Understanding diabetic foot ulcers

The most common mistake with a diabetic foot ulcer is judging it by pain. A numb foot can carry a deep wound that feels like nothing at all. A second mistake is assuming a small opening means a small problem, when the damage under a callus can be wider than the hole in the skin. People also tend to think that keeping the wound covered is the whole treatment, yet a good dressing does little if the foot still bears weight on that spot all day. And many people believe an ulcer leads straight to amputation. It does not have to. Early attention, pressure relief and steady follow-up are what clinicians rely on to protect the foot.

What an assessment covers

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.

Local context: Alton

People in Alton 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.

Alton rises from the Mississippi River in steep hills and bluffs, on the Illinois side upriver from St. Louis. The Clark Bridge connects it to Missouri, and the Great River Road follows the bluffs toward Grafton. It is an old city with brick streets, tall houses and neighborhoods that sit above or below one another. Those hills are part of what people love about Alton, and they are hard on anyone with a leg wound, poor balance or limited strength. Gateway arranges wound care and primary care in the home or facility, so the hills stay outside the door.

Care at home

A home visit for a diabetic foot ulcer shows the treating clinician things a clinic never does: the slippers by the bed, the step down into the garage, the route to the bathroom at night. During the visit the clinician examines the wound, provides the care that is needed and updates the orders. Gateway schedules the visit, confirms the address and how to get in, and sends records ahead so the clinician arrives informed. Afterward we follow up on whatever was ordered, such as a boot, dressing supplies or a test, so those items are not left waiting on a phone call.

For residents of nursing and senior living communities

Assisted living poses a particular challenge for diabetic foot ulcers. Residents are fairly independent, staff may not be permitted to change wound dressings, and a person can walk on a sore foot for days before anyone sees it. When Gateway arranges visits in an assisted living community, we ask who handles dressings between visits: facility staff, a home health nurse or family. The treating clinician shapes the plan around that answer. We also let the community’s nurse or wellness director know what to watch for, such as drainage on socks or a resident who has stopped wearing the prescribed shoe.

Signs to tell the clinician about

Whoever changes the dressing is well placed to spot trouble. Let the treating clinician know if you see any of the following:

  • Drainage soaking through sooner than it used to
  • The wound measuring larger, or new openings nearby
  • Skin around the wound turning white, soggy or raw
  • A new blister or rubbed area where the boot, cast or shoe touches
  • Fresh blood on a dressing that used to come off clean

Bleeding that will not stop with firm pressure, sudden weakness, slurred speech or difficulty breathing are reasons to call 911, not to wait for a call back.

Why primary care matters here

Healing an ulcer takes protein, calories and fluids, and that can pull against an eating plan built around blood sugar or kidney disease. Sorting out what to eat while a wound is open is a question for the primary care clinician or a dietitian. Medications deserve the same review. Some can affect swelling, blood sugar or healing, and only the prescribing clinician should adjust them. Arranging wound care and primary care together means these questions are asked by someone with the full medication list and recent lab results in hand, not saved for an appointment that is months away.

Primary care at home in Alton →

Getting care arranged in Alton

You may already have a surgeon, a wound clinic or a home health nurse and still want help with diabetic foot ulcer care closer to home in Alton. That is a fine reason to call 314-325-0126. Tell us who is treating the wound now and what is not working, whether that is the travel, the gaps between appointments or unclear instructions. Gateway does not replace your current clinicians. We can arrange for a partner clinician to see the wound where you live and, with your permission, share notes with the offices already involved so the plans agree.

Alton has two hospitals of its own, Alton Memorial Hospital and OSF Saint Anthony’s Health Center, and many local hospital stays happen at one or the other. Gateway is not affiliated with either. When someone comes home with a wound that needs follow-up or a changed list of medications, the family can call us to ask about visits. Hospital discharge planners and social workers can refer by phone or by fax at 314-786-7966. We gather the discharge records, coordinate with a partner clinician and keep the patient’s regular doctor informed.

More wound care in Alton

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

Common questions

How do I start diabetic foot ulcer care in Alton?

Call 314-325-0126 or send the request form with your name and phone number. Please leave medical details out of the form. We will call back to ask where you live, who is involved in your care and what has been tried so far. Then we confirm which partner clinician can see you and set up the first visit.

Does a diabetic foot ulcer always mean there is an infection?

No. Every open wound has bacteria on its surface, and that is different from infection in the tissue. When clinicians suspect infection, they may order a culture, blood work or imaging to find out how deep it goes. Antibiotics are prescribed only when the clinician judges they are needed. Report changes quickly all the same, because infection in a diabetic foot can spread fast.

Can I shower or get my foot wet while I have an ulcer?

Ask the treating clinician, because the answer depends on the dressing and the offloading device. Some dressings must stay dry, and some casts cannot get wet at all. Soaking the feet is generally discouraged for people with diabetes, since it softens the skin and numb feet cannot judge water temperature. The clinician can suggest a safe way to bathe, such as a cover or a shower chair.

Gateway is based in Missouri. Does it really arrange care in Alton, Illinois?

Yes. Gateway coordinates wound care and primary care across the Metro East as well as Greater St. Louis, and Alton is part of that region. Care is delivered by partner clinicians, and availability is confirmed for each Illinois location and care setting. Call 314-325-0126 and tell us the address and where the patient is living.

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.