It flows southwest from Tūroa ski field, on the slopes of Mount Ruapehu, and passes through the town of Raetihi before its confluence with the Mangawhero River.

[1] The New Zealand Ministry for Culture and Heritage gives a translation of "white heron stream" for Mākōtuku.

In 2018 Veolia added activated carbon dosing, coagulation, flocculation, a lamella settler, filters and UV disinfection to the previous two settling ponds and chlorination, to minimise the effect of future pollution events.

The 2013 leak required Raetihi to have 21 days of water supply from road tankers.

[10] The 1.2 km (0.75 mi) Makotuku River Walkway was upgraded in 2021, with loop tracks on the east side of Raetihi.