Sore Hocks in Rabbits: Causes, Stages + Treatment
This article is based on Dr. Mark Silpa’s Vet Set talk at Bun Chia Burrow, August 23, 2026. Dr. Silpa is a board-certified exotic companion mammal specialist practicing at Exotic Animal Veterinary Center in Pasadena, CA.
Want to watch the talk? Link coming soon!
Pododermatitis - commonly called sore hocks - is one of the most misunderstood conditions in domestic rabbits. Dr. Mark Silpa, board-certified exotic companion mammal specialist and the second vet in California to receive that certification, broke it down at BCB's August Vet Set.
What are Sore Hocks
Sore hocks are essentially pressure sores.
Unlike dogs and cats, rabbits have no foot pads. Their feet are protected entirely by thick fur - fur that acts as insulation, shock absorption, and a surface that allows them to dig their toes in and activate the superficial flexor tendon that keeps their heel lifted when they move. When rabbits can't dig in, on hardwood, tile, or even carpet, that tendon doesn't engage properly, the heel stays down, and pressure builds.
Over time, that pressure causes a cascade: first hair loss, then callus formation, then ulceration, then infection, then tendon and bone involvement. Once it progresses to tendon involvement, that damage is permanent.
The Scoring Systems
There are two scoring systems:
Jenkins Scale (mild / moderate / severe)
Mild: thinning of the fur pad, no ulceration, one foot
Moderate: established infection, inflammation, scabbing, possible open ulceration
Severe: connective tissue involvement, necrosis, abscess, joint and bone involvement
Pet Rabbit Pododermatitis Scoring System (PRPPS)
Dr. Silpa's preferred system which uses a 0-6 scale:
0: normal
1: small area of hair loss, minor redness, possible early callus
2: lesion extends up the foot, confirmed hair loss, redness, dry/flaking skin
3: infection begins — mild, but present
4: full thickness skin loss, visible ulcer, tissue breakdown
5: severe deep infection, tendon visible, bone and tendon involvement
6: loss of use of the limb, possible tendon slip (permanent)
Score 1 and 2 are not considered painful. Score 3 and above involve infection and pain. Score 6 may warrant humane euthanasia discussion.
How Common are Sore Hocks?
More common than most rabbit parents realize - and this is a disease of captivity, i.e. there are no published cases of pododermatitis in wild rabbits. In farmed rabbits, studies show the vast majority land at score 3. In pet rabbits, studies from both the UK and UC Davis found most pet rabbits fall at score 1 or 2.
The good news: most pet rabbits with sore hocks are not in pain. Catching it early and preventing progression is of utmost importance.
What Causes Sore Hocks?
There are varying predisposing factors:
Inappropriate Flooring: hardwood, tile, and even carpet (artificial fibers create friction that wears fur away)
Wire Floors: still seen in some setups; a major contributor
Obesity and Inactivity: increased pressure, reduced movement
Poor Nutrition: impairs wound healing, contributes to obesity
Urinary or Fecal Incontinence: moisture plus pressure is a double hit
Certain Breeds: Rex rabbits have less protective fur; large breeds carry more weight
Arthritis or Spinal Issues: pain reduces movement, increasing pressure
Poor Conformation: bad breeding affects how weight is distributed
Long Nails: prevents proper foot placement, shifts weight to the heel
Home Care
Flooring: Child play foam mats (available at Costco, approximately $20 for a large set) are the top recommendation. They deform under weight, allowing the rabbit to dig toes in and activate the tendon. Place something on top, like a blanket or fleece, to prevent chewing the foam.
Alternatives: yoga mats work, but are expensive. IKEA rugs with some give are better than hardwood alone, but the goal is a surface that flexes.
If a rabbit is already at score 1 or 2, adding foam mats under existing rugs can help stabilize the condition.
Litter boxes: If using a grated litter box, plastic grating only - never wire. Monitor how much time the rabbit spends in the litter box, particularly if hay is only offered there.
Enrichment and movement: Scatter feeding encourages movement. Target training and rabbit agility are among the best tools for getting sedentary rabbits moving. Movement is treatment.
Booties: Useful once fur is lost and cannot grow back. Available on Etsy ($30-40) or sewable from online patterns.
Key rules: never leave wet, use a non-stick telfa bandage inside if there is an open wound, remove and check at least twice daily.
Nail trims: Overgrown nails shift weight and prevent proper foot placement. Keep nails trimmed. Dr. Silpa has seen rabbits return to normal gait immediately after a nail trim that corrected their posture.
When to See your Vet
Score 1-2: begin investigating underlying causes (arthritis, diet, flooring, weight)
Score 3: topical or oral antibiotics, culture recommended
Score 4: culture, X-rays, blood work - treat the infection and the underlying cause
Score 5-6: bandaging, possible amputation, humane euthanasia discussion at score 6
Important note: a rabbit presenting with what looks like sore hocks is not always sore hocks. Dr. Silpa treated one case that turned out to be cutaneous squamous cell carcinoma -running diagnostic testing matters!
The Honest Prognosis
Once fur is lost, it does not reliably grow back. The goal is stabilization - keeping a score 1 or 2 from becoming a score 3. With appropriate management of the underlying cause and environmental changes, most rabbits at score 3 or 4 can be brought back down to score 1 or 2. Score 6 is permanent.
Score 1 and 2 with no infection and no pain is manageable. It is not a welfare crisis. It is a signal to look at the whole picture.
Sources Referenced
Dr. Mark Silpa, DVM — Vet Set Talk, Bun Chia Burrow, August 23, 2026. Board-Certified Exotic Companion Mammal Specialist, Exotic Animal Veterinary Center, Pasadena, CA.
Jenkins JR — Skin Disorders of the Rabbit. Veterinary Clinics of North America: Exotic Animal Practice, 2001.
Mancinelli E, Keeble E, Richardson J, Hedley J — Husbandry Risk Factors Associated with Hock Pododermatitis in UK Pet Rabbits. Veterinary Record, 2014. (PRPPS development)
Rommers JM, Meijerhof R — Effect of Leg Rests on Footpad Injuries in Breeding Does. World Rabbit Science, 1996.