<p>The extensive application of pesticides has ensured consistent high crop yields in agriculture, yet it has presented challenges to soil health. To support the sustainable use of agricultural land, regularly evaluating the health of pesticide-contaminated soil can be beneficial in many cases. The diverse toxic effects of pesticides on earthworms offer various indicators based on earthworms for assessing soil health. Although many factors, such as soil compaction, affect soil health, pesticide contamination is a particularly significant concern in this context. As vital organisms in soil ecosystems, earthworms can be exposed directly to pesticide in the soil and exhibit a range of quantifiable responses, including mortality, reduced biomass, alterations in enzyme activity, abnormal behaviors, and DNA damage. The sub-individual level indicators of earthworms are typically more sensitive than those of individual or population level indicators, enabling them to be quantified even in lower concentrations of pesticides. At present, the key to using earthworms for the health assessment of pesticide-contaminated soil is to establish a consistent and measurable relationship among the pesticide pollution level, local earthworm response indicators, and soil health indicators under similar conditions. This article reviews the research status and potential development of earthworms as ecologically significant and responsive indicators for assessing the health of pesticide-contaminated soil. This review paper is expected to construct a knowledge framework and provide theoretical references for the fields of ecological assessment of pesticide-contaminated soil and sustainable development of modern agriculture with a focus on soil health.</p>