What to know about venous leg ulcers

Venous leg ulcers are more common in older adults, but age is not the only factor. People who have had a blood clot in a leg vein, varicose veins, leg surgery or a serious leg injury carry more risk. So do people who stand or sit for most of the day, people with a higher body weight, and women who have had several pregnancies. A family history of vein trouble is common.

Anything that keeps the ankle from bending, such as arthritis, an old fracture or weakness after a stroke, also plays a part. Many people notice years of warning signs first: ankles that swell by evening, legs that feel heavy, and skin that slowly darkens above the ankle.

What an assessment covers

A first visit for a venous leg ulcer covers more than the wound. The treating clinician typically records:

  • Where the ulcer sits, and its length, width and depth
  • The appearance of the wound base and edges
  • How much drainage there is and what it looks like
  • The surrounding skin: staining, hardening, rash, or pale soggy areas
  • Swelling in both legs, often measured at the ankle and calf
  • Pain, and what makes it better or worse

Those findings become the baseline. The same points are checked again at later visits, so the care plan is adjusted on what the leg is doing, not on guesswork.

Venous leg ulcer care in the Central West End

City housing shapes venous ulcer care in the Central West End. A third-floor walk-up means the leg hangs down and works hard on every trip, and a bulky multi-layer wrap may not fit the shoes you trust on stairs. Tell us about steps, elevators, entry buzzers and where a visiting clinician can park, so the visit is not delayed at the door. Dressing and compression supplies sent to an apartment building can sit in a lobby or mailroom, so we ask who can receive packages. The clinician can also suggest where in a small apartment you can raise your legs comfortably.

Housing in the Central West End stacks up as much as it spreads out. There are doorman towers along Lindell Boulevard and Kingshighway, brick walk-ups and converted mansions on the side streets, newer apartment buildings near the medical campus, and senior apartments, assisted living and skilled nursing within the neighborhood or a short distance away. Gateway arranges partner clinician visits in all of them. For secured buildings we ask ahead about the front desk, entry codes and visitor parking. For facilities we coordinate with the nursing team on timing and orders.

When care happens at home

Family caregivers often carry part of the work for a venous leg ulcer at home. Depending on the orders, that might mean helping with a stocking or adjustable garment, changing an outer dressing, propping the legs at rest, or watching the toes and skin for changes. No one should have to guess. The treating clinician can show a caregiver which tasks are theirs and which to leave alone, and Gateway can request visit times when the caregiver is able to be there. If the caregiver works, travels or lives elsewhere, tell us, and with your permission we will keep them informed by phone.

For residents of nursing and senior living communities

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.

Changes to report

Compression should feel snug and supportive, not painful. Contact the treating clinician promptly if any of these occur while a wrap or garment is on:

  • Toes that look pale, bluish or darker than usual, or feel cold
  • Numbness, tingling or pins and needles in the foot
  • New or sharper pain under the wrap, particularly over the shin or ankle
  • A wrap that has rolled, slid down or formed a tight band
  • Swelling that bulges above or below the wrap

Follow the instructions you were given for these situations, including whether to take the wrap off. Call 911 if the foot or leg suddenly turns cold, pale and severely painful.

How primary care fits in

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.

Primary care at home in the Central West End →

Arranging venous leg ulcer care in the Central West End

Setting up venous leg ulcer care for someone in the Central West End usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

Barnes-Jewish Hospital is in the neighborhood itself. SSM Health Saint Louis University Hospital is a short drive southeast on Grand Boulevard, and SSM Health St. Mary’s Hospital in Richmond Heights is just west of Forest Park. Gateway is independent of all three. When a patient from the Central West End is discharged, the case manager can fax a referral, or the family can call. We request the discharge records, confirm the home or facility address, and arrange follow-up with a treating clinician, so wound care continues after the hospital’s part ends.

Related care in the Central West End

Read the full guide to venous leg ulcers, or see everything Gateway arranges on the mobile wound care in the Central West End page.

Common questions

Do I need a referral to start venous leg ulcer care in the Central West End?

No referral is needed to call Gateway. Patients, family members and caregivers can contact us directly, and hospitals, facilities and practices can refer as well. Some health plans have their own referral or authorization rules, which depend on the plan and the treating provider. We will tell you what records or orders the treating clinician needs before a first visit.

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.

What is the difference between a venous ulcer and an arterial ulcer?

Venous ulcers come from blood pooling in the leg. They tend to be shallow, wet and located near the ankle on a swollen leg. Arterial ulcers come from too little blood reaching the tissue and are often on the toes, foot or shin, with a dry base and pain that worsens when the leg is raised. Some people have both. Telling them apart takes a clinical exam and circulation testing.

Can a clinician visit a high-rise or secured building in the Central West End?

Yes. Tell us the building name, the unit number and how guests are admitted, whether through a front desk, a call box or a code. If the building needs advance notice or a name at the desk, we pass that to the visiting clinician. Mention any guest parking or the closest side street. Details like these are a normal part of planning a visit in the Central West End.

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.