Red, Swollen Toe: Is It Gout or an Infection?

A red, swollen toe can be alarming. It may appear suddenly, feel warm to the touch, and throb with pain—sometimes so severely that even the weight of a bedsheet feels unbearable. Two of the most common causes of this symptom are infection and gout, and while they can look similar at first, they require very different treatments.

Understanding the difference is crucial. Let’s break down what might be happening, how to tell them apart, and when you should seek medical care.

What Is Gout?

Gout is a form of inflammatory arthritis caused by a buildup of uric acid in the blood. When uric acid levels become too high, sharp crystals can form in joints—most commonly in the big toe.

Common Signs of Gout:

• Sudden, intense pain (often overnight)

• Redness and swelling

• Warmth in the joint

• Extreme tenderness

• Shiny or tight-looking skin

• Recurring flare-ups

Gout attacks can come on quickly and peak within 12–24 hours. The pain is often described as severe and stabbing. While the big toe is the classic location, gout can also affect the ankle, knee, or other joints.

Who Is at Risk?

• Men over 40

• Postmenopausal women

• People with high uric acid levels

• Those who consume high-purine foods (red meat, shellfish)

• Individuals who drink alcohol frequently

• People with kidney disease or metabolic conditions

What Is a Toe Infection?

A toe infection can involve the skin, nail, soft tissue, or even bone. It may develop from:

• An ingrown toenail

• A cut, blister, or puncture wound

• Athlete’s foot cracks

• Poor circulation

• Diabetes-related wounds

Infections can range from mild skin irritation to serious conditions like:

• Cellulitis (a spreading skin infection)

• Paronychia (infection around the nail)

Signs of Infection:

• Redness that spreads

• Swelling

• Warmth

• Throbbing pain

• Pus or drainage

• Fever (in more severe cases)

• Red streaking up the foot or leg

Unlike gout, infection often worsens gradually and may be linked to a visible injury or wound.

Infection vs. Gout: How to Tell the Difference

While both conditions cause redness, swelling, and pain, there are important differences:

Onset

• Gout: Sudden and dramatic, often overnight

• Infection: Gradual or following trauma

Pain Type

• Gout: Intense, sharp, and extremely tender

• Infection: Throbbing, aching, sometimes with pressure

Associated Symptoms

• Gout: May recur in the same joint; no wound present

• Infection: May have pus, an open sore, or spreading redness

Systemic Symptoms

• Gout: Rarely causes fever

• Infection: Fever and chills are possible

That said, the two can sometimes be confused—even by experienced clinicians. In certain cases, fluid from the joint may need to be tested to confirm the diagnosis.

Why an Accurate Diagnosis Matters

The treatments for gout and infection are completely different.

Gout Treatment

• Anti-inflammatory medications

• Colchicine

• Steroids

• Long-term uric acid management

Infection Treatment

• Antibiotics

• Drainage of abscess (if needed)

• Wound care

• Monitoring for spread

Treating gout with antibiotics won’t help. Ignoring an infection can allow it to spread—especially dangerous for individuals with diabetes or poor circulation.

When to Seek Medical Attention

You should see a healthcare provider immediately if you have:

• Fever

• Spreading redness

• Severe, worsening pain

• Pus or drainage

• Diabetes or immune compromise

• Inability to bear weight

Prompt treatment can prevent complications such as joint damage, bloodstream infection, or chronic gout flares.

Can You Prevent These Conditions?

To Reduce Gout Risk:

• Stay hydrated

• Limit alcohol

• Reduce high-purine foods

• Maintain a healthy weight

• Manage blood pressure and kidney health

To Prevent Toe Infections:

• Trim toenails properly (straight across)

• Keep feet clean and dry

• Treat athlete’s foot early

• Wear well-fitting shoes

• Inspect feet daily if you have diabetes

The Bottom Line

A red, swollen toe is not something to ignore. While it may be gout—a painful but manageable condition—it could also be a bacterial infection requiring urgent care.

If you’re unsure, don’t self-diagnose. A proper evaluation can quickly determine the cause and get you on the right treatment path—relieving pain and preventing complications.

Your feet carry you every day. When they signal a problem, it’s worth listening. Contact our office today with Dr. Gireesh Reddy or Dr. Sirisha Pokala by calling (469) 573-3427 or by booking an appointment online.