The toes, especially the first metatarsophalangeal joint, are a good site for gout, but the swelling and pain in the first metatarsophalangeal joint is not always caused by gout and needs to be analyzed on a case-by-case basis. Gout is a crystal-related arthropathy caused by uric acid deposits, which can lead to joint inflammation if uric acid crystals are deposited in the joints of the foot. The first metatarsophalangeal joint is the most common clinical manifestation of gout in the acute phase, which occurs suddenly at night or during sleep in the early hours of the morning, mostly unilaterally, with no symptoms on the other side. The joint swelling and pain caused by an acute attack of gout is severe and unbearable, like a knife cut or insect bite, but it is self-limiting, even without the use of drugs, the joint symptoms can be relieved on their own within a few days or 2 weeks, or even disappear. However, if the disease is not well controlled, joint swelling and pain may occur frequently. In addition, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and other diseases can also cause the first metatarsophalangeal joint swelling and pain, but all have their own characteristics, such as rheumatoid arthritis is mostly symmetrical joint swelling and pain, and rheumatoid factor positive; ankylosing spondylitis is also accompanied by sacroiliac joint pain, HLA-B27 more positive; psoriatic arthritis is mostly accompanied by psoriatic rash. Therefore, the first metatarsophalangeal joint is a good site for gout, but there are many causes of swelling and pain in the first metatarsophalangeal joint, so you should promptly visit the rheumatology department and improve the relevant tests to clarify the diagnosis.