A gouty toe is the name for a condition where the big toe accumulates large concentrations of uric acid which forms crystals inside the joint. The big toe swells up, is red and hot, and very painful. Even putting on a sock may increase the pain. Cause A gouty toe only occurs in those who have gout or high levels of uric acid. Gout is a form of arthritis that is associated with the increase in uric acid from the breakdown of purines from food and in the body. In normal physiology, the body is able to remove uric acid so that it won’t accumulate in the joints. However, normal physiology becomes abnormal in conditions such as diabetes, high blood pressure, obesity, and while taking certain medications such as aspirin and diuretics. Treatment and Prevention Diet changes should be made immediately, avoiding red wine, beer, other alcoholic drinks, red meat, shellfish and organ meats while increasing the consumption of pure water. By increasing water, the crystals can be prevented from forming in the body in the first place. Without treatment the symptoms will subside, however, it helps to stay off the feet and to elevate the foot to help reduce swelling. Painkillers may also be recommended. The avoidance of tight shoes during episodes of gouty toe is a no-brainer, since the pressure from just wearing a shoe increases pain. Consider ¾ cushioned insoles that would not be near the gouty toe.