As the result of current and historical metal mining, river channels and floodplains in many parts of the world have become contaminated by metal-rich waste in concentrations that may pose a hazard to human livelihoods and sustainable development. Environmental and human health impacts commonly arise because of the prolonged residence time of heavy metals in river sediments and alluvial soils and their bioaccumulatory nature in plants and animals. This paper considers how an understanding of the processes of sediment-associated metal dispersion in rivers, and the space and timescales over which they operate, can be used in a practical way to help river basin managers more effectively control and remediate catchments affected by current and historical metal mining. A geomorphological approach to the management of rivers contaminated by metals is outlined and four emerging research themes are highlighted and critically reviewed. These are: (1) response and recovery of river systems following the failures of major tailings dams; (2) effects of flooding on river contamination and the sustainable use of floodplains; (3) new developments in isotopic fingerprinting, remote sensing and numerical modelling for identifying the sources of contaminant metals and for mapping the spatial distribution of contaminants in river channels and floodplains; and (4) current approaches to the remediation of river basins affected by mining, appraised in light of the European Union's Water Framework Directive (2000/60/EC). Future opportunities for geomorphologically-based assessments of mining-affected catchments are also identified.