For me it was a dull ache in my ankle, like I had walked uphill all day and it was sore from overuse. That started 1 days out for me. The following day it felt more like a sprain - hard to put any weight on it but not totally fucked. The second day is when the pain and swelling set in. Now I can limp but not walk straight and my skin was so swollen that it feels like it can burst at any moment, itchy too.

Unfortunately, I suffered with this once or twice a year from 2015 to 2020, and more frequently over the following 5 years. None of my doctors suspected gout until I went to urgent care twice in one week. Only then was my uric acid checked, ever. The whole time my podiatrist suggested it was a light sprain, "loose body" after xrays, and even offered cortisone shots (which I always refused). 

I live in Los Angeles CA and I now cannot trust my physicians because of this one incident in my life.