Gout acute attack with sudden onset of the first metatarsophalangeal joint (usually called the big toe joint) red, swollen and hot pain as a common clinical manifestation, but can cause the first metatarsophalangeal joint pain there are many diseases, and need to be differential diagnosis and gout, the following list of common: 1, traumatic arthritis, if the patient has a previous history of the first metatarsophalangeal joint trauma, infection or plain high exercise, etc., then traumatic arthritis can occur This can lead to pain at the joint. This can be combined with the patient’s medical history, improve joint X-rays and blood uric acid and other tests to identify. 2, osteoarthritis, osteoarthritis is a degenerative changes in the joint cartilage leading to joint pain, the disease is usually found in the knee, hip and other large joints, but some patients can also develop in the small joints can appear in the first metatarsophalangeal joint pain discomfort. For middle-aged and elderly patients with the onset of the first metatarsophalangeal joint pain can be identified by blood uric acid, joint x-ray, nuclear magnetic examination, etc. 3, secondary gout, it should be noted that for patients with joint pain caused by high uric acid, we should also pay attention to the secondary gout caused by factors such as kidney and blood system lesions, such patients can disappear after treatment of the primary cause of gout. Patients with sudden elevation of blood uric acid should consider the possibility of secondary gout and promptly undergo renal function and blood and urine tests for identification. In summary, there are many diseases that can cause pain in the first metatarsophalangeal joint (commonly known as the big toe joint) other than gout, so the patient’s medical history, symptoms and relevant laboratory tests should be combined to identify and treat the patient after a clear diagnosis.