Understanding venous leg ulcers

A venous leg ulcer is a break in the skin of the lower leg that stays open because the veins beneath it are not doing their job. Most appear between mid-calf and ankle, commonly on the inner side near the ankle bone. They are usually shallow, with an irregular outline and a moist red or yellowish base. Drainage can be heavy enough to soak through dressings and socks.

The skin nearby tells part of the story. It may look stained brown or purple, feel tight, hard or itchy, and swell more as the day goes on. Pain varies. Some people feel a dull ache that eases when the leg is raised, and others feel very little.

What an assessment covers

Before anything is wrapped, the treating clinician needs to know that the arteries in the leg can tolerate pressure. That usually means feeling for pulses in the foot, and often a bedside test that compares blood pressure at the ankle with blood pressure in the arm. If the result is unclear, further vascular testing may be ordered.

This step matters because some leg ulcers involve both vein and artery disease, and those call for a different plan. Once circulation is understood, the clinician decides whether compression is appropriate, which form to use and how firm it should be. The dressing choice follows, matched mainly to how much the ulcer drains.

Local context: Alton

People in Alton with venous leg ulcers sometimes see a vascular specialist in St. Louis and receive the rest of their care in Illinois. That split can leave gaps, such as test results from one side of the river never reaching the clinician who wraps the leg on the other. Gateway gathers the records, including circulation studies done before compression, and shares them with the treating clinician. When a trip across the river for specialty care is needed, we help with scheduling and transportation. Whether a Missouri-based provider can be used under an Illinois plan is checked first, not assumed.

Much of the housing in Alton is older: large houses in the historic districts, frame houses on narrow lots, apartments in converted buildings and newer homes farther from the river. Many front doors are reached by a long flight of steps. The city and its neighbors also have senior apartments, assisted living, and skilled nursing and rehabilitation centers. Gateway arranges visits from partner clinicians in every one of these settings. We ask about steps, entrances and parking ahead of time, and in facilities we coordinate the visit and the resulting orders with nursing staff.

Care at home

At a home visit, the partner clinician removes the old wrap and dressing, checks the skin, measures the ulcer and the swelling, and reapplies what was ordered. Seeing the home helps. The clinician can look at the chair where you spend most of the day, whether a footstool or recliner raises your legs, and how far you walk to the bathroom or kitchen. Details like these often explain why a leg is more swollen on some days than others. Gateway schedules the visits, confirms the day with you or a family member, and passes the clinician’s notes and orders to the others involved in your care.

Care in skilled nursing and assisted living

In a skilled nursing facility, venous leg ulcer care is shared work. The partner clinician sees the resident on site, assesses the ulcer and the circulation, and writes or recommends orders in line with the facility’s process. Nursing staff carry out dressing changes and compression between visits and document what they see. Gateway keeps the two connected by scheduling rounds with the facility, sending visit notes and following up on open questions. The attending physician stays informed and remains in charge of the resident’s overall medical care, including the heart, kidney and medication issues that affect leg swelling.

What to report and when to call 911

Changes in the skin around a venous ulcer are worth reporting even when the wound itself looks the same. Let the treating clinician know about:

  • Dressings that soak through earlier than expected
  • Skin near the ulcer that turns white, soggy or raw
  • A new itchy rash or blisters under a dressing, tape or wrap
  • A new open area anywhere on either leg
  • Clear fluid weeping from skin that was intact
  • A dressing or wrap that got wet or dirty

Call 911 if bleeding will not stop with firm pressure, or if the person becomes confused, very drowsy or hard to wake.

Why primary care matters here

The calf muscle acts as a pump for the leg veins, and it only works when the ankle moves. Arthritis, nerve damage, an old injury, pain from the ulcer itself or fear of falling can shrink a person’s walking to a few steps a day. A primary care clinician can look at what is limiting movement, manage pain, review fall risk and order physical therapy or equipment when appropriate. Sleep is part of this too. People who sleep upright in a recliner because of breathing trouble or back pain keep their legs down all night, and the reason behind that habit needs a medical answer.

Primary care at home in Alton →

How to get started in Alton

For a resident of a nursing home, assisted living or memory care community in Alton, a request for venous leg ulcer care can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

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 venous leg ulcers, or see everything Gateway arranges on the mobile wound care in Alton page.

Common questions

My mother lives in a nursing home in Alton. Can Gateway arrange venous ulcer care there?

Often, yes. Partner clinicians see residents in skilled nursing, assisted living, memory care and rehabilitation settings, working alongside the facility’s nurses and the attending physician. Start by telling us the facility’s name, or ask its nursing staff to contact Gateway. We confirm whether visits are available at that location and what the facility needs in order to begin.

What should I have ready before the first visit?

A few things help: a list of your medications and allergies, the names of your other clinicians, any recent hospital or clinic records about the leg, and results of circulation tests if you have had them. Keep the dressings and wraps you are using now so the clinician can see them. If a family member helps with your care, ask them to be present or available by phone.

Could a leg ulcer that will not heal be something other than a venous ulcer?

Yes. Poor arterial circulation, diabetes, pressure, inflammatory conditions, certain infections and, rarely, skin cancer can all cause leg wounds that resemble venous ulcers. That is one reason the clinician reassesses an ulcer that is not responding as expected. Further circulation testing, lab work, a tissue sample or a specialist referral may be ordered. Raise the question directly if you are worried.

I have an Illinois Medicaid or Medicare Advantage plan. Can I ask about visits in Alton?

Yes, you can ask. Tell us the plan name and that it is an Illinois plan. Participation and benefits depend on the treating provider, the plan and the care needed, and they are not always the same on both sides of the river. We help check before a visit is scheduled and will not assume anything on your behalf.

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.