Intertidal sediments are rich in biological resources, which are important for material circulation and energy exchange. Meanwhile, these areas can be treated as sinks as well as sources of coastal heavy metal pollutants. Due to the influence of the tide, the intertidal sediments are in a state of periodic flooding and exposure, and environmental factors such as dissolved oxygen, salinity and overlying water pressure are changeable. Heavy metals in sediments are prone to migration and transformation with the dynamic effects of tidal water and the changes in the environment factors, which increase the bioavailability of heavy metals. In this review, the characteristics of distribution and the bioavailability of heavy metals in intertidal sediments are described; the migration and transformation behavior of heavy metals and its influencing factors under tidal conditions are analyzed; and the mechanisms of heavy metal’s migration and transformation in the intertidal zone are summarized. Moreover, the bioaccumulation of heavy metal by organisms and the remediation techniques are discussed. Therefore, this review systematically summarizes the states of existence, the transport mechanisms, and the fate of heavy metals in the intertidal sediment, fills in the research gap of the cycling of heavy metal in the intertidal zone, and provides a theoretical basis for the control of heavy metal pollution.