People match with similar scores every year.

That said, its an uphill battle for sure. Need to have something else stand out in your application. Might want to consider taking a research year.

FOr most programs, your step 1 score is used to screen the applications. Most programs have it set somewhere in the 220s, others have no screen, a few have set their screens higher like in the 230s. All you have to do is get past the screen; that may not be possible for all programs but once you get an interview your job is to kill it. It also helps to rotate and do very well at that rotation. It also helps to have good reserach. It also helps to have an advocate who knows you and is willing to call for you. Many things combine to help you match. The step 1 is just an initial screen usually (a few programs use the step 1 to compile a composite ranking after interviews, but that isn't very common).