Lameness is one of the most pressing health and welfare problems in cattle, especially on dairy farms. The most common cause of lameness is claw pathology, often due to lack of appropriate functional claw trimming. Functional claw trimming restores the physiological shape of the claws, distributes weight properly between the claws and over the claw weight-bearing surface. It also allows closer examination of the claws for early signs of pathology. The methods of functional claw trimming described in the previous century are still applicable today, considering some recent findings on the subject. It is essential not to over-trim the claws and to maintain strict hygiene of the trimming tools. Claw horn pathology in the early stages is usually treated effectively by therapeutic claw trimming alone. The stoic nature of cattle and their natural tendency to hide pain often result in delayed treatment of claw diseases, leading to more advanced stages of disease/pathology associated with higher-grade lameness. This situation often leads to the development of neuropathic pain and hyperalgesia requiring multimodal treatment. Because claw horn diseases are multifactorial, veterinarians and others involved in animal management must be familiar with the preventive measures available to improve claw health in a cattle herd. Further research to improve claw horn quality and effectively control/prevent claw infections without polluting the environment or negatively affecting worker and animal health is still needed. This article reviews the latest knowledge on functional claw trimming and treatment of the most common claw horn diseases in cattle.