The aim of this study is to present a case series of patients with congenital Zika syndrome (CZS), giving special attention to the more relevant aspects for the paediatric orthopaedic surgeon.An analytical cross-sectional study was performed in a group of 47 patients affected by CZS with maternal Zika serology confirmation. Clinical features of the maternal Zika infection, prenatal and perinatal complications, and patient demographic data were recorded. In addition, clinical and radiographic evaluations of the lower limb (hip, knee, and foot) were performed.Maternal Zika infection occurred at an average of 12.5 (± 6.4) weeks of gestation. The rates of complications during pregnancy and delivery were 37% and 17.4%, respectively. At the time of the clinical evaluation, spasticity was appreciated in 77.3% of the cases, and arthrogryposis was present in 15.2%. Foot deformities were appreciated in 41.2% of the cases, hip alterations in aggregate in 29.8% (adduction contracture in 20.2%; displacement in 7.5%), and knee alterations in 12.8% (displacement in 6.4%). The deformities in arthrogrypotic patients were both more prevalent and severe. All arthrogrypotic patients were simultaneously spastic.The current study demonstrates a high prevalence of musculoskeletal alterations in patients with CZS. Affected patients were able to be classified as belonging to one of three types at the time of evaluation: Type I patients presented with a low incidence of musculoskeletal complications; Type II demonstrated progressive deformities; Type III presented with simultaneously the most prevalent and severe deformities. This classification system could help guide medical and surgical management of CZS patients based on the frequency and severity of the deformities at the time of initial evaluation.