INTRODUCTION: Medial tibial stress syndrome (MTSS) is also called soleus syndrome because the resultant periostitis is localized to the medial insertion of the soleus muscle. This study explores the effectiveness of dry needling (DN) targeting soleus myofascial trigger points (MTrPs) in managing MTSS. AIM: To assess the impact of DN on pain reduction and ankle range of motion (ROM) improvement in athletes with MTSS. STUDY DESIGN: This randomized controlled trial (RCT) included 50 university-level athletes. (DN group = 25; control group = 25). METHOD: Outcome variables, pain, and ankle dorsiflexion ROM were measured using the Numeric Pain Rating Scale (NPRS) and universal goniometer, respectively. The trial used statistical analyses like Wilcoxon rank test for within-group comparisons and Mann-Whitney U test for between-group comparisons. The trial was registered with the Clinical Trials Registry of India; CTRI/2023/10/058837. RESULT: There were 24 Females (Age = 21.4 ± 2.06) & 26 Males (Age = 20.5 ± 2.35). DN significantly reduced pain in the intervention group from NPRS 7 ± 1.30 to 2 ± 0.87 ( < 0.001), but in the control group, the pain increased from NPRS 7 ± 0.99 to 7 ± 1.05 ( = 0.009). There was no improvement in ankle ROM. CONCLUSION: DN effectively alleviated MTSS-associated pain in the short-term but was not effective in improving ankle ROM.