Makinen misjudged a corner, rolling his Mitsubishi heavily just 500 metres into the rally and went out of the race. The Finn's co-driver, Seppo Harjanne, injured his back and was taken by helicopter in Perugia.
The first special stage in this eighth round of the world championship was cancelled after another Finn, Jarmo Kytolehto, crashed his Ford within sight of the start.
In another incident, the German driver Guenther Gils suffered a broken leg when he was run over by another rally car as he walked along the road.
With Makinen out, Britain's Colin McRae drove his Subaru into the lead. McRae, who lost his world title to Makinen, led his Subaru team-mate Piero Liatti of Italy by 4sec.
Spain's Carlos Sainz, originally listed fifth, was later given a 10-second penalty and fell to eighth, 44sec behindMcRae.
SAN REMO RALLY Leading positions after first day (Arrezzo, It): 1 C McRae (GB) Subaru Impreza 1hr 32min 47sec; 2 P Liatti (It) Subaru Impreza +4sec; 3 A Dallavilla (It) Toyota Celica +19; 4 G Pianezzola (It) Toyota Celica +24; 5 D Auriol (Fr) Mitsubishi Lancer +37; 6 K Eriksson (Swe) Subaru Impreza +38; 7 B Thiry (Bel) Ford Escort Cosworth +40; 8= F Cunico (It) Ford Escort Cosworth; C Sainz (Sp) Ford Escort Cosworth +44; 10 A Medeghini (It) Subaru Impreza +1min 23sec.Reuse content