With the growth of the global population and increasing concern for environmental issues, the development of sustainable and eco-friendly materials has become increasingly important. Starch, as a renewable resource, is one of the most abundant polysaccharides in nature, with the advantages of good biocompatibility, high biodegradability, and low cost. Starch-based hydrogels (SBHs) have attracted widespread attention due to their unique physical and chemical properties. This article provides a comprehensive review of the latest research progress in SBHs, discussing their main characteristics, formation mechanisms, diverse applications, and future development trends. First, it outlines the biocompatibility, degradability, water absorption and retention, environmental responsiveness, and mechanical strength of SBHs. Then, it elaborates in detail on the formation mechanisms of SBHs, including physical crosslinking (hydrogen bonding, electrostatic interactions, host-guest and coordination interactions), chemical crosslinking (such as initiators, heat, light, radiation, and click reactions), and synergistic effects. Subsequently, it analyzes the applications of SBHs in cutting-edge fields such as flexible sensors, medical dressings, drug delivery, tissue engineering, soil protection, wastewater treatment, and food packaging. Finally, it summarizes the challenges in current research and provides an outlook on future development trends, emphasizing the importance of further optimizing the performance of SBHs to meet broader industrial needs and environmental protection goals. This review not only provides a systematic theoretical framework for the study of SBHs but also charts a course for their innovative applications in the field of sustainable materials, playing a significant role in advancing the continuous development of this area.