Diabetic foot ulcer care in Clayton and Central County.

What to know about 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.

How the care plan is built

Clinicians grade diabetic foot ulcers by severity, and the grade shapes what follows. A shallow wound with good blood flow and no infection can often be managed with visits at home or in a facility. A wound with spreading infection, exposed bone or tendon, or poor circulation may need a hospital, a surgeon or a vascular specialist, and the treating clinician will tell you if that is the case. Between those two ends, the clinician weighs what can be done on site against what calls for imaging, lab work or a specialist’s opinion. Gateway’s part is to move the resulting orders and referrals along and to let you know who should be calling you.

Arranging this care in Clayton and Central County

In Clayton and Central County, a person with a foot ulcer is often a long-time homeowner whose spouse or neighbor helps out, and whose podiatrist and primary care doctor are close by. That existing circle is an asset. Gateway sends updates to each office after wound visits, so the people who know the patient are not working from old information. Seniors who have moved to an independent or assisted living community nearby can be seen there too. In either setting, show the clinician the worn house shoes by the door, because comfortable old footwear is a frequent source of rubbing.

Clayton is where St. Louis County does its business. The county seat has courthouses and office towers downtown, condominium buildings a few blocks away and tree-lined residential streets beyond. Around it sit the Mid County communities of Richmond Heights, Brentwood, Maplewood, University City and Ladue, tied together by Clayton Road, Hanley Road, Big Bend Boulevard and Interstates 64 and 170. Everything in Clayton and Central County is close, but close is not the same as easy. Traffic, parking garages and stairs make outings hard for someone with a wound or limited mobility.

At home between visits

Family caregivers do much of the day-to-day work when a diabetic foot ulcer is cared for at home. A spouse or adult child may be the only person who can see the sole of the foot, hold a mirror or notice a damp sock. The treating clinician decides which dressing tasks a caregiver can take on and explains what is expected. Caregivers also help by keeping the offloading device within reach, clearing clutter from walking paths, and writing down blood sugar readings and questions for the next visit. If the tasks become more than your household can manage, tell us and we will raise it with the clinician.

For residents of nursing and senior living communities

In a skilled nursing facility, a diabetic foot ulcer is managed by several people at once. A partner clinician visits on site to assess the wound and write or recommend orders, the facility nurses carry out dressing changes and daily skin checks, and the attending physician oversees the resident’s overall care. Gateway keeps those lines connected. We schedule rounds with the facility, send visit notes for the chart and confirm that new orders were received and signed as the building requires. Offloading orders, such as heel protection in bed or a boot for transfers, go to the nursing and therapy staff who apply them every shift.

Signs to tell the clinician about

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.

Primary care and overall health

Blood sugar and wound healing are closely tied. When glucose runs high over time, the cells that fight infection and rebuild tissue work less well, and an infected wound can in turn push readings higher. Wound visits do not manage diabetes medications. That belongs to the primary care clinician or endocrinologist, who may review recent readings, lab results and the current regimen while the ulcer is being cared for. Gateway helps the two sides share information, so the clinician managing diabetes knows there is an open wound and the wound clinician knows how glucose has been running.

Primary care at home in Clayton and Central County →

Getting care arranged in Clayton and Central County

You may already have a surgeon, a wound clinic or a home health nurse and still want help with diabetic foot ulcer care closer to home in Clayton and Central County. That is a fine reason to call 314-325-0126. Tell us who is treating the wound now and what is not working, whether that is the travel, the gaps between appointments or unclear instructions. Gateway does not replace your current clinicians. We can arrange for a partner clinician to see the wound where you live and, with your permission, share notes with the offices already involved so the plans agree.

For people in Clayton and Central County, the nearest hospital is usually SSM Health St. Mary’s Hospital in Richmond Heights. Many also go east to Barnes-Jewish Hospital or west to Missouri Baptist Medical Center in Town and Country. Gateway has no affiliation with these hospitals. A discharge planner can refer by fax, and a family member can call us while the patient is still admitted. We ask for the discharge summary and wound orders, verify the address the patient is returning to, and arrange follow-up with a treating clinician who directs wound care from that point.

• County: St. Louis County, Missouri
• ZIP codes: 63105, 63117, 63124
• Nearby hospitals: SSM Health St. Mary's Hospital in Richmond Heights; Barnes-Jewish Hospital; Missouri Baptist Medical Center in Town and Country (not affiliated with Gateway)
• Nearby communities: Richmond Heights, University City, Ladue, Brentwood, Maplewood, Central West End
• 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 Clayton and Central County page.

• Venous leg 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
• Diabetic foot ulcer care in University City
• Diabetic foot ulcer care in Ladue
• Diabetic foot ulcer care in the Central West End

Common questions