Understanding diabetic foot ulcers

Change in a diabetic foot ulcer comes slowly, which is why the wound is measured at regular visits. In the early weeks of care, clinicians look for the wound to become smaller and shallower and for healthy red tissue to fill in the base. A wound that stays the same size visit after visit is a signal to look for a cause instead of simply waiting longer. Setbacks are common. A few days in the wrong shoes, or a stretch without the protective device, can undo progress. Once the skin closes, the area stays weaker than the skin around it, and ulcers often return at or near the same spot. The months after closure call for protective footwear and continued foot checks.

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 Belleville

People in Belleville 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.

Belleville is the seat of St. Clair County and the largest city in the Metro East, southeast of downtown St. Louis on the Illinois side of the Mississippi. Main Street runs for miles through the middle, crossing Illinois Route 159 at the public square. Swansea, Fairview Heights, Shiloh and O’Fallon lie to the north and east. A city this size has every kind of household, including many older adults in older houses. When a wound or a chronic illness makes travel hard, even crosstown appointments get missed. Care arranged at home or in a facility closes that distance.

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

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

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.

Primary care and overall health

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 Belleville →

Getting care arranged in Belleville

For a resident of a nursing home, assisted living or memory care community in Belleville, a request for diabetic foot 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.

Hospital care for Belleville is spread among Memorial Hospital Belleville, Memorial Hospital Shiloh and HSHS St. Elizabeth’s Hospital in O’Fallon, Illinois. Gateway is not affiliated with any of the three. A discharge often comes with wound instructions, medication changes and follow-up appointments that are hard to keep. Patients and family members can call us to ask about follow-up at home. Discharge planners and case managers at Metro East hospitals can refer by phone at 314-325-0126 or by fax at 314-786-7966. We request the records and coordinate a visit with a partner clinician.

  • County: St. Clair County, Illinois
  • ZIP codes: 62220, 62221, 62223, 62226
  • Nearby hospitals: Memorial Hospital Belleville; Memorial Hospital Shiloh; HSHS St. Elizabeth's Hospital in O'Fallon, Illinois (not affiliated with Gateway)
  • Nearby communities: Fairview Heights, O'Fallon, Illinois, St. Clair County, Illinois, Collinsville, Metro East
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

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

Common questions

My parent lives in a nursing home in Belleville. 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.

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.

Does Medicare or Medicaid pay for diabetic foot ulcer care in Belleville?

We cannot say in advance. Coverage depends on the treating provider, your specific plan and the care that is ordered, and the rules for visits, dressings and offloading devices can differ. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Gateway checks what it can with the provider and the plan before the first visit and tells you what we find.

Can Gateway arrange follow-up in Belleville after a stay at a St. Louis hospital?

Yes. People from Belleville sometimes have surgery or specialty care across the river and come home needing follow-up. The hospital’s discharge planner can refer, or you can call 314-325-0126 yourself. We request the records, coordinate with a partner clinician for your Belleville address and confirm availability for that location. Tell us the discharge date as soon as you know it.

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.