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Multimodal Mathematical Reasoning (MMR) has recently attracted increasing attention for its capability to solve mathematical problems that involve both textual and visual modalities. However, current models still face significant challenges in real-world visual math tasks. They often misinterpret diagrams, fail to align mathematical symbols with visual evidence, and produce inconsistent reasoning steps. Moreover, existing evaluations mainly focus on checking final answers rather than verifying the correctness or executability of each intermediate step. To address these limitations, a growing body of recent research addresses these issues by integrating structured perception, explicit alignment, and verifiable reasoning within unified frameworks. To establish a clear roadmap for understanding and comparing different MMR approaches, we systematically study them around four fundamental questions: (1) What to extract from multimodal inputs, (2) How to represent and align textual and visual information, (3) How to perform the reasoning, and (4) How to evaluate the correctness of the overall reasoning process. Finally, we discuss open challenges and offer perspectives on promising directions for future research.