Venous leg ulcer care in St. Louis.

What a venous leg ulcer is

A venous leg ulcer is an open sore on the lower leg, most often just above the inner ankle. Gateway arranges venous leg ulcer care in St. Louis and the Metro East with partner clinicians who visit homes and facilities.

The ulcer forms when the small valves inside the leg veins stop closing well. Blood that should travel back up to the heart pools in the lower leg, pressure builds in the veins, and fluid leaks into the surrounding tissue. Over time the skin turns fragile, and a minor bump or scratch can become a wound that stays open.

These ulcers tend to be shallow with uneven edges, and they often drain heavily. The skin around them may be swollen, discolored (brownish, reddish or darker than your usual skin tone), itchy or thickened.

Gateway arranges care for this kind of wound across the region. See wound care in St. Louis for how visits at home and in facilities are set up.

Why venous leg ulcers can be slow to heal

The cause of the wound, high pressure in the leg veins, is present every hour the leg hangs down. A dressing covers the ulcer but does nothing about that pressure. Other things add to it:

• Swelling that stretches the skin and keeps fluid weeping into the wound
• Drainage that sits on nearby skin and breaks it down
• Limited walking or a stiff ankle, which weakens the calf muscle that helps push blood upward
• Conditions such as heart failure, kidney disease, obesity or a past blood clot
• Artery disease in the same leg, which changes what treatment is safe

Our guide to leg swelling and wounds explains the connection.

What the treating clinician considers

The treating clinician looks at both legs, not only the sore, and typically reviews:

• The ulcer’s location, size, depth and amount of drainage
• Swelling and the condition of the surrounding skin
• Pulses and blood flow to the foot
• Past ulcers, blood clots, vein procedures and what has been tried before
• Pain and any signs of infection
• Whether you can manage wraps or stockings, and who can help

Compression therapy (wraps, stockings or garments that apply steady pressure to the leg) is a standard part of venous ulcer care. Because it can cause harm when the arteries are narrowed, clinicians check circulation first, as described in circulation tests before compression. The treating clinician decides whether compression is appropriate, which type to use and how firm it should be.

Venous leg ulcer care at home and in facilities

At home, the clinician sees things a clinic visit would miss: the chair you spend the day in, whether you sleep in a recliner with your legs down, and whether you can reach your own feet. Gateway coordinates the ordered compression therapy for leg wounds, supply deliveries and updates to home health if an agency is involved.

In skilled nursing, assisted living and rehabilitation settings, nursing staff usually handle dressings and wraps between visits. Partner clinicians see residents on site and send findings and orders to the facility team.

How primary care factors in

Vein disease is only one cause of leg swelling. The heart, kidneys, liver and some medications can all contribute. A primary care clinician sorts out which causes are in play and manages them, including any decisions about medications that affect fluid.

If you need a primary care clinician who can come to you, Gateway can arrange blood pressure and heart follow-up at home alongside wound visits.

Changes to report and when to call 911

Contact the treating clinician if you notice:

• Redness, warmth or tenderness spreading around the ulcer or up the leg
• A sudden increase in drainage, pus or a new odor
• Fever or chills
• New or worse pain, numbness or tingling under a wrap
• Toes that turn pale, blue or cold under a wrap (call right away)
• A wrap that has slipped, bunched or gotten wet
• New swelling or calf pain in one leg (possible blood clot, needs urgent evaluation)

For minor wrap trouble, see keeping compression wraps comfortable. Call 911 for chest pain, trouble breathing, bleeding from the leg that does not stop with firm pressure, or a leg that suddenly becomes cold, pale and very painful.

How Gateway helps arrange venous leg ulcer care

Call 314-325-0126 with your city or ZIP code and your care setting. We explain what records or orders the treating clinician will need, confirm whether visits are available where you are, and follow up after each visit to keep supplies and orders current. Benefits depend on the treating provider, the plan and the care needed.

You can also request a callback online. The form asks only for a name and phone number, so please do not add health details.

Common questions

Related pages

• Compression therapy
• Leg ulcer compression questions
• Leg swelling and weeping skin
• Lymphedema and edema management
• Venous vs arterial ulcers
• Arterial and mixed wounds
• Pressure injuries and bed sores
• Non-healing wounds