OBJECTIVE To describe the incidence of specific causes of lameness and the associations of cause and severity of lameness on the outcome for cattle on commercial feedlots. DESIGN Dynamic population longitudinal study. ANIMALS Cattle on 6 commercial feedlots in Kansas and Nebraska during a 12-month period (mean daily population, 243,602 cattle; range, 223,544 to 252,825 cattle). PROCEDURES Feedlot personnel were trained to use a standardized diagnostic algorithm and locomotion score (LMS) system to identify and classify cattle by cause and severity of lameness. Information regarding lameness cause, severity, and treatments was recorded for individual cattle. Cattle were monitored until they left the feedlot (ie, outcome; shipped with pen mates [shipped], culled prematurely because of lameness [realized], or euthanized or died [died]). Incidence rates for various causes of lameness, LMSs, and outcomes were calculated. The respective associations of cause of lameness and LMS with outcome were evaluated. RESULTS Lameness was identified in 2,532 cattle, resulting in an overall lameness incidence rate of 1.04 cases/100 animal-years. Realized and mortality rates were 0.096 cattle/100 animal-years and 0.397 deaths/100 animal-years, respectively. Injury to the proximal portion of a limb was the most frequently identified cause of lameness followed by undefined lameness, septic joint or deep digital sepsis, and interdigital phlegmon (foot rot). As the LMS (lameness severity) at lameness detection increased, the percentage of cattle that died but not the percentage of cattle that were realized increased. CONCLUSIONS AND CLINICAL RELEVANCE Results provided clinically useful prognostic guidelines for management of lame feedlot cattle.