Most patients have no precursors to gout. A small number of patients may have vague pain in the toe, ankle or knee joints, which may intensify late at night, with pain in the form of cutting, tearing or insect bites. The first attack of gout usually affects a single joint, such as the first metatarsophalangeal joint, and the second attack may also affect the ankle, knee, heel and dorsum of the foot. Gout stones can be formed after a gout attack, mostly in the auricle or around joints with recurrent gout, and appear as yellowish-white bulges of varying sizes.