Lameness is a major welfare and economic concern in the dairy industry. The aim of this study was to identify herd- and management-related risk factors for lameness, describe dairy cattle production practices in Egypt, and assess farm personnel’s knowledge and perceptions of common foot lesions associated with lameness. A cross-sectional study of 16,098 dairy cows from 55 farms was conducted. Milking cows were visually assessed for locomotion as they exited the milking parlor using a 0–3 scoring system. The within-herd prevalence of lameness was calculated as the proportion of cows scoring ≥ 2. Management data were collected through structured questionnaires with farm managers, combined with direct observations and measurements on the farms. Farm personnel responsible for lameness management were evaluated on their ability to identify and provide information about the causes and treatments of seven common foot lesions using pictorial descriptors. A mixed-effects logistic regression model incorporating Farm ID as a random-effects variable was used to investigate risk factors for within-herd lameness prevalence. The final model revealed that adequate footbath disinfectant concentration (OR = 0.28, 95% CI: 0.16–0.5) and increased bedding abrasiveness (OR = 0.30, 95% CI: 0.15–0.6) were significantly associated with reduced odds of lameness, while sharp corners at the parlor exit were associated with increased lameness prevalence (OR = 1.9, 95% CI: 1.1–3.4). A significant interaction was observed between footbath disinfectant concentration and bedding abrasiveness (OR = 3.3, 95% CI: 1.1–9.8), indicating that the association between bedding type and lameness prevalence was modified by footbath adequacy. Specifically, bedding type was associated with lameness only when footbath disinfectant concentration was inadequate, while under adequate footbath conditions, lameness prevalence was uniformly low regardless of bedding type. Knowledge gaps were identified among farm personnel in diagnosing and treating lameness. These findings highlight the importance of optimizing footbath management and bedding quality to mitigate lameness risk and provide evidence-based recommendations for improving lameness prevention and animal welfare in Egyptian dairy herds. Implementing educational programs and establishing a foot-trimming certification body in Egypt could further enhance the capability of farm personnel in effectively managing foot lesions.