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Although there is a general understanding that there is a link between poor cow comfort and lameness, the mechanisms by which one leads to the other are poorly understood. The objective of this article is to review the environmental impacts on hoof health in the dairy cow, describing the potential interactions between cow comfort and the trigger factors which ensure cows get lame and the subsequent interactions once cows become lame which ensure that she stays lame. These are the dual roles of cow comfort. The discussion will make the case that it is the duration of daily standing activity, combined with the type of surface that the cow stands upon, that are the principal components of cow comfort that need to be addressed if we are to break the cycle of get lame stay lame.