MadWorld is divided into several levels representing different parts of Jefferson Island that have been converted into sets for the game show DeathWatch.

A few levels feature motorcycle-based combat where the main character, Jack, is assaulted by foes as they race down a track or in a small arena.

A common feature of each of these levels is the "Bloodbath Challenge", a time-limited minigame that rewards the player for completing a specific type of activity with additional points.

[7] MadWorld does not make use of the Wii Remote's infrared sensor, as its developers found it unnecessary to pinpoint movements on the screen in order to attack.

Jack Cayman (Steve Blum), a man with a chainsaw attached to his prosthetic arm, enters the games and manages to gain sponsorship from "Agent XIII" (Jim Ward).

Meanwhile, Jack meets Leo Fallmont (Danny Cooksey), a hospital doctor who was unwittingly trapped in the city but managed to obtain the vaccine.

[14] The developers chose violence as the main theme of the title, but experimented with a variety of cartoon-like art styles to alleviate the violent content with a sense of humor, ultimately deciding upon a black-and-white aesthetic with splashes of red for blood.

"[14] MadWorld was developed primarily for a Western audience, and the team extensively analyzed American pop culture in search of material that was so extreme and unrealistic it produced a comedic effect.

Nishikawa chose to focus entirely on combat, omitting extraneous puzzle-solving or collection elements, with the goal of making the game easy to play in short sessions.

An emphasis was placed on earning high scores, while "Bloodbath Challenge" minigames were used to incorporate additional variety into the game's design.

To avoid this, the developers limited the amount of on-screen movement and adjusted the game's textures to include more gradual changes from black to white.

[13] While some of MadWorld relies on the Havok engine for modeling physical interactions in the game, the developers found they had to resort to their own programs to capture some of the reactions and behaviors of the enemies for many of the unique killing methods.

[15] The game's story was written by Yasumi Matsuno, famous for his design in the Ogre Battle series and a number of Square Enix titles.

[16] Proops and DiMaggio, who had previously worked together on animated films such as Asterix and the Vikings and Kaena: The Prophecy, were both contacted by the voice cast director Jack Fletcher to play the parts of the announcers for the North American and European release.

[18] At the request of Inaba, the music styles included hip hop and rock, taking inspirations from the mashup album Collision Course from Linkin Park and Jay-Z.

[18] Tanaka created the backtracks first using Cubase SX and ACID, then gave these, along with the general theme of the level associated with the music, to the artists for them to add lyrics and other performances.

[45] About.com felt the game was more flash than substance, giving it a 3/5 and stating: "Divorced of its unique graphics and over-the-top presentation, this is actually a rather mediocre beat-em-up.

"[46] Game Informer disagreed, praising the deep combat system and arguing: "for an amateur to become a talented executioner, you'll have to lash out creatively, prolonging your victim's death through multiple phases of pain.

"[32] IGN opined: "MadWorld does not place emphasis on style over gameplay...there's plenty of fun, smart mechanics to back up the overwhelmingly slick look and sound of the title.

"[27] Sean Ratcliffe, Vice President of Marketing for Sega of America stated that, in terms of sales, "the first set of data for Madworld is very encouraging".

[50][needs update] MadWorld fared much poorer in Japan, where it debuted at number 33 on Japanese sales charts and only selling around 3,000 units during its release week.

[53] However, PlatinumGames announced a few days later that they would like to do a sequel to MadWorld,[54] which ended up as Anarchy Reigns, a 3D fighting game for PlayStation 3 and Xbox 360 that was released in 2012 in Japan and 2013 in western territories.

[58][59] On March 10, 2020, PlatinumGames celebrated MadWorld's eleventh anniversary with new artwork of Jack created by lead character designer Masaki Yamanaka.