. Appropriate surfaces include: solid plastic or rubber flooring covered with 4+ inches of hay or straw; fleece blankets over foam mats; commercially available rabbit cage mats (rubber stall mats, Vetbed, canvas runner rugs). The surface must be changed or washed at least twice weekly to prevent urine softening of skin. Any rabbit that has had sore hocks should permanently live on soft surfaces -- the recurrence risk on hard or wire surfaces is nearly 100%.
Check rabbit feet weekly as part of routine grooming. Part the fur on the hind foot plantar surface and look for thinning, redness, or any skin change. Early detection allows simple management before veterinary intervention becomes necessary.
Sources: Meredith & Flecknell (2006) BSAVA Manual of Rabbit Medicine and Surgery; Harcourt-Brown (2002) Textbook of Rabbit Medicine; Varga (2013) Textbook of Rabbit Medicine; Merck Veterinary Manual rabbit section.