What to know about arterial and mixed wounds

An arterial ulcer is an open sore that develops because the arteries feeding the leg or foot have narrowed and can no longer carry enough blood to keep skin alive and repair it. Clinicians also call these ischemic wounds. They show up most on the tips of the toes, between the toes, on the heel, over the ankle bone and along the shin, places far from the heart or pressed on by shoes. The sore is often small, deep and dry, with a clean border. A mixed wound, sometimes called a mixed arterial-venous ulcer, sits on a leg where the veins are also failing, so swelling and drainage appear alongside the signs of a poor arterial supply.

What an assessment covers

The first visit is as much about the leg as the wound. The treating clinician feels for pulses at the ankle and on top of the foot, compares the temperature and color of both feet, and checks how quickly color returns to a toe after gentle pressure. The wound is measured, and its base, edges and drainage are described.

Then comes the question that shapes everything else: is there enough arterial flow for this wound to heal? If the answer is unclear, the clinician may order circulation testing before choosing dressings, deciding whether dead tissue should be removed, or allowing any compression.

Arterial and mixed wound care in Affton

Many homes in Affton were built with the bedrooms upstairs, and people with arterial pain often end up sleeping in a recliner on the main floor with their feet down. That eases the ache but can bring swelling and leave a heel pressed against a footrest for hours. A treating clinician who visits the home can see the setup and adjust the plan for heel protection and positioning. Gateway arranges those visits for long-time residents who want to stay in the houses they know, and coordinates supplies so protective padding and dressings are delivered there.

Most of Affton is single-family housing, often with a few steps up to the front door and a basement below, alongside duplexes, garden apartments and senior apartment buildings near the main roads. Assisted living, memory care and skilled nursing communities serve the area as well. Gateway arranges visits from partner clinicians in each of these settings. In a private home we work out timing with the family. In a facility we coordinate with the nursing staff so the visit, the orders and the supplies line up with the resident’s existing care plan.

At home between visits

Family caregivers are often the first to notice trouble with an arterial wound, because they see the foot every day. The treating clinician can show a spouse, adult child or paid aide what the wound should look like, how the dressing is handled under the current orders, and which changes call for a phone call.

Caregivers also help in quieter ways: checking that socks and shoes are not leaving marks, keeping walkways clear so toes are not stubbed, and making sure bedding is not pressing on sore toes at night. Gateway can include a caregiver on scheduling calls and updates when the patient agrees.

In a facility

Assisted living staff usually help with daily routines but may not perform wound care, so arterial wounds in these communities often involve a home health agency, the resident’s own physician and family. Gateway helps connect those pieces. The treating clinician visits the resident’s apartment, and we share the plan with the nurse or wellness director, the agency and the family contact.

Aides who help with bathing and dressing can be told what to watch for on the feet, such as a new dark spot on a toe or a sock that leaves a deep groove, and whom to tell when they see it.

Changes to report

Arterial wounds can change quietly, so small differences are worth a call. Contact the treating clinician’s team promptly if you notice:

  • Pain that is stronger, or that now wakes you at night
  • A toe or patch of skin turning dusky, purple or black
  • The wound getting wider or deeper
  • New drainage or odor, or a dry scab turning soft
  • Redness or warmth spreading out from the wound

Call 911 if a foot or leg suddenly turns cold, pale or blue, goes numb, or becomes severely painful or hard to move. A sudden loss of blood flow is an emergency.

How primary care fits in

Peripheral artery disease is rarely limited to the legs. The same buildup that narrows a leg artery often affects the vessels of the heart and brain, which is why a foot wound from poor circulation leads clinicians to look at the whole person.

A primary care clinician manages blood pressure, cholesterol and diabetes, and reviews the medications prescribed to protect the heart and blood vessels. Gateway can arrange primary care alongside wound care, so the clinician dressing the wound and the clinician managing overall health share records and each knows what the other has ordered.

Primary care at home in Affton →

Arranging arterial and mixed wound care in Affton

To arrange arterial and mixed wound care in Affton, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.

When you call 314-325-0126 about someone in Affton, have the street address, a phone number for the person who will be home, the name of the primary care doctor and any recent discharge papers nearby. Mention stairs, pets or a side-door entrance. Because Affton is compact and close to major roads, visits here can be planned alongside others in Mehlville, Crestwood, Shrewsbury, Webster Groves, South St. Louis and the rest of South County. Availability is confirmed for your address and care setting when you call.

  • County: St. Louis County, Missouri
  • ZIP codes: 63123
  • Nearby hospitals: Mercy Hospital South; SSM Health St. Mary's Hospital in Richmond Heights; St. Luke's Des Peres Hospital (not affiliated with Gateway)
  • Nearby communities: Mehlville, South County, Webster Groves, Crestwood, South St. Louis, Shrewsbury
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

Read the full guide to arterial and mixed wounds, or see everything Gateway arranges on the mobile wound care in Affton page.

Common questions

Can a wound care clinician come to a home in Affton to look at an arterial ulcer?

Gateway arranges home visits from partner clinicians for arterial and mixed wounds, and availability is confirmed by location and care setting. Call 314-325-0126 or send a callback request with your name and phone number. We will ask where in Affton the patient lives, what kind of home or facility it is, and whether any vascular records exist, then explain what happens next.

What should I have ready before the first visit for an arterial or mixed wound?

Helpful items include a current medication list, the names of your primary care clinician and any vascular or heart specialists, and results of past circulation tests or leg procedures if you have them. Set out the shoes and slippers you wear most. Write down when the wound started and when pain is worst. Gateway can request outside records for the treating clinician, so missing paperwork is no reason to delay calling.

Will Medicare or my insurance cover arterial wound care and circulation testing?

You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a visit, test or supply is a covered benefit depends on the treating provider, your specific plan and the care the clinician orders, so we cannot tell you in advance that something is a covered benefit. Have your insurance card handy when you call. We will explain what the treating provider’s office needs and what to ask your plan.

Does Gateway have a clinic in Affton where we can walk in?

No. Gateway does not run a walk-in clinic in Affton. We arrange for partner clinicians to see patients where they live, in homes and care facilities, and in some outpatient or office settings with clinical partners. Our administrative office in Chesterfield does not see patients. To start, call us or send the request form with a name and phone number only.

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.