Diabetic foot ulcer care in the Riverbend.

Understanding diabetic foot ulcers

Most diabetic foot ulcers begin with pressure or friction that the person never feels. Years of high blood sugar can damage the nerves that carry pain and temperature signals from the feet, so a pebble in a shoe, a tight seam or hot pavement does its harm unnoticed. The same nerve damage can dry the skin until it cracks, and it can weaken the small muscles of the foot so the toes curl and bones press down in new places. Callus builds over those pressure points, and the tissue underneath breaks down. When narrowed arteries also limit the blood supply, the skin is less able to repair small injuries, and a minor break becomes an open wound.

How the care plan is built

Part of building a plan is finding out what a person can realistically do. Expect the treating clinician to ask questions such as:

• How far do you walk in a day, and on what surfaces?
• Can you see and reach the bottoms of your feet?
• Who is available to help with dressings?
• Have you had an ulcer, foot surgery or an amputation before?
• What has already been tried on this wound?

The answers shape the choice of offloading device and the dressing schedule. A plan that fits daily life is one a person can keep following, and reassessment at each visit shows whether it is working.

Diabetic foot ulcer care in the Riverbend

People in the Riverbend with a diabetic foot ulcer often split their care between two states: a primary care office and hospital in Illinois, and a vascular surgeon or foot specialist in St. Louis. Records do not always follow across the river. Gateway requests them from both sides so the treating clinician can see the circulation studies, cultures and imaging already done. If a specialist visit in Missouri is ordered, we first check whether your plan and that provider work together, then help with transportation across the bridge so the foot is not walked on more than necessary.

The Riverbend is the name people give to the cluster of Illinois towns where the Mississippi swings east near its meeting with the Missouri: Alton, Godfrey, East Alton, Wood River, Bethalto, Roxana and Hartford. They share a river, a long history of industrial work and a set of state highways. They differ a great deal on the ground, from bluff-top neighborhoods to flat blocks of small houses to open country north of Godfrey. In every one of them, people who cannot travel easily still need wound care and regular medical follow-up, and that is the part Gateway arranges.

At home between visits

When dressings need changing more often than visits occur, the treating clinician may order home health nursing, and Gateway helps set that up with an agency that serves your area. The agency nurse follows the wound orders and reports changes back. Supplies are the other piece. Dressings, wraps and offloading devices are ordered by the clinician, and we track each order so the right sizes arrive before the current stock runs out. Store supplies together in one clean, dry place, and tell us early if a box is running low or if the boot or shoe no longer fits well.

For residents of nursing and senior living communities

A resident with dementia may not remember having a foot wound, may pull off a dressing, or may refuse a boot that feels strange. Memory care teams know these patterns, and the treating clinician plans with them. That can mean choosing dressings that stay in place, timing care for a calmer part of the day, and asking staff which footwear the resident will keep on. Because the resident often cannot report pain or changes, staff observations carry extra weight. Gateway relays those observations to the clinician between visits and helps keep family members or legal decision-makers informed about the plan.

Changes to report

A foot ulcer can affect the whole body, and sometimes the first warning shows up away from the wound. Tell the treating clinician about:

• Blood sugar readings that run higher than usual for no obvious reason
• Nausea, poor appetite or unusual tiredness
• New pain in a foot that normally feels very little
• A sore, crack or callus appearing on the other foot
• A fall, or an offloading device that is damaged or no longer fits

Call 911 for severe shortness of breath, chest pain, new confusion or a person who cannot be woken.

Why primary care matters here

The blood that reaches the foot is what feeds a healing ulcer, and the health of the arteries is largely a primary care matter. Blood pressure, cholesterol, kidney function and tobacco use all affect the vessels in the legs. A primary care clinician tracks these, orders the lab work and can coordinate referrals to vascular or kidney specialists when the wound clinician raises a concern. Leg swelling from heart or kidney conditions matters as well, because a swollen foot fits poorly in an offloading device. When Gateway arranges both kinds of care, findings from one visit can inform the other instead of sitting in separate charts.

Primary care at home in the Riverbend →

Getting care arranged in the Riverbend

Setting up diabetic foot ulcer care for someone in the Riverbend usually goes in this order:

1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
2. Gateway talks with you about the wound, the address and the insurance.
3. We confirm availability for that location and gather records for the treating clinician.
4. The clinician visits, assesses the wound and writes the orders.
5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

The two general hospitals in the Riverbend, Alton Memorial Hospital and OSF Saint Anthony’s Health Center, are both in Alton. Patients from Wood River, Bethalto and the other towns are commonly discharged from them, and Gateway has no affiliation with either. A discharge to a home a few towns away can leave a family unsure who checks the wound next. Families can call us with that question. Discharge planners can refer by phone at 314-325-0126 or fax at 314-786-7966, and we coordinate follow-up with a partner clinician and the regular doctor.

• County: Madison County, Illinois
• ZIP codes: 62002, 62035, 62024, 62095, 62010
• Nearby hospitals: Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton (not affiliated with Gateway)
• Nearby communities: Alton, Godfrey, Illinois, Edwardsville, Granite City
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in the Riverbend

Read the full guide to diabetic foot ulcers, or see everything Gateway arranges on the mobile wound care in the Riverbend page.

• Venous leg ulcers
• Pressure injuries and bed sores
• Arterial and mixed wounds
• Non-healing wounds
• Post-surgical wounds
• Reopened (dehisced) surgical wounds
• Surgical site infections
• Skin tears and traumatic wounds
• Wounds with lymphedema
• Skin graft aftercare
• Wound VAC (NPWT) follow-up
• Diabetic foot ulcer care in Alton
• Diabetic foot ulcer care in Godfrey
• Diabetic foot ulcer care in Edwardsville
• Diabetic foot ulcer care in Granite City

Common questions