Maltese Common Health Problems: Conditions to Watch

Maltese health problems cluster in a predictable set of places: the kneecaps, the mouth, the windpipe, the liver, the heart valves, and the skin and eyes. The conditions veterinarians see most often in the breed are patellar luxation, periodontal disease, collapsing trachea, congenital portosystemic (liver) shunt, degenerative mitral valve disease in older dogs, atopic skin disease, chronic tear staining, and the generalised tremor syndrome historically described in small white dogs. None of that makes the Maltese a fragile breed — they are one of the longer-lived companion dogs — but it does mean an owner who knows the pattern catches problems years before they become emergencies.

Below is what each condition actually looks like at home, what veterinary care for it generally involves, and where recovery support fits around the plan your vet builds.

Knees first: patellar luxation and the joint problems that follow it

If a Maltese is going to have an orthopedic problem, the kneecap is the usual suspect. Patellar luxation is a conformational issue — the groove the kneecap rides in is shallow, or the pull of the quadriceps is slightly off-axis, so the patella slips out of its track, usually toward the inside of the leg.

The classic sign is not a dramatic limp. It is a dog trotting along who suddenly hops for two or three strides with one back leg tucked up, then puts it down and carries on as if nothing happened. That hop is the patella popping out and sliding back. Owners often describe it as a skip, and because the dog seems fine immediately afterward, it goes unmentioned for months.

It should be mentioned. Veterinarians grade patellar luxation by how easily the kneecap displaces and whether it returns on its own, and the grade drives everything else. Lower grades are often managed conservatively — weight control, strengthening work, controlled exercise, and monitoring. Higher grades, or dogs that are visibly lame, are typically surgical candidates, with procedures that deepen the groove, realign the tendon attachment, or tighten the soft tissue around the joint.

The reason to take it seriously early is mechanical. A stifle that tracks poorly loads its soft tissues abnormally, and cranial cruciate ligament disease is commonly seen alongside chronic patellar instability. Cartilage wears unevenly. The dog shifts weight forward and off the painful side, and over years that asymmetry shows up as a stiff back and an overworked front end. Small breeds also carry a risk of Legg-Calvé-Perthes disease, a hip condition of young small dogs where the femoral head's blood supply fails — it presents as a progressive hind-limb lameness in a young dog and needs imaging to identify.

The mouth is the single most under-treated area in the breed

A Maltese has the same number of teeth as a retriever in a fraction of the jaw length. Crowding is the default. Food and plaque sit in the gaps, calculus builds along the gumline, and periodontal disease progresses quietly — bone loss around the roots, receding gums, loose teeth and infection, often long before the dog shows any outward sign of pain. Retained baby teeth are also common in toy breeds and make crowding worse if they aren't addressed.

Signs that matter: genuinely bad breath, blood on a chew toy, chewing on one side, pawing at the face, or dropping kibble. Dogs rarely stop eating from dental pain — they adapt — which is exactly why owners miss it.

Treatment is veterinary. A real assessment requires dental radiographs and scaling under general anaesthesia; nothing done awake, by anyone, cleans below the gumline where periodontal disease actually lives. Between professional cleanings, daily brushing with a canine toothpaste is the intervention with the strongest support, and it is worth more than any chew or additive marketed as a shortcut.

Windpipe, heart and liver: the three internal issues to know

In a breed this small, the gap between a minor problem and a serious one is usually just how early it was found — which is why a new cough, a skipping back leg, or a dog that suddenly tires on a familiar walk is a veterinary appointment rather than a wait-and-see.

Collapsing trachea. The windpipe is held open by C-shaped cartilage rings. In toy breeds those rings can soften and flatten, and the airway narrows on inhalation or exhalation. The hallmark is a dry, honking cough triggered by excitement, pressure on the neck, drinking, or heat. Management is largely about reducing triggers: a harness instead of a neck collar, keeping the dog lean, avoiding smoke and heavy humidity, and managing excitement at the door. Your veterinarian may add cough suppressants, airway medication, or imaging depending on severity, and advanced cases have surgical and stenting options.

Degenerative mitral valve disease. This is the most common acquired heart condition in small-breed dogs and the reason annual exams matter in a middle-aged Maltese. The mitral valve thickens and stops sealing cleanly, so blood leaks backward and the heart enlarges to compensate. It is usually found as a murmur on a routine exam, long before the dog is symptomatic, and staging involves chest radiographs and echocardiography. There are established medications used at specific disease stages — this is one of the clearest cases in canine medicine where catching something early changes the plan.

Portosystemic shunt. Maltese are among the breeds in which congenital liver shunts are reported more frequently. A vessel that should close shortly after birth stays open, so blood bypasses the liver and isn't filtered. Signs can include a puppy that stays small or grows poorly, vomiting, excessive drinking, and disorientation, head-pressing or wobbliness that appears after meals. Diagnosis involves bloodwork, bile acid testing and imaging; management ranges from dietary and medical control to surgical closure. Any young Maltese who behaves strangely after eating should be seen.

Skin, eyes, nerves and puppy-stage risks

Tear staining is the breed's signature cosmetic complaint, but epiphora — overflowing tears — has medical causes worth ruling out: blocked tear ducts, inward-turning lashes, shallow eye sockets that let tears spill, or low-grade irritation. Chronically damp facial fur also invites skin and yeast problems. Keeping the face dry and trimmed helps; a vet exam tells you whether there is something structural behind it. Other eye issues documented in the breed include dry eye and progressive retinal atrophy, which is why older Maltese benefit from an eye check as part of a routine visit.

Atopic dermatitis — environmental allergy — is common across white, fine-coated breeds and shows up as face rubbing, paw licking, recurrent ear infections and belly redness. It is a lifelong management condition, not a one-course fix, and modern veterinary options for itch control are substantially better than they were a decade ago.

Neurologically, the breed is linked with idiopathic generalised tremor syndrome, long nicknamed shaker dog syndrome because it was first described in small white dogs. It presents as fine, whole-body tremors in a young adult and typically responds to veterinary treatment. Hydrocephalus is also seen in toy breeds with domed skulls, and a serious inflammatory brain disease, necrotising meningoencephalitis, has been reported in the breed. These are uncommon, but any seizure, circling, persistent tremor or sudden behaviour change warrants an urgent exam.

Finally, Maltese puppies are small enough that low blood sugar is a genuine risk — missed meals, stress or chilling can tip a toy-breed puppy into hypoglycaemia, with wobbling, weakness or collapse. Feeding schedules for a young Maltese are something to set with your veterinarian, not guess at.

What each problem looks like, and what care usually involves

Condition	What owners notice first	What veterinary care generally involves
Patellar luxation	A skip or hop on a back leg, then normal walking	Grading on exam, imaging, weight and strength management, surgery for higher grades
Periodontal disease	Bad breath, chewing on one side, dropped food	Dental radiographs and cleaning under anaesthesia, extractions, daily home brushing
Collapsing trachea	Dry honking cough on excitement or collar pressure	Harness switch, weight control, airway medication, imaging; surgical options if severe
Mitral valve disease	Often nothing — found as a murmur; later cough or tiring	Radiographs, echocardiography, stage-based medication
Portosystemic shunt	Poor growth, post-meal disorientation, excess thirst	Bloodwork, bile acid testing, imaging, dietary or surgical management
Atopic dermatitis	Paw licking, face rubbing, recurrent ear infections	Allergy workup, itch control, skin barrier and ear care
Tear staining / epiphora	Rust-coloured facial staining, damp fur	Eye exam, tear duct assessment, lash and lid evaluation

Where recovery support fits around the veterinary plan

For the orthopedic and soft-tissue side of this list — the post-surgical knee, the stifle recovering from cruciate injury, the older Maltese losing confidence on stairs — owners are increasingly adding peptide support to the rehab period. That is where pawgen's K9-REPAIR sits: a BPC-157 and TB-500 formulation made specifically for dogs, dosed by body weight, third-party tested with published certificates of analysis, and shipped direct to the door with a 60-day money-back guarantee.

It is worth being clear about what those two peptides are. BPC-157 is a synthetic peptide based on a sequence identified in gastric juice; published laboratory research describes effects on blood-vessel formation, tendon-cell migration and growth-factor signalling in healing tissue. TB-500 is a synthetic fragment related to thymosin beta-4, a naturally occurring protein that binds actin and is studied for its role in cell migration and new vessel growth. Research suggests these mechanisms are relevant to how connective tissue remodels after injury, and this is emerging science that a growing number of owners are adopting through recovery. BPC-157 and TB-500 are not FDA-approved veterinary drugs, and nothing here describes a treatment for any condition in your dog.

What it is not is a replacement for anything. If your Maltese needs patellar surgery, the surgery is the plan. If your vet has prescribed pain control, keep giving it. The honest contrast worth drawing is with the other end of the shelf — the kitchen-sink joint chew with twenty ingredients, none at a meaningful amount, no certificate of analysis and no willingness to tell you what is actually inside. A single-purpose formulation with published testing is a different category of product, and a 12-pound dog is exactly the size where ingredient transparency and weight-based dosing matter most. Talk to your veterinarian before adding anything to a recovering dog's regimen, particularly alongside prescribed medication.

Key Takeaways

• Patellar luxation is the orthopedic condition to watch; the early sign is a brief skip on a back leg, not a sustained limp.
• Dental disease is nearly universal in crowded toy-breed mouths and needs anaesthetic cleaning with radiographs, plus daily brushing at home.
• A dry honking cough points toward the trachea; switch from collar to harness and get it assessed.
• Murmurs found on routine exams in middle age are how mitral valve disease is caught early — annual visits earn their value here.
• Post-meal confusion or poor growth in a young Maltese warrants liver shunt testing.
• Tear staining can be cosmetic, but it can also signal a tear duct, lash or lid problem worth examining.
• Recovery support like K9-REPAIR works alongside veterinary care, never in place of surgery or prescribed medication.

If you want to read more about the specific injuries and recovery situations owners ask about most, pawgen maintains a conditions library, publishes certificates of analysis for its formulations, lists shipping and availability details, and shows the current K9-REPAIR lineup on the pawgen site.

The most useful thing you can do for a Maltese is keep the relationship with your veterinarian active rather than reactive — a yearly exam on a dog who seems fine is how murmurs, loose kneecaps and early periodontal disease get found. Your veterinarian owns the diagnosis and the treatment plan. Supplements and peptides operate in the space that proper veterinary care creates, not instead of it.

Owners exploring peptide support for their dog can review K9-REPAIR — BPC-157 + TB-500 formulated for dogs — at https://pawgen.com/. BPC-157 and TB-500 are not FDA-approved veterinary drugs. Nothing in this article treats, cures or prevents any condition; every decision about your dog's care belongs with your veterinarian.