To investigate the value of free peroneal artery perforator flap assisted by 3D-CTA in repairing skin and soft tissue defects of forefoot. Methods A total of 48 patients with forefoot skin and soft tissue defects admitted to Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University from February 2021 to June 2022 were selected as the research control. They were divided into control group and observation group by random number table method, with 24 patients in each group. The control group was treated with pedicle flap repair, and the observation group was treated with free peroneal artery perforator flap repair assisted by 3D-CTA. The clinical efficacy, pain degree and foot function of the two groups were compared. Results The total effective rate of treatment in the observation group was 95.83%, which was higher than 75.00% in the control group (P <0.05). The AOFAS score of the observation group was higher than that of the control group, and the VAS score was lower than that of the control group (P <0.05). Conclusion The effect of free peroneal artery perforator flap assisted by 3D-CTA in repairing of skin and soft tissue defect of forefoot is good, which can promote the recovery of skin flap sensory function, reduce postoperative pain, improve the foot function of patients and promote recovery.