What a diabetic foot ulcer is
A diabetic foot ulcer is an open sore on the foot of a person who has diabetes. Gateway arranges diabetic foot ulcer care in St. Louis and the Metro East with partner clinicians who see patients at home and in facilities.
Most ulcers form on the bottom of the foot, the toes or the heel, where the skin takes pressure with every step or rubs against a shoe. Many start as something small: a callus, a blister, a cracked heel or a cut that went unnoticed. Our guide to diabetic foot ulcer basics explains the terms you will hear.
If you are looking for help with this wound close to home, start with our overview of wound care in St. Louis.
Why a diabetic foot ulcer can be slow to heal
Diabetes can change the foot in several ways at once, and each one makes healing harder.
- Less feeling. Nerve damage (neuropathy) can dull pain, so a sore may not hurt and you keep walking on it.
- Less blood flow. Narrowed arteries in the legs carry less oxygen to the wound.
- High blood sugar. Blood sugar that stays high can slow tissue repair and make infection harder to fight.
- Repeated pressure. Changes in foot shape, calluses and tight shoes load the same spot repeatedly.
- Infection. Infection can spread into deeper tissue or bone, sometimes without much pain.
What the treating clinician considers
The treating clinician looks at the wound and at the whole foot. A visit commonly covers:
- The ulcer’s size, depth and drainage, and the tissue in its base
- Feeling in the foot and pulses at the foot and ankle
- Signs of infection, including whether deeper tissue could be involved
- Where pressure falls, and what shoes or devices you use
- Recent blood sugar readings, other conditions and medications
The clinician then decides what to order, which may include a way of taking pressure off the wound, called offloading, removal of unhealthy tissue, a dressing plan, circulation testing, or a referral to podiatry or a vascular specialist. Those decisions belong to the treating clinician, not to Gateway.
Diabetic foot ulcer care at home and in facilities
Getting to a clinic every week is hard when you have been told to limit walking on a sore foot. Mobile wound care at home brings the visit to you, so the clinician also sees your shoes, your floors and how you move around the house.
In skilled nursing, assisted living and memory care, partner clinicians see residents on site through mobile wound care for facilities and share findings and orders with the nursing staff who handle care between visits.
How primary care factors in
A foot ulcer is one sign of how diabetes is affecting the body. Blood sugar, blood pressure, kidney function, circulation and nutrition all shape how the wound responds. Those are managed by a primary care clinician or a diabetes specialist, not at the wound visit.
If you are homebound or have no regular clinician, Gateway can also arrange diabetes care at home. We then help wound findings and primary care notes move between the two clinicians.
Changes to report and when to call 911
Tell the treating clinician promptly about any of these:
- New redness, warmth or swelling around the ulcer or spreading up the foot
- More drainage, pus or a new odor
- A wound that is larger or deeper, or dark or black skin on a toe or heel
- New pain in a foot that is usually numb
- Fever, chills, or blood sugar running higher than usual for no clear reason
- A new blister, sore or callus anywhere on either foot
Our list of diabetic foot ulcer warning signs goes into more detail. Call 911 for confusion, trouble breathing, chest pain, fainting, bleeding that will not stop, or a foot or leg that suddenly turns cold, pale or blue. Gateway is not an emergency service.
How Gateway helps arrange care
You or a family member can call 314-325-0126 without a referral. We ask where you live or are staying, what care setting you are in and who is already involved.
From there we gather records, confirm visit availability for your location, schedule with a partner clinician, and follow up on orders, supplies and communication with your podiatrist, primary care clinician or facility. Ask us about coverage, which varies with the treating provider, your plan and the care needed.
Request care with your name and phone number only. Please leave medical details out of the form. Professionals can refer a patient online or by fax at 314-786-7966.
Common questions
My foot ulcer does not hurt. Is it still serious?
It can be. Diabetes often damages the nerves in the feet, so a wound may cause little or no pain even when it is deep or infected. Clinicians go by what they see and measure, not by how the foot feels. Have any open area, stain on your sock or spot that will not close looked at, even if it feels fine.
Should I stay off my foot while the ulcer heals?
Pressure is one of the main reasons these wounds stall, so most care plans include some way of protecting the area. What that means for you (special footwear, a boot, a cast or limits on standing) is the treating clinician’s decision. Ask exactly how much walking is allowed and what to wear indoors.
Do I still need my podiatrist if a wound care clinician is visiting?
Usually, yes. Podiatrists, wound care clinicians, primary care clinicians and vascular specialists each handle a different part of diabetic foot care, and a wound visit does not replace them. Tell us who you already see, and Gateway will include those offices when visit notes and orders are shared.
Can a family member help between visits?
Yes. A family member can look at both feet each day, including the heels and between the toes, watch for the changes listed above and keep track of supplies. The treating clinician will explain which dressing tasks, if any, a caregiver should do and which to leave alone.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.