Hi Thank you for asking HCM I have gone through your query. If the swelling is reddish and yellowish white spots then it can be most likely a gout attack. During gout attack the irritation on the area will be more and even difficult for sleeping. Serum uric acid should be checked to rule out this. If uric acid is absolutely normal then it can be tendinitis. If gout then in acute stage like this should be treated with NSAIDs like naproxen or ibuprofen. Cochicine is helpful in acute stage if used judiciously by your doctors advise. Protein intake from meat or fish should be controlled also. Hope this may help you. Let me know if anything not clear. Thanks.