Why Do Dogs Chew On Their Paws? This behavior can stem from various underlying issues, ranging from physical discomfort to psychological distress. At WHY.EDU.VN, we provide an in-depth exploration of why your canine companion might be engaging in this habit, offering solutions and insights to promote their well-being. Understanding these canine behaviors and paw-licking triggers is crucial for pet health and the overall wellness of your beloved dog.
1. Understanding Paw Chewing in Dogs: Common Causes
Paw chewing in dogs is a multifaceted issue, and understanding the common causes is the first step towards addressing it. It’s essential to differentiate between occasional grooming and excessive chewing that may indicate an underlying problem. Identifying the root cause can help pet owners take appropriate action to alleviate their dog’s discomfort and prevent further complications.
1.1 Physical Discomfort and Injuries
One of the primary reasons dogs chew on their paws is physical discomfort. This could be due to a range of issues:
- Injuries: Cuts, punctures, or abrasions on the paws can cause pain and irritation, leading dogs to chew in an attempt to soothe the area.
- Foreign Objects: Thorns, splinters, or small stones lodged between the toes can be a significant source of discomfort, prompting chewing and licking.
- Burns: Contact with hot surfaces or chemicals can cause burns on the paws, leading to intense pain and chewing.
Dog paw examination
1.2 Allergies: A Frequent Culprit
Allergies are a common cause of paw chewing in dogs. Allergic reactions can manifest in various ways, often causing skin irritation and itching, which leads to excessive chewing and licking.
- Food Allergies: Certain ingredients in dog food can trigger allergic reactions, leading to skin problems, including itchy paws. Common allergens include beef, chicken, corn, and soy.
- Environmental Allergies: Pollen, mold, dust mites, and other environmental allergens can cause atopic dermatitis, a condition characterized by itchy, inflamed skin, particularly on the paws.
- Contact Allergies: Exposure to certain substances, such as cleaning products, lawn chemicals, or even certain types of grass, can cause localized allergic reactions on the paws.
1.3 Parasitic Infestations
Parasites are another common cause of paw chewing in dogs. These tiny creatures can cause significant irritation and discomfort, leading to excessive grooming and chewing.
- Fleas: Fleas are a common external parasite that can infest dogs, causing intense itching and irritation. Dogs may chew on their paws in an attempt to relieve the itch.
- Mites: Various types of mites, such as mange mites, can burrow into the skin, causing intense itching and inflammation. This can lead to secondary bacterial infections, further exacerbating the problem.
- Ticks: While ticks are more commonly found in other areas of the body, they can also attach to the paws, causing localized irritation and chewing.
1.4 Infections: Bacterial and Fungal
Infections can also contribute to paw chewing in dogs. These infections can be caused by bacteria or fungi and often occur secondary to other underlying issues, such as allergies or injuries.
- Bacterial Infections: Bacteria can enter the skin through cuts, abrasions, or areas of inflammation, leading to infections. These infections can cause redness, swelling, pain, and discharge, prompting dogs to chew on their paws.
- Fungal Infections: Fungal infections, such as ringworm or yeast infections, can also affect the paws, causing itching, inflammation, and a characteristic odor. Dogs may chew on their paws in an attempt to relieve the discomfort.
1.5 Behavioral Issues: Anxiety and Boredom
In some cases, paw chewing may be a behavioral issue rather than a physical one. Dogs may engage in excessive grooming as a way to cope with anxiety, stress, or boredom.
- Anxiety: Dogs suffering from anxiety, whether it’s separation anxiety or general anxiety, may develop compulsive behaviors, such as paw chewing, as a way to self-soothe.
- Boredom: Dogs that are not adequately stimulated, either physically or mentally, may develop destructive habits, such as paw chewing, as a way to relieve boredom.
1.6 Environmental Factors
The environment in which a dog lives can also contribute to paw chewing. Certain environmental factors can irritate the paws, leading to discomfort and chewing.
- Harsh Surfaces: Walking on rough or abrasive surfaces, such as concrete or asphalt, can damage the paw pads, causing pain and irritation.
- Extreme Temperatures: Exposure to extreme temperatures, whether it’s hot pavement in the summer or cold, icy surfaces in the winter, can injure the paws, leading to chewing.
- Chemical Irritants: Contact with chemical irritants, such as salt used to melt ice, can cause chemical burns on the paws, leading to intense pain and chewing.
2. Symptoms to Watch Out For
Recognizing the signs of abnormal paw chewing is essential for early intervention. Pet owners should be vigilant and observant of their dog’s behavior, noting any changes that may indicate an underlying problem. Early detection and treatment can prevent the issue from escalating and causing further discomfort for the dog.
2.1 Excessive Licking and Chewing
One of the primary symptoms to watch out for is excessive licking and chewing of the paws. This behavior may be more frequent or intense than normal grooming habits.
- Constant Attention to Paws: Dogs may spend a significant amount of time focused on their paws, licking, chewing, or biting at them repeatedly.
- Inability to Distract: Attempts to distract the dog with toys, treats, or attention may be unsuccessful, as they remain fixated on their paws.
2.2 Redness and Inflammation
Redness and inflammation of the paws are common signs of irritation or infection. These symptoms may be localized to specific areas or more widespread.
- Red, Swollen Paws: The paws may appear red, swollen, and inflamed, indicating an underlying problem.
- Inflamed Paw Pads: The paw pads may be particularly affected, appearing red, raw, or ulcerated.
2.3 Open Sores or Lesions
Open sores or lesions on the paws are a sign of more advanced irritation or infection. These sores may be painful and prone to secondary bacterial infections.
- Visible Sores: Sores may be visible on the paws, ranging from small abrasions to larger, deeper lesions.
- Crusting or Scabbing: The sores may be covered with crusts or scabs, indicating healing or ongoing inflammation.
2.4 Discharge or Odor
Discharge or an unusual odor emanating from the paws is a sign of infection. The discharge may be clear, yellow, or greenish, and the odor may be foul or pungent.
- Purulent Discharge: The presence of pus indicates a bacterial infection, requiring prompt veterinary attention.
- Unpleasant Odor: A foul odor may indicate a fungal or bacterial infection, even if discharge is not readily apparent.
2.5 Changes in Gait or Mobility
Changes in gait or mobility, such as limping or reluctance to walk, may indicate pain or discomfort in the paws. These symptoms may be subtle at first but can worsen over time.
- Limping: Dogs may limp or favor one paw over the other, indicating pain or injury.
- Reluctance to Walk: Dogs may be reluctant to walk or exercise, preferring to rest and avoid putting weight on their paws.
2.6 Hair Loss or Discoloration
Hair loss or discoloration around the paws may be a sign of chronic irritation or inflammation. This symptom may be accompanied by other skin changes, such as thickening or scaling.
- Thinning Hair: The hair around the paws may become thin or sparse due to excessive licking and chewing.
- Stained Fur: The fur around the paws may become stained or discolored due to saliva and other secretions.
3. Diagnostic Procedures
If your dog is exhibiting signs of abnormal paw chewing, it’s essential to seek veterinary care. A veterinarian can perform a thorough examination and diagnostic tests to determine the underlying cause of the problem.
3.1 Physical Examination
The first step in diagnosing paw chewing is a thorough physical examination. The veterinarian will examine the paws, looking for signs of injury, inflammation, infection, or other abnormalities.
- Visual Inspection: The veterinarian will visually inspect the paws, looking for redness, swelling, sores, or other abnormalities.
- Palpation: The veterinarian will palpate the paws, feeling for any lumps, bumps, or areas of tenderness.
3.2 Skin Scrapings
Skin scrapings may be performed to check for the presence of parasites, such as mites. A small sample of skin is scraped from the affected area and examined under a microscope.
- Detection of Mites: Skin scrapings can help identify the presence of mites, such as mange mites, which can cause intense itching and inflammation.
- Identification of Other Parasites: Skin scrapings may also reveal the presence of other parasites, such as lice or fleas.
3.3 Cytology
Cytology involves collecting cells from the affected area and examining them under a microscope. This test can help identify the presence of bacteria, fungi, or inflammatory cells.
- Identification of Bacteria: Cytology can help identify the presence of bacteria, allowing the veterinarian to determine the appropriate antibiotic treatment.
- Detection of Fungi: Cytology can also detect the presence of fungi, such as yeast, helping the veterinarian diagnose and treat fungal infections.
3.4 Allergy Testing
If allergies are suspected, allergy testing may be recommended. Allergy testing can help identify the specific allergens that are causing the dog’s symptoms.
- Skin Testing: Skin testing involves injecting small amounts of allergens into the skin and observing the dog’s reaction.
- Blood Testing: Blood testing involves measuring the levels of IgE antibodies in the blood, which can indicate an allergic reaction to specific allergens.
3.5 Biopsy
In some cases, a biopsy may be necessary to obtain a tissue sample for further analysis. A biopsy can help diagnose more complex or unusual conditions.
- Histopathology: The tissue sample is examined under a microscope to identify any abnormalities, such as tumors, inflammatory cells, or infectious agents.
- Culture: The tissue sample may also be cultured to identify any bacteria or fungi that are present.
4. Treatment Options
The treatment for paw chewing in dogs depends on the underlying cause. Once the cause has been identified, the veterinarian can recommend the appropriate treatment plan.
4.1 Addressing Physical Discomfort
If paw chewing is due to physical discomfort, the treatment will focus on relieving the pain and irritation.
- Wound Care: Cuts, abrasions, and other injuries should be cleaned and bandaged to prevent infection and promote healing.
- Foreign Object Removal: Foreign objects, such as thorns or splinters, should be carefully removed from the paws.
- Pain Management: Pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed to relieve pain and inflammation.
4.2 Managing Allergies
If allergies are the cause of paw chewing, the treatment will focus on managing the allergic reaction.
- Dietary Changes: If food allergies are suspected, a hypoallergenic diet may be recommended.
- Medications: Antihistamines, corticosteroids, or other medications may be prescribed to relieve itching and inflammation.
- Immunotherapy: Immunotherapy, also known as allergy shots, may be recommended for dogs with environmental allergies.
4.3 Treating Parasitic Infestations
If parasites are the cause of paw chewing, the treatment will focus on eliminating the parasites.
- Topical Medications: Topical medications, such as flea and tick shampoos or sprays, may be used to kill parasites on the skin.
- Oral Medications: Oral medications may be prescribed to kill parasites internally.
- Environmental Control: Environmental control measures, such as washing bedding and vacuuming carpets, may be necessary to prevent reinfestation.
4.4 Addressing Infections
If infections are the cause of paw chewing, the treatment will focus on eliminating the infection.
- Antibiotics: Antibiotics may be prescribed to treat bacterial infections.
- Antifungals: Antifungal medications may be prescribed to treat fungal infections.
- Topical Treatments: Topical treatments, such as medicated shampoos or creams, may be used to treat localized infections.
4.5 Addressing Behavioral Issues
If paw chewing is due to behavioral issues, the treatment will focus on addressing the underlying anxiety, stress, or boredom.
- Behavior Modification: Behavior modification techniques, such as counter-conditioning and desensitization, may be used to reduce anxiety and stress.
- Enrichment: Providing adequate mental and physical stimulation can help reduce boredom and prevent destructive behaviors.
- Medications: In some cases, medications may be prescribed to help manage anxiety or depression.
5. Preventive Measures
Preventing paw chewing is often easier than treating it. By taking certain preventive measures, pet owners can reduce the risk of their dogs developing this habit.
5.1 Regular Paw Inspections
Regular paw inspections can help identify potential problems early on. Pet owners should examine their dog’s paws regularly, looking for signs of injury, inflammation, or infection.
- Check for Injuries: Look for cuts, abrasions, or other injuries on the paws.
- Check for Foreign Objects: Look for thorns, splinters, or other foreign objects lodged between the toes.
- Check for Inflammation: Look for redness, swelling, or other signs of inflammation.
5.2 Proper Hygiene
Proper hygiene is essential for maintaining healthy paws. Pet owners should keep their dog’s paws clean and dry, especially after walks or outdoor activities.
- Wash Paws Regularly: Wash the paws regularly with mild soap and water to remove dirt and debris.
- Dry Paws Thoroughly: Dry the paws thoroughly after washing to prevent fungal infections.
- Trim Nails Regularly: Trim the nails regularly to prevent them from becoming too long and causing discomfort.
5.3 Balanced Diet
A balanced diet is essential for maintaining healthy skin and coat. Pet owners should feed their dogs a high-quality diet that is appropriate for their age, breed, and activity level.
- Choose High-Quality Food: Choose a high-quality dog food that is made with wholesome ingredients.
- Avoid Allergens: Avoid feeding your dog foods that contain common allergens, such as beef, chicken, corn, or soy.
- Supplement as Needed: Supplement the diet with omega-3 fatty acids to promote healthy skin and coat.
5.4 Environmental Management
Managing the environment can help reduce the risk of paw irritation and injury.
- Avoid Harsh Surfaces: Avoid walking your dog on rough or abrasive surfaces, such as concrete or asphalt, especially during hot weather.
- Protect Paws in Extreme Weather: Protect your dog’s paws from extreme temperatures by using booties or paw wax.
- Limit Exposure to Chemical Irritants: Limit your dog’s exposure to chemical irritants, such as salt used to melt ice.
5.5 Mental and Physical Stimulation
Providing adequate mental and physical stimulation can help prevent boredom and anxiety, reducing the risk of paw chewing.
- Regular Exercise: Provide regular exercise to help your dog burn off energy and reduce stress.
- Interactive Toys: Provide interactive toys to keep your dog mentally stimulated.
- Training: Train your dog to perform tricks or commands to keep them mentally engaged.
6. Potential Complications of Untreated Paw Chewing
Untreated paw chewing can lead to a variety of complications, ranging from minor skin irritations to more serious infections. It’s essential to address the underlying cause of the problem promptly to prevent these complications from occurring.
6.1 Secondary Infections
One of the most common complications of untreated paw chewing is secondary infections. Excessive licking and chewing can damage the skin, creating an entry point for bacteria and fungi.
- Bacterial Infections: Bacteria can enter the skin through cuts, abrasions, or areas of inflammation, leading to infections.
- Fungal Infections: Fungal infections, such as yeast infections, can also develop on the paws, especially in moist environments.
6.2 Deep Pyoderma
Deep pyoderma is a severe bacterial infection that affects the deeper layers of the skin. This condition can be very painful and difficult to treat.
- Symptoms: Symptoms of deep pyoderma include deep, draining sores, swelling, and pain.
- Treatment: Treatment typically involves long-term antibiotics and topical medications.
6.3 Acral Lick Granuloma
Acral lick granuloma is a skin lesion that develops as a result of chronic, compulsive licking. This condition is often associated with underlying anxiety or boredom.
- Symptoms: Symptoms of acral lick granuloma include a raised, ulcerated lesion on the paw.
- Treatment: Treatment typically involves addressing the underlying behavioral issue and using topical medications to promote healing.
6.4 Self-Mutilation
In severe cases, untreated paw chewing can lead to self-mutilation. Dogs may chew on their paws to the point of causing significant damage to the skin, tissues, and even bones.
- Symptoms: Symptoms of self-mutilation include severe wounds, bleeding, and tissue damage.
- Treatment: Treatment typically involves addressing the underlying behavioral issue and providing intensive wound care.
6.5 Chronic Pain
Chronic pain is another potential complication of untreated paw chewing. Constant irritation and inflammation can lead to nerve damage and chronic pain.
- Symptoms: Symptoms of chronic pain include limping, reluctance to walk, and changes in behavior.
- Treatment: Treatment typically involves pain medications and other therapies to manage the pain.
7. Expert Opinions and Studies
Veterinarians and researchers have conducted numerous studies on the causes and treatment of paw chewing in dogs. These studies have provided valuable insights into this complex issue.
7.1 Dr. Karen Becker
Dr. Karen Becker, a renowned holistic veterinarian, emphasizes the importance of addressing the underlying cause of paw chewing rather than simply treating the symptoms. She recommends a holistic approach that includes a balanced diet, regular exercise, and stress reduction techniques.
7.2 American Veterinary Medical Association (AVMA)
The AVMA recognizes paw chewing as a common problem in dogs and recommends seeking veterinary care to determine the underlying cause. They also emphasize the importance of preventive measures, such as regular paw inspections and proper hygiene.
7.3 Research Studies
Several research studies have investigated the causes of paw chewing in dogs. These studies have identified allergies, parasites, infections, and behavioral issues as common contributing factors.
- Study 1: A study published in the Journal of the American Animal Hospital Association found that allergies were the most common cause of paw chewing in dogs.
- Study 2: A study published in the Veterinary Dermatology journal found that behavioral issues, such as anxiety and boredom, were also significant contributing factors to paw chewing in dogs.
8. The Role of Diet and Nutrition
Diet and nutrition play a crucial role in maintaining healthy skin and coat, which can help prevent paw chewing. A balanced diet that is rich in essential nutrients can help reduce the risk of allergies, infections, and other skin problems.
8.1 Essential Fatty Acids
Essential fatty acids, such as omega-3 and omega-6 fatty acids, are important for maintaining healthy skin and coat. These fatty acids help reduce inflammation and promote skin hydration.
- Omega-3 Fatty Acids: Omega-3 fatty acids can be found in fish oil, flaxseed oil, and other sources.
- Omega-6 Fatty Acids: Omega-6 fatty acids can be found in vegetable oils, such as sunflower oil and corn oil.
8.2 Vitamins and Minerals
Vitamins and minerals are also essential for maintaining healthy skin and coat. Vitamin E, vitamin A, and zinc are particularly important for skin health.
- Vitamin E: Vitamin E is an antioxidant that helps protect the skin from damage.
- Vitamin A: Vitamin A is important for cell growth and development.
- Zinc: Zinc is important for wound healing and immune function.
8.3 High-Quality Protein
High-quality protein is essential for maintaining healthy skin and coat. Protein is the building block of skin and hair, and a deficiency can lead to skin problems.
- Choose High-Quality Protein Sources: Choose dog foods that contain high-quality protein sources, such as meat, poultry, or fish.
- Avoid Low-Quality Protein Sources: Avoid dog foods that contain low-quality protein sources, such as corn or soy.
8.4 Hydration
Hydration is also important for maintaining healthy skin and coat. Dehydration can lead to dry, itchy skin, which can increase the risk of paw chewing.
- Provide Fresh Water: Provide your dog with fresh, clean water at all times.
- Add Moisture to Food: Add moisture to your dog’s food by adding water or broth.
9. Home Remedies and Supportive Care
In addition to veterinary treatment, there are several home remedies and supportive care measures that can help alleviate paw chewing.
9.1 Epsom Salt Soaks
Epsom salt soaks can help relieve pain and inflammation in the paws. Add Epsom salts to warm water and soak your dog’s paws for 10-15 minutes.
9.2 Oatmeal Baths
Oatmeal baths can help soothe itchy, irritated skin. Add colloidal oatmeal to warm water and soak your dog’s paws for 10-15 minutes.
9.3 Cone of Shame
A cone of shame, also known as an Elizabethan collar, can prevent your dog from licking and chewing their paws. This can help promote healing and prevent secondary infections.
9.4 Bandaging
Bandaging the paws can also prevent your dog from licking and chewing. Use a soft, breathable bandage and change it regularly.
9.5 Distraction
Distracting your dog when they start to lick or chew their paws can help break the habit. Offer them a toy, take them for a walk, or engage them in other activities.
10. When to Seek Professional Help
While home remedies and supportive care can be helpful, it’s essential to seek professional help if your dog’s paw chewing is severe or persistent.
10.1 Severe Symptoms
Seek veterinary care if your dog is exhibiting severe symptoms, such as:
- Severe pain
- Bleeding
- Open wounds
- Swelling
- Discharge
- Limping
10.2 Persistent Symptoms
Seek veterinary care if your dog’s symptoms persist despite home treatment. Persistent paw chewing may indicate an underlying medical condition that requires professional treatment.
10.3 Unsure of the Cause
If you’re unsure of the cause of your dog’s paw chewing, it’s always best to seek veterinary care. A veterinarian can perform a thorough examination and diagnostic tests to determine the underlying cause of the problem.
11. The Human-Animal Bond and Paw Chewing
The human-animal bond plays a significant role in managing paw chewing in dogs. A strong bond can help reduce stress and anxiety, which can contribute to paw chewing.
11.1 Providing Love and Attention
Providing your dog with love and attention can help reduce stress and anxiety. Spend time petting, playing, and interacting with your dog.
11.2 Creating a Safe and Comfortable Environment
Creating a safe and comfortable environment can also help reduce stress and anxiety. Provide your dog with a comfortable bed, a quiet space, and plenty of toys.
11.3 Training and Socialization
Training and socialization can help your dog develop confidence and reduce anxiety. Enroll your dog in obedience classes and expose them to a variety of people, places, and situations.
12. Case Studies: Real-Life Examples
Real-life case studies can provide valuable insights into the causes and treatment of paw chewing in dogs.
12.1 Case Study 1: Allergies
A 3-year-old Labrador retriever presented with chronic paw chewing. Allergy testing revealed that the dog was allergic to several environmental allergens. Treatment included allergy shots and a hypoallergenic diet. The dog’s paw chewing resolved within a few months.
12.2 Case Study 2: Behavioral Issues
A 5-year-old terrier mix presented with compulsive paw chewing. A veterinary behaviorist diagnosed the dog with separation anxiety. Treatment included behavior modification techniques and anti-anxiety medication. The dog’s paw chewing decreased significantly within a few weeks.
12.3 Case Study 3: Infections
A 7-year-old poodle presented with paw chewing and a foul odor emanating from the paws. Cytology revealed a bacterial infection. Treatment included antibiotics and topical medications. The dog’s paw chewing resolved within a few weeks.
13. Future Research and Innovations
Future research and innovations may lead to new and improved treatments for paw chewing in dogs.
13.1 Novel Therapies
Researchers are exploring novel therapies for paw chewing, such as:
- Stem Cell Therapy: Stem cell therapy may help regenerate damaged tissues in the paws.
- Gene Therapy: Gene therapy may help correct underlying genetic defects that contribute to skin problems.
- Probiotics: Probiotics may help improve gut health and reduce the risk of allergies.
13.2 Advanced Diagnostics
Advanced diagnostics may help identify the underlying cause of paw chewing more accurately.
- Next-Generation Sequencing: Next-generation sequencing may help identify specific allergens or infectious agents.
- Biomarker Analysis: Biomarker analysis may help identify early signs of skin problems.
14. Conclusion: Addressing Paw Chewing for a Happier Dog
Addressing paw chewing in dogs requires a comprehensive approach that includes identifying the underlying cause, providing appropriate treatment, and implementing preventive measures. By understanding the various factors that can contribute to paw chewing, pet owners can help their dogs live happier, healthier lives. Remember, a happy dog often starts with healthy paws.
Is your dog constantly chewing on their paws, and you’re unsure why? Don’t let your furry friend suffer in silence. At WHY.EDU.VN, we understand the complexities of canine behavior and health. Our team of experts is dedicated to providing accurate, reliable information to help you understand and address your dog’s paw-chewing habits. Whether it’s allergies, injuries, behavioral issues, or something else, we can guide you toward the best solutions.
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15. Frequently Asked Questions (FAQs)
Here are some frequently asked questions about paw chewing in dogs:
15.1 Why is my dog suddenly chewing on his paws?
Sudden paw chewing can be due to a new injury, allergy, or infection. It’s important to examine your dog’s paws for any visible signs of trauma or irritation.
15.2 Is paw chewing always a sign of a problem?
Occasional paw licking is normal, but excessive chewing that leads to redness, swelling, or hair loss is a sign of an underlying issue.
15.3 Can stress cause paw chewing in dogs?
Yes, stress, anxiety, and boredom can all contribute to paw chewing in dogs. Providing mental and physical stimulation can help reduce stress-related paw chewing.
15.4 What are the most common allergens that cause paw chewing?
Common allergens include food ingredients like beef, chicken, and corn, as well as environmental allergens like pollen, mold, and dust mites.
15.5 How can I tell if my dog has a paw infection?
Signs of a paw infection include redness, swelling, discharge, an unpleasant odor, and pain.
15.6 Are certain dog breeds more prone to paw chewing?
Yes, some breeds, such as Labrador retrievers, golden retrievers, and terriers, are more prone to allergies and skin problems that can lead to paw chewing.
15.7 Can I use human medications to treat my dog’s paw chewing?
No, you should never use human medications to treat your dog’s paw chewing without consulting a veterinarian. Some human medications can be toxic to dogs.
15.8 How often should I check my dog’s paws?
You should check your dog’s paws at least once a week, or more often if they are prone to paw problems.
15.9 What are some ways to prevent paw chewing in dogs?
Preventive measures include regular paw inspections, proper hygiene, a balanced diet, environmental management, and adequate mental and physical stimulation.
15.10 When should I take my dog to the vet for paw chewing?
You should take your dog to the vet if their paw chewing is severe, persistent, or accompanied by other symptoms, such as pain, bleeding, or swelling.