Leg torsion and distal asymmetry (LTDA) among cows reared on intensive farms in the Comarca Lagunera region of northern Mexico may be indicative of underlying health concerns. To ascertain whether the incidence of LTDA is associated with trough measurements and with productive, reproductive, and disease variables, the prevalence of LTDA was determined in lactating dairy cows. The data were derived from two intensive dairy farms in northern Mexico (G60: 2043 cows in 13 pens with 142.0 m of linear feed bunk space and 65.0 m of pen depth; G100: 2227 cows in 12 pens with 215.0 m of linear feed bunk space and 49.0 m of pen depth). The cows were observed over the course of a week to identify any macroscopic lesions indicative of LTDA. Cows exhibiting lesions were assigned a value of “1”, while those without lesions were assigned a value of “0”. Furthermore, data regarding other limb diseases (LDs) were collected and subjected to analysis. A comparison was conducted to ascertain the impact of reproductive, productive, and feed bunk size variables on the prevalence of LTDA and other LDs. To ascertain the prevalence of LTDA and LDs, a chi-squared test was employed. The prevalence of LTDA was found to be 27.6% (G60: 31.4%, G100: 22.4%). No association was identified between LTDA and the variables included in the study. However, a correlation was identified between LDs and the following variables: total width, distance from the edge, width from the feed bunk to the tramp, and the presence of a manure crust on the walls. Principal component analysis (PCA) was conducted to examine the correlation between LDs and various factors at the farm and pen levels. The findings indicated that the distance from the feed bunk to the trough, the presence of manure crusts on the walls, and the breeding time were associated with LDs in G100, as well as in three of the twelve pens (302, 306, and 308) within G100. The findings suggest that the prevalence of LDs is associated with an increase in the width of the feed bunk and the width of the manure crust on the walls, particularly in pregnant cows. The results permit the conclusion that LTDA and LDs are associated with the measurements of the feed bunks, the absence of manure cleaning of the feed bunks, and gestation. This association gives rise to significant health issues for Holstein cows on these farms, with more than one in four cows affected. To reduce the prevalence of LTDA in lactating dairy cows, it is recommended that the standard measurements for feed bunk design be adhered to. This will reduce the prevalence of LTDA and LDs, promote the cleaning protocols to avoid the accumulation of manure crusts, and facilitate close monitoring of pregnant cows, thereby alleviating the impacts of these foot pathologies on animal welfare.