Lameness is one of the most important dairy cow welfare issues and has inspired a growing body of literature on gait assessment. Validation studies have shown that several methods of gait assessment are able to successfully distinguish cows with and without painful pathologies. While subjective methods provide an immediate, on-site assessment and require no technical equipment, they show variation in observer reliability. On the other hand, objective methods of gait assessment provide accurate and reliable data, but typically require sophisticated technology, limiting their use on farms. In this critical review, we evaluate gait assessment methods, discuss the reliability and validity of measures used to date, and point to areas where new research is needed. We show how gait can be affected by hoof and leg pathologies, treatment of these ailments and the pain associated with lameness. We also discuss how cow (e.g. conformation, size and udder fill) and environmental features (e.g. flooring) contribute to variation in the way cows walk. An understanding of all these factors is important to avoid misclassifying of cows and confounding comparisons between herds.