A needle in the big toe will only generate positive results if you are having a flare up at the time. I would be very surprised if your internal medicine or family doc would attempt this. They generally leave that up to the orthopedist as they are more experienced in injecting and aspirating joints. More often than not, treatment is generally based on the symptoms and response to treatment vs. a lab analysis of joint fluid. Definitely ask what you can do to treat gout prophylatically. Sometimes it is easier to prevent gout than to treat a flare up. It is certainly less painful FYI, gout shows up in lots of other joints and areas other than the big toe: ankle, knee, elbow, wrist, hand, and tendons.