Foot problems are a common concern in elephant husbandry. Studies on this topic with sample sizes greater than 100 animals have only been carried out in North America. We investigated foot health of 243 Asian elephants (Elephas maximus) in 69 European institutions. During on-site visits between August 2016 and July 2017, standardized pictures were taken of each elephant's nails and pads. The pictures were analyzed with respect to pathological lesions (i.e. nail cracks, abscesses), care issues (i.e. minor abnormalities, which are easily resolvable with routine foot work), and pad structure. Of all analyzed nails and pads, 35.6% revealed varying degrees of pathological lesions, with minor nail cracks and overgrown cuticles with attachment to the nails being most frequently observed. The most lateral nail (N5) on both front feet demonstrated the highest percentage of pathological lesions, providing support to a separate study showing that the mean peak pressure of an elephant's foot occurs along the most lateral digits; however, this was not observed along the most lateral nail (N5) of the rear feet. Three (of 243) elephants did not show any pathological lesions in their feet. The most common issues requiring foot care were fissures in the nail sole. The structure of the pads was categorized in four grades reflecting the percentage of surface marked by sulci. These four grades occurred at nearly equal frequency. Pearson product moment correlations revealed no significant association between the frequency of care issues and pathological lesions per nail. Despite this finding, it may be prudent to implement husbandry protocols that could alleviate commonly observed pathological and care foot issues in captive Asian elephants. A standardized approach to evaluate elephant foot health will provide a more objective way to monitor responses to management and medical decisions and ultimately contribute to the overall wellbeing of elephants in human care.