BACKGROUND: Standard treatment of plantar first metatarsal head neuropathic ulceration with underlying osteomyelitis consists of extensive debridement of infected soft tissues and bone and often first ray amputation. The purpose of this study was to present a previously unreported, one stage, alternative to first ray amputation in patients with chronic first metatarsal head ulceration and associated chronic osteomyelitis. MATERIALS AND METHODS: A retrospective review was conducted of all patients that underwent one stage resection of the first metatarsophalangeal joint with pin stabilization for treatment of chronic plantar first metatarsal head ulceration with associated chronic osteomyelitis. The study included 15 patients (18 feet) who underwent 18 resections and stabilizations. All patients had a diagnosis of diabetic peripheral neuropathy, chronic plantar first metatarsal head ulceration of at least 3 months duration with exposed bone, and no gross purulence or acute cellulitis. Nine patients (60%) (11 feet) were available for followup telephone interviews. Four of the 15 (27%) (four feet) were deceased so they had medical record review only. The average followup was 48.8 months. RESULTS: All ulcers healed with the exception of one foot (5%) who required a transmetatarsal amputation for worsening infection and wound complications. Three feet (17%) developed recurrent ulcerations. No foot had amputation of only the hallux or first ray. CONCLUSION: This study presents a previously unreported, relatively simple, one stage treatment option for chronic first metatarsal head ulceration with underlying chronic osteomyelitis. This procedure allowed for successful healing of the ulcer while retaining the first ray.