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Why is the big toe most affected by gout?

Gout is one of the most painful forms of arthritis. It occurs when too much uric acid builds up in the body. The buildup of uric acid can lead to:

Sharp uric acid crystal deposits in joints, often in the big toe
Deposits of uric acid (called tophi) that look like lumps under the skin
Kidney stones from uric acid crystals in the kidneys.

For many people, the first attack of gout occurs in the big toe. Often, the attack wakes a person from sleep. The toe is very sore, red, warm, and swollen.

Gout can cause:

Pain
Swelling
Redness
Heat
Stiffness in joints.

In addition to the big toe, gout can affect the:

Insteps
Ankles
Heels
Knees
Wrists
Fingers
Elbows.