Abstract: [Objective] To investigate the clinical efficacy and safety of flexor hallucis longus transfer through a single incision for achilles enthesopathy accompanied with acute rupture. [Methods] Retrospective analysis was performed on the data of 32 patients (32 feet) with achilles enthesopathy accompanied with acute rupture who met the inclusion and exclusion criteria of the study from September 2014 to November 2016, including 28 males and 4 females. The average age was (45.78±7.49) years old. All the patients were treated with posterior medial single incision approach with hallucis longus transfer. Postoperative complications were observed and the time of cast-wearing was recorded. At the last follow-up, the American association for foot and ankle surgery (AOFAS) ankle-posterior foot function score and visual analogue pain score (VAS) were used to evaluate foot function; and evaluate the hallux flexion power. [Results] 32 patients were followed up for 30 to 45 months, with an average of (37.38±3.48) months. The duration of postoperative use of cast in this group was 7 ~ 16 weeks, with an average of (11.63±2.31) weeks. Post of the operation, superficial infection of the wound occurred in 3 cases and healed after dressing change, without deep infection, tendon re-rupture, interference screw pulling, etc. At the last follow-up, all patients could achieve single heel lift time of 5 seconds on the affected side. The flexion strength of the hallux was slightly lower than that of the healthy one, but no patient complained that insufficient flexion strength affected daily life. AOFAS ankle-hindfoot function score was 80 ~ 100 points, with an average score of (94.69±5.62). VAS score after 1km walking was 0 ~ 3 points (0.53±1.08), among which 25 cases (78.13%) had no pain at all. [Conclusion] Flexor hallucis longus transfer through a single incision for achilles enthesopathy accompanied with acute rupture is convenient, safe and effective.