By tailoring metamaterials with chiral unit cells, giant optical activity and strong circular dichroism have been achieved successfully over the past decade.Metamaterials based on arrays of metal helices have revolutionized the field of chiral metamaterials, because of their capability of exhibiting these pronounced chiro-optical effects over previously unmatched bandwidths. More recently, a large number of new metamaterial designs based on metal helices have been introduced with either optimized optical performance or other chiro-optical properties for novel applications. The fabrication of helical metamaterials is, however, challenging and even more so with growing complexity of the metamaterial designs. As conventional two-dimensional nanofabrication methods, for example, electron-beam lithography, are not well suited for helical metamaterials, the development of novel three-dimensional fabrication approaches has been triggered. Here, we will discuss the theory for helical metamaterials and the principle of operation. We also review advancements in helical metamaterial design and their limitations and influence on optical performance. Furthermore, we will compare novel nano- and microfabrication techniques that have successfully yielded metallic helical metamaterials. Finally, we also discuss recently presented applications of helical metamaterials extending beyond the use of far-field circular polarizers.