The aetiological aspects as well as postural attitude implications represent an open question in the evaluation and in the treatment to be applied in scoliosis. Legs asymmetry is often recognized in scoliotic patients, but still controversial is the use of underfoot wedges in order to compensate pelvis tilt. This could be due to the great uncertainty and intrinsic error level of the traditional clinical and visual measurements methods that present limitations in the assessment of all the 3D involved postural and morphological parameters. This is especially true given the clinical difficulty in the estimation of pelvic torsion usually coupled to leg asymmetry. In such a topic, a significant helpful tool has been demonstrated to be the opto-electronic measurement approach proposed by D'Amico et al., particularly given the innocuousness of the analysis and the speed of the clinical parameter extraction procedure. The present investigation demonstrates on a sample of 220 patients the efficacy of under-foot wedge use in leg asymmetry correction, posture re-balancing and spine deformities reduction, pointing out the significant contribution of the 3D opto-electronic measurement approach in the critical process of assessing the correct under-foot wedge size, therapy monitoring and follow-up.