This condition may develop for two reasons. In both cases a condition called hyperuricemia results. Over time, the uric acid begins to crystallize and settle in the joint spaces, most commonly the first metatarsal phalangeal joint of the big toe or the ankle joint. The most common symptoms of gout are inflammation, swelling and tenderness in the joint of the first toe. Touching or moving it will be intensely painful.
Patients often say it hurts to have as much as a bedsheet rest on top of a gouty toe.
Attacks of gout develop quickly rather than gradually, and typically occur in only one joint in the body at a time. In some cases, gouty symptoms develop in two or three joints simultaneously, but this is rare. If symptoms occur more widespread than that, it is probably not gout. The most reliable way to diagnose gout is to examine the patient's joint fluid for uric acid crystals. This is done by drawing fluid from the joint with a needle and examining it under a special polarized light microscope.