In many people, gout initially affects the joints of the big toe. But many other joints and areas around the joints can be affected in addition to or instead of the big toe. These include the insteps, ankles, heels, knees, wrists, fingers, and elbows.igns and Symptoms of Gout. 1  hyperuricemia. 2  presence of uric acid crystals in joint fluid. 3  more than one attack of acute arthritis. 4  arthritis that develops in a day, producing a swollen, red, and warm joint. 5  attack of arthritis in only one joint, often the toe, ankle, or knee.