Abstract The customized production pattern has brought significant innovation to the design and manufacturing of footwear. To improve the matching degree between the consumer’s feet and deepen the customization of the sole’s personalized function, a three-dimensional (3D) Voronoi strut midsole structural design method driven by plantar pressure distribution is proposed in this paper, which not only realizes the functional requirements but also takes into account the aesthetic of midsoles. In this method, the foot characteristics and pressure information obtained by the foot measuring system are employed as the data-driven basic of the midsole structural design, and a weighted random sampling strategy is introduced for constructing the Voronoi sites. Moreover, a Voronoi clipping algorithm is proposed to make the 3D Voronoi diagram adaptive to the midsole boundary. And then, taking the clipped 3D Voronoi edges as skeleton lines, the smooth and continuous 3D Voronoi strut midsoles are generated by the implicit surface modelling technology and implicit function fusion. All the algorithms are integrated into a digital framework by independent programming. And both the static and dynamic tests show that the 3D Voronoi strut midsole can make the plantar pressure distribution more homogenous and can effectively reduce the load on the metatarsal and heel region. What is more, it can provide superior energy absorption and cushioning properties, offer better resilience, bring consumers a more comfortable wearing experience and reduce the probability of joint injury caused by the abnormal plantar pressure concentration.