The aim of this study was to assess the effect of grazing (G) vs. zero-grazing (ZG), level of milk production, and quality and type of housing system [free stalls (FS) and straw yards (SY)] on the prevalence of lameness and leg injuries in dairy cows. Observations were made on 37 commercial dairy farms across Great Britain. A single visit of 5 d duration was made to each farm. During this visit, lameness scores and the incidence of swellings, rubs, and injuries to hocks and knees were recorded on all the peak- or mid-lactation cows. Aspects of the quality of housing and management that were likely to affect foot and leg health were recorded. There were more lame cows on ZG farms (39 +/- 0.02%) than on grazing (G) farms (15 +/- 0.01%), and lameness scores were higher on FS farms compared with SY farms (0.25 +/- 0.01 vs. 0.05 +/- 0.01). Cows on SY farms had fewer hock and knee injuries compared with FS farms. The frequency of knee swellings was higher on ZG farms (0.31 +/- 0.02) than on G farms (0.15 +/- 0.01). Aspects of the free-stall design affected foot and leg health. The number of hock swellings increased with increasing stall gradient (0.16 +/- 0.01 with no slope vs. 0.39 +/- 0.02 at a 0 to 1.5% slope). There was an interaction between the length of the free-stall lunging space and the hip width of the cow, indicating that the incidence of lameness is generally highest on farms with small free stalls and heavy cows. High levels of milk production did not affect lameness or leg injury. The results indicate that housing cows throughout the year potentially has a detrimental effect on foot and leg health. However, good free-stall design may reduce lameness and leg lesions.