What to know about diabetic foot ulcers

Foot ulcers are more likely in people who have had diabetes for many years, especially once feeling in the feet has faded. Anyone who has had an ulcer or an amputation before is at higher risk, because healed skin stays fragile and the pressure pattern behind the first wound is often still there. Other things that raise risk include poor circulation in the legs, kidney disease, changes in foot shape such as hammertoes, bunions or a collapsed arch, vision loss that makes foot checks hard, and trouble bending to reach the feet. People who live alone, or who cannot easily get properly fitted shoes, are more exposed too. None of this makes an ulcer certain. It tells clinicians whose feet to watch closely.

What an assessment covers

The wound is only part of the exam. The treating clinician also checks the foot and leg for whatever caused the ulcer and could keep it open:

  • Sensation, often tested with a thin filament touched to several spots
  • Pulses at the ankle and the top of the foot, skin temperature and color
  • Foot shape, callus, nail problems and the skin between the toes
  • The other foot, which shares the same risks
  • Shoes, insoles and socks, including wear patterns inside the shoe

If pulses are weak, the clinician may order a circulation study or a vascular referral before deciding how to approach the wound itself.

Arranging this care in Arnold

Many newer homes in Arnold have a garage entry with few steps and a main-floor room that can serve as a bedroom, which makes offloading easier to follow than in an older house. The harder part is distance. Specialists and testing sites may be miles away, so when a partner clinician orders a circulation study or imaging, Gateway looks at grouping appointments into fewer trips and arranging transportation. Dressings and devices are ordered ahead with delivery time in mind. Senior living communities are growing in this part of the region, and residents there can ask about on-site wound visits.

Cross the Meramec River on Interstate 55 and the first city you reach is Arnold, the largest in Jefferson County. Subdivisions spread over the hills on both sides of the interstate, and Jeffco Boulevard carries much of the local traffic. For daily errands Arnold is self-contained, but a good deal of specialty care sits north of the river in St. Louis County. For someone with a wound that needs frequent attention, or for a caregiver who works, that bridge crossing adds up. Care that comes to the home or facility takes the trip out of the week.

When care happens at home

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.

In a facility

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.

Changes to report

Infection is the change clinicians most want to hear about early, and in a numb foot it may not hurt. Contact the treating clinician promptly if you notice:

  • Redness that is spreading, or a red streak moving up the foot or leg
  • Skin around the ulcer that feels warmer than the other foot
  • Thicker, cloudy or foul-smelling drainage
  • New swelling of the foot or ankle
  • Fever, chills or feeling generally unwell

Call 911 for confusion, a racing heart, trouble breathing or fainting. Gateway is not an emergency service.

Why primary care matters here

Being told to keep weight off a foot changes daily life. A boot or cast can alter balance, raise the chance of a fall and make it harder to reach appointments, the pharmacy or the kitchen. Primary care looks at that wider picture: fall risk, vision, mood, sleep, vaccinations, and whether a walker, wheelchair or shower chair would help. For people who are homebound or have lost touch with a regular doctor, Gateway can arrange primary care visits alongside wound visits. With one coordinating point for both, it is less likely that the foot gets attention while the rest of a person’s health goes unwatched.

Primary care at home in Arnold →

Getting care arranged in Arnold

Before anything is scheduled, Gateway checks two things for every request for diabetic foot ulcer care in Arnold: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.

Arnold residents commonly use three hospitals: Mercy Hospital South just north of the Meramec, Mercy Hospital Jefferson in Festus down Interstate 55, and SSM Health St. Clare Hospital in Fenton, reached by Route 141. Gateway has no affiliation with them. If you are a family member, tell us which hospital and the expected discharge date, and we will request records. If you are a discharge planner, fax the referral with the face sheet and wound orders. We then check availability in 63010 and arrange the first follow-up visit with a treating clinician.

  • County: Jefferson County, Missouri
  • ZIP codes: 63010
  • Nearby hospitals: Mercy Hospital South; Mercy Hospital Jefferson in Festus; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
  • Nearby communities: Jefferson County, Oakville, Imperial, Fenton, Mehlville
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Arnold

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

Common questions

My parent lives in a nursing home in Arnold. Can Gateway arrange foot ulcer visits there?

You can ask, and we will confirm availability for that building. Partner clinicians see residents in skilled nursing, assisted living, memory care and rehabilitation settings. A facility has its own attending physician and nursing staff, so we coordinate with them before scheduling. Call us, or ask the director of nursing to send a referral. Updates go to family when the resident or legal representative agrees.

What shoes should I wear once the ulcer has closed?

Footwear after closure is a medical decision more than a shopping one. Many people are measured for shoes and inserts made for diabetic feet, usually through a podiatrist or a footwear specialist on a clinician’s order. Going back to the shoes worn before the ulcer is a common reason wounds return. Ask the treating clinician when and how to move out of the offloading device.

Will the clinician remove tissue from the wound during a visit?

Possibly. Removing callus and dead tissue, called debridement, is a common part of diabetic foot ulcer care, because unhealthy tissue hides the true size of the wound and can hold bacteria. Whether it is done, by what method and how often is up to the treating clinician, who considers blood flow first. Ask what to expect afterward, since a freshly cleaned wound can look larger.

Does Gateway arrange visits south of the Meramec River in Arnold?

Yes. Gateway’s region includes Jefferson County, and Arnold sits at the county’s northeast corner on Interstate 55. You can ask about care in a private home, an apartment or a care facility anywhere in the 63010 ZIP code. When you call, we check whether a visit is available for the specific address and care setting, since availability depends on location.

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.