Objective To study the effect of ultra-thin anterolateral thigh free flap in repairing deep wounds of distal foot. Methods A total of 76 patients with deep wounds of distal foot admitted to our hospital from January 2022 to January 2023 were selected as the research objects. Based on the random lottery method, they were divided into control group and observation group, with 38 patients in each group. The control group was repaired with retrograde flap, and the observation group was repaired with ultra-thin anterolateral thigh free flap. The survival rate, sensory function, ankle function, appearance and repair satisfaction of the two groups were compared. Results The flap survival rate of the observation group was 97.37%, which was higher than 92.11% of the control group, but the difference was not statistically significant (P >0.05). The scores of BMRC and AOFAS in the observation group were higher than those in the control group at 3 and 6 months after treatment (P <0.05). The excellent and good rate of appearance in the observation group was 97.37%, which was higher than 84.21% in the control group (P <0.05). The repair satisfaction of the observation group was 94.74%, which was higher than 78.95% of the control group (P <0.05). Conclusion During the treatment of deep wounds of the distal foot, the ultra-thin anterolateral thigh free flap can improve the skin state, restore the local sensory function as soon as possible, and the survival rate of the flap is high, which has good clinical application value.