Treated wastewater (TWW) reuse mitigates water scarcity but may induce soil salinization and trace metal accumulation if improperly managed. This field study evaluated the combined effects of irrigation water quality (TWW vs. well water) and irrigation method (surface vs. subsurface drip irrigation, SDI) on soil chemical properties, okra growth, yield, and nutrient/trace element dynamics under semi-arid Mediterranean conditions. Soil pH remained stable across treatments. Electrical conductivity was not significantly affected by water quality but increased in deeper layers under surface drip irrigation, indicating salt migration. SDI promoted more uniform nutrient distribution and favored Na+ displacement toward deeper layers, reducing root-zone exposure. Cations stratified vertically, with Ca2+, Mg2+, and K+ concentrated in surface layers and Na+ at depth. Water quality exerted a stronger influence than irrigation method. The fertilizing effect of TWW significantly enhanced plant height (53%), leaf dry matter (43%), aboveground biomass (81%), and fruit yield (16.3%). When combined with SDI, TWW improved irrigation water use efficiency by 20%. Although fruit Cd concentrations increased under TWW irrigation, all trace metals remained below international food safety standards. These findings indicate that integrating TWW with SDI enhances productivity and water use efficiency while maintaining short-term food safety, though long-term monitoring remains essential.