Multiparous dairy cows between 10 to 30 d in milk (DIM) were enrolled in a clinical trial to evaluate the effects of rubber flooring on the development of claw lesions, locomotion scores, clinical lameness, and rates of hoof growth and wear. Two groups of cows were housed in identical free-stall facilities, except that 1 pen (rubber, n = 84) had rubber alley mats covering the entire concrete floor of the pen, whereas cows in the second pen were exposed to concrete flooring (concrete, n = 82) without rubber alley mats. All cows were evaluated 3 times between 10 and 30, 74 and 94, and 110 and 130 DIM for 1) the presence of claw lesions on their rear feet, 2) the occurrence of clinical lameness based on a locomotion score, and 3) rates of claw growth and wear as observed on the dorsal wall of the right lateral claw. No differences between flooring groups at the time of enrollment were detected for lactation number, mean DIM at first examination, body condition score, and proportion of cows with claw lesions at the first examination. Odds of developing claw lesions between examinations were not different for cows exposed to the rubber surface compared with those exposed to concrete. Cows on concrete, however, had greater odds of developing or exacerbating existing heel erosion than cows on rubber flooring. Regardless of the flooring surface, the lateral claw was more likely to develop lesions than the medial claw. Odds of becoming lame by the third examination and the proportion of cows requiring therapeutic hoof trimming because of lameness were greater for concrete-exposed cows than those on rubber. Cows on rubber flooring had decreased claw growth and wear between the first and last examination compared with cows on concrete. Regardless of flooring surface, second-lactation cows had greater wear rates than those in third or greater parities. Results of our study suggest that a soft flooring surface, such as interlocking rubber, is beneficial for hoof health.