What could be causing my dog to constantly lick her paws?

Question

For a few months now (since around late August), my pitbull is obsessed with licking her paws. It is to the point where she almost cannot stop unless she is sleeping or closely supervised. It's so much that she leaves behind large puddles of saliva on whatever furniture she is on from all the licking, and her paws are really starting to get beat up from it (tearing in her pads, small cuts).

Our regular vet isn't quite sure what to do for her. We asked if it could be yeast, but the vet doesn't think so, and pretty much recommends we handle this with her special allergist vet. We know she has bad allergies to nearly everything outdoors. She has been allergy tested and we found that she is allergic to many grasses, weeds, trees, and other things. The allergist said it's some of the most severe allergies in a dog they have seen. But even with all these allergies, I'm not sure that that is the root cause of her licking, since only recently has she been this bad. In the past, she certainly licked her paws some, but nowhere near to the degree it is now.

Things I've tried to help her include:

• Bathing her using a 4% chlorhexidine gluconate shampoo, which our vet recommends to eliminate any kind of bacterial issues
• Soaking her feet in an epsom salt water bath
• A "natural" cream to rub on her paws (natural in the sense that it's made from only natural ingredients)
• A prescribed steroidal spray
• A prescribed antihistamine (Hydroxyzine Hydrochloride) and OTC ones
• A prescription for Gabapentin
• Apoquel (which she's been on for a good portion of her life)

All of these don't seem to provide relief.

I am suspecting something else is at play here. I am beginning to wonder if it's more of a nervous thing for her that she somehow developed into. Environmentally, nothing has really changed, so if it is a nervous issue, I'm unsure what it could be.

Here are some images of her front left paw (click the image to enlarge):

What else could be causing my dog to lick her paws all the time?

Answer 1

Paw licking can have so many causes, it will be hard to determine the true origin in her case. There could even be several causes cumulating at the same time.

Infection

Just like humans, dogs can get fungal or bacterial infections on their skin. The vet kind-of ruled that out and you're already treating for that.

Dermatitis

This is most commonly caused by allergies or chemicals and occurs most commonly on the paws (because that's what touches the environment most) and the face.

In addition to the obvious allergies to grasses and trees, also consider other stuff that coats surfaces. If you wipe your floors very often, consider using less detergent or a different type of detergent for at least 4 weeks to see if her condition improves.

May there be fertilizer in your yard or the park where you take her for walks? Are the streets or sidewalks in your area are defrosted with salt? Does she have to walk through puddles on the street that may contain gasoline or motor oil? Or maybe over searing hot asphalt that burns her paws? Put dog boots on her to protect her feet.

Dry skin

This is a very unfortunate result of a pre-existing condition that can spiral out of control. Because of her licking, her skin is dry and itchy. Because her skin is itchy, she continues licking. Her skin never gets the chance to fully heal.

Anxiety / OCD

Paw licking and biting is a common sign in anxious and nervous dogs. Especially if she does it all the time and ignores other stimuli like toys to continue licking.

The problem with Mental disorders in dogs is that if you prevent her from licking her paws without treating the underlying cause, she will simply develop another coping mechanism that will be just as severe. She might start chewing walls and furniture, start eating anything she can get hold of (a condition called pica) or bark or whine constantly without pause.

Leash pulling

Yes, that can lead to paw licking. The main nerves that connect her paws to her brain run through the front of her neck. If she pulls too much on her leash, she can damage those nerves, resulting in a constant "pins and needles" sensation. Of course she then licks her paws in an attempt to alleviate the tingling.

If she is a strong leash puller, you should use a harness instead of a collar for her. Please look for special weight pulling harnesses. I've once had a harness for my dog that constricted his rib cage to the point where he wheezed whenever he started pulling.

Rheumatism and/or Arthritis

Another source of chronic pain in the paws can be rheumatism and/or arthritis. There are other conditions, too, that cause chronic pain, but those are the most common. Just like with the nerve damage due to leash pulling, the dog tries to alleviate the constant pain by licking.

Parasites

Fleas and mites usually cause itchiness, but also usually spread over more than just the paws. However, if there are parasites living in the soil (like sand fleas) they might bite your dog without actually infesting her body.

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Here are some links that I hope will help you:

American Kennel Club: Why Does My Dog Lick Their Paws?

PetMD: Why Do Dogs Lick and Chew Their Paws?. It lists a lot of products you may try to treat her licking, but too much treatment could also contribute to more licking. I highly encourage you to go through a checklist with your vet(s) and try to prove or disprove as many as possible before going wild and treating her against everything.

The Spruce Pets: Why Is My Dog Licking His Paws?. This one concentrates more on the mental disorders and links to other articles that help you treat them.

Answer 2

Allergies can get worse over time.

Environment is really hard to nail down, for example one of your neighbors might have planted some plant that she's especially allergic to or something relatively subtle like that. Pollen levels change seasonally and also from year to year. Even non-obvious environmental factors--food allergies can make environmental allergies worse, even when the food allergy on it's own isn't really a problem. (Oh, and sometimes pet food companies change ingredients without changing the name of the food or anything.)

Since you do have one for sure known cause of general itching, anything you can do about that will probably help. (Even if it's, say, anxiety--if you reduce any reaction from her allergies that will reduce stress and anxiety.) So brushing/vacuuming after she's been outside to remove allergens, vacuuming the house frequently, rechecking her food for allergens, that kind of thing.

You've already tried some things to narrow down the problem, but there are a few big ones that aren't on your list. These aren't necessarily the long term solutions, but ways to narrow down the problem:

Antihistamines. Cheap and usually available over the counter (obviously talk to your vet first). Usually pretty fast acting, within a few days to a week. If she stops, it's a strong sign that her allergies were the main trigger. (There are multiple classes of antihistamines, with different people/pets reacting differently, so if you get to the end of the list maybe circle back to this and try another class of antihistamine.)

Anti-licking boots/socks. This can break the cycle of dry skin -> itching -> licking -> dry skin and also prevents contact irritants.

Anti-anxiety medication. You would need a prescription, but if nothing else is working it's worth talking to your vet about doing a trial with this.

NSAID painkiller. You should get a prescription for this, as well, but usually these are cheap and widely available. Super effective for rheumatoid arthritis, some nerve issues are also caused by swelling as well. (For horses, you might also try a local numbing/nerve block if you suspected pain, but that seems to be less available for small pets.)

You should keep a journal of how much she's licking and any factors you can think of (did you go for a walk, what's the pollen count, etc.). Even if it seems non-stop right now, it's good to have a baseline to compare to.