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You don't have to put down area rugs everywhere but I would recommend that where the pup is likely to walk a lot you should. My Mokha has hip and elbow dysplasia and we have tiled floors. I will never know if all those times he slipped while he was growing had anything to do with it but I would never risk it again. We have area rugs and runners everywhere now, I would rather vacuum than risk him hurting himself especially since we paid out thousands for surgery.