The objectives of this study were to (1) estimate herd-level lameness prevalence (HLLP) on Canadian dairy farms, (2) compare the detected HLLP to the perceived lameness estimated by farmers, and (3) assess the associations between hoof-health management practice (HHMP) and HLLP. A cross-sectional study (National Dairy Study (NDS)) was conducted in the summer of 2015. The NDS consisted of a questionnaire and a follow-up farm visit. The questionnaire had an 11% response rate (n = 1,157) and contained farmer HLLP estimates, herd demographics, HHMP (e.g., use of a footbath). On-farm, HLLP was assessed using locomotion score (LS) for cows in freestall/pack farms, or in-stall lameness score (SLS) for cows in tie-stalls. The 14 assessors achieved a group inter-rater reliability Fleiss’s kappa score of 0.63 (substantial agreement), and a rater-expert Byrt’s Kappa of 0.73 (substantial agreement), ranging from 0.62 to 0.78. Lameness assessments were performed on a representative sample of milking cows on 374 farms across Canada. HLLP was determined by 1) the proportion of cows with LS ≥3 on a 5 point scale, where 1 = normal, 3 = mild, and 5 = severely lame or 2) the proportion of cows with SLS of ≥ 2 out of 4 behavioral indicators of lameness, where < 2 indicated a non-lame cow, and ≥ 2 indicated a lame cow. The mean HLLP was 29.2%, which was 2.8 times greater, on average, than the prevalence estimated (10.3%) by the farmers. In multivariable models, the use of deeper bedding was associated with lower HLLP. Pack barns were associated with lower HLLP (8.3%) when compared with freestall (20.1%), which was lower than tie stall (29.6%) (P < 0.05). Using a professional trimmer was associated with lower HLLP when compared with farmer/vet (15.7% vs 19.5%, P < 0.05). Providing the milking herd pasture access at least part of the year was associated with lower HLLP compared with no pasture access (14.4% vs 21.2%, P < 0.05). Results from this study highlight the need to educate farmers on detecting lameness, and provide insight into HHMP that may reduce the HLLP across Canada.