About 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 the treating clinician looks at
The history shapes a venous ulcer plan as much as the exam does. The treating clinician asks how long the ulcer has been open, whether this leg has ulcerated before, and whether you have had a blood clot, a vein procedure, leg surgery or an injury. Allergies are reviewed, along with any skin reaction to past dressings, tapes or wraps, so the same products are not ordered again.
The clinician also asks what you have already tried and what happened. An ulcer that does not look or behave like a typical venous wound, or one that fails to respond, may lead to more tests or a referral to a vascular or skin specialist.
Local context: Arnold
Adult children in Arnold often manage a parent’s leg ulcer around a workday and a commute. They leave before the morning swelling check and get home after the wrap has slipped. Gateway plans around that. We can request visit times when a caregiver can attend, or give a phone update afterward, and we time supply orders so dressings and wrap layers arrive before the last ones are used. For a parent who has moved into a senior living community nearby, we coordinate with the staff there as well as with the family.
Housing in Arnold ranges from older ranch homes near the center of town to newer subdivisions, townhomes, apartment complexes and manufactured home communities. Hilly lots and sloped driveways are part of the landscape. The area also has senior apartments, assisted living and skilled nursing and rehabilitation centers. Gateway arranges partner clinician visits in all of these. For a home visit we ask about entry steps and where the patient rests. For a facility resident we coordinate with the director of nursing or the unit staff so orders reach the people carrying them out.
When care happens at home
Most of the healing in a venous leg ulcer happens between visits. The treating clinician leaves instructions for those days: how long a wrap stays on, how to keep it dry, when to put your feet up, and what to do if a wrap slides down. If a wrap comes off early or drainage soaks through, call instead of waiting for the next scheduled visit. Gateway takes those calls, relays the question to the clinician and arranges whatever follows, such as a supply shipment or an earlier visit when one is available. Writing down questions as they come up makes each visit more useful.
In a facility
Residents in memory care may not understand why a leg is wrapped. They may pull at the bandage, scratch the skin beneath it or be unable to say that it feels too tight. The treating clinician takes that into account when choosing dressings and compression, and may adjust the plan when a resident does not tolerate a wrap. Staff observations carry extra weight here. Restlessness, guarding the leg, a change in walking or a new refusal to wear shoes can all signal discomfort. Gateway shares the clinician’s instructions with the care team and keeps the family or legal representative updated on visits and changes.
Signs to tell the clinician about
Some changes point beyond the ulcer to the rest of the body. Tell the treating clinician promptly about:
- New swelling, pain or tenderness in one calf or thigh
- Swelling that rises quickly in both legs
- Rapid weight gain over a few days
- Needing more pillows to breathe comfortably at night
- A fall or a new injury to the leg
Call 911 right away for sudden shortness of breath, chest pain, coughing up blood, or a racing heartbeat with lightheadedness. These can be signs of a blood clot in the lungs or a heart problem, and they should not wait for a scheduled visit.
Why primary care matters here
Not all leg swelling comes from the veins. The heart, kidneys, liver and thyroid can each cause fluid to build up, and so can certain medicines for blood pressure, pain or diabetes. Sorting out which causes apply is primary care work, usually involving an exam, a medication review and sometimes blood tests or heart testing. That information changes wound care. A clinician planning compression wants to know, for example, whether heart failure is present and how stable it is. When Gateway arranges wound care and primary care together, findings move in both directions and the leg is not handled as if it were separate from the person.
Getting care arranged in Arnold
For a resident of a nursing home, assisted living or memory care community in Arnold, 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.
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 venous leg ulcers, or see everything Gateway arranges on the mobile wound care in Arnold page.
- Diabetic foot 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
- Venous leg ulcer care in Jefferson County
- Venous leg ulcer care in Oakville
- Venous leg ulcer care in Mehlville
Common questions
My mother lives in a nursing home in Arnold. 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.
Can I shower or bathe with a compression wrap on?
Most wraps need to stay dry, because a wet wrap can irritate skin and lose its hold. How you bathe depends on the type of compression ordered. Some garments come off for bathing, while layered wraps usually stay on until the next change. Ask the treating clinician what applies to you and which cover, if any, they suggest. Report a wrap that gets wet.
Will Medicare or my insurance pay for compression supplies and visits?
You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. What is paid for depends on the treating provider, your specific plan and the care that is needed, and rules for compression garments and dressings vary a good deal from plan to plan. Gateway helps confirm the details before care starts so you can decide with clear information.
Arnold is in Jefferson County, not St. Louis County. Can I still ask about my insurance?
Yes. Living in Jefferson County does not stop you from asking. People in Arnold can ask about Medicare, Medicare Advantage, Medicaid and commercial plans. Participation and benefits depend on the patient’s plan, the treating provider and the care needed, so we cannot tell you in advance what a plan will pay for. We can explain what to ask your plan and what the treating practice will need.
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.