A nurse practitioner comes directly to your home or facility to treat your diabetic foot wound — no clinic trip, no transportation burden, no ER visit. Expert DFU care wherever you are.
A diabetic foot ulcer (DFU) is an open wound or sore — most commonly found on the bottom of the foot — that develops as a complication of diabetes. Peripheral neuropathy reduces sensation, so injuries and pressure points go unnoticed. Peripheral arterial disease reduces blood flow, slowing or preventing healing. Together, these factors make even a minor wound dangerous.
According to the CDC's National Diabetes Statistics Report, more than 11% of adults in Missouri have diagnosed diabetes — and the American Diabetes Association (ADA) estimates that roughly 15% of all people with diabetes will develop a foot ulcer during their lifetime. Without proper treatment, DFUs carry a high risk of infection, osteomyelitis (bone infection), and lower-limb amputation.
For many St. Louis patients, getting to a wound care clinic is itself a problem. Transportation limitations, mobility restrictions, pain, and fatigue make every clinic trip a barrier to the consistent follow-up that DFU healing requires. Gateway Wound Care eliminates that barrier — our nurse practitioners come to you, in Chesterfield, Creve Coeur, Kirkwood, and throughout our 50-mile service area.
The Wagner Ulcer Classification System is the most widely used tool for grading diabetic foot ulcers. It rates wound severity from Grade 0 (intact skin with risk factors) through Grade 5 (extensive gangrene). Most patients treated at home fall within Grades 1–3.
| Grade | Description | Typical Home Care Role |
|---|---|---|
| 0 | Pre-ulcer — intact skin, bony prominence, callus | Preventive education, offloading guidance |
| 1 | Superficial ulcer — partial or full thickness, no subcutaneous involvement | Dressing changes, debridement, offloading |
| 2 | Deeper ulcer — extends to tendon, capsule, or bone without abscess/osteomyelitis | Advanced dressings, debridement, infection monitoring |
| 3 | Deep ulcer with abscess, osteomyelitis, or tendinitis | Wound vac, antibiotic coordination, podiatry/vascular referral |
| 4–5 | Partial or extensive gangrene | Facilitate urgent specialist referral; not managed solely at home |
Gateway NPs assess each wound at every visit, tracking grade and trajectory. A wound that isn't improving prompts immediate escalation — whether that means adding wound vac therapy, ordering imaging, or referring to a podiatrist or vascular surgeon.
Diabetic patients often have neuropathy, visual impairment, or mobility restrictions that make driving unsafe. Arranging rides for twice-weekly wound visits over 8–12 weeks is impractical. Home care removes that obstacle entirely.
DFU healing depends on the same clinician seeing the same wound over time — tracking progress, adjusting dressings, and catching deterioration early. ER visits provide no continuity; every visit is a fresh start with unfamiliar staff.
Diabetic patients are immunocompromised. ER and hospital waiting rooms expose them to resistant organisms. Home visits eliminate that risk — care is delivered in the patient's own clean environment.
ER visits for chronic wound management generate high facility fees with no long-term care plan. Outpatient home wound care covered by Medicare or commercial insurance is consistently more cost-effective than episodic ER use.
Every Gateway visit begins with a thorough wound assessment — measuring depth, surface area, and wound bed tissue composition, checking for signs of infection (warmth, erythema, induration, purulent drainage), and reviewing the patient's most recent labs and glycemic control. Our NPs document with photos at every visit and communicate findings directly to the referring or primary care physician.
Removing devitalized tissue (slough, eschar, callus) is the foundation of DFU treatment. Our NPs perform enzymatic and conservative sharp debridement at bedside — no OR scheduling, no transportation.
Offloading — removing pressure from the wound — is as important as dressing selection. We provide offloading guidance, coordinate with your podiatrist or DME supplier for appropriate footwear and devices, and educate caregivers on pressure relief schedules.
We select evidence-based dressings matched to wound exudate, depth, and infection status. For qualifying wounds, we initiate wound vac (NPWT) therapy at home. When vascular compromise or osteomyelitis is suspected, we coordinate prompt podiatry or vascular surgery referral.
Medicare Part B covers medically necessary wound care services — including wound assessment, debridement, and dressing changes — provided by a nurse practitioner in the patient's home or facility. Wound vac (NPWT) coverage is governed by Medicare's Local Coverage Determination (LCD) and requires documentation of qualifying wound characteristics; our NPs provide complete documentation support.
We also accept most major commercial insurance plans, Medicaid, and Medicare Advantage plans. Our care coordinator verifies your benefits before the first visit — at no cost to you — so there are no billing surprises.
We serve diabetic foot ulcer patients throughout Greater St. Louis — including in Chesterfield, Creve Coeur, Des Peres, Town & Country, Kirkwood, Ballwin, and throughout our 50-mile service area. View full service area.