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 the treating clinician looks at

A care plan for a diabetic foot ulcer usually rests on a few parts that the treating clinician fits to the person. Pressure relief comes first, whether through a removable boot, a cast, a special shoe or limits on standing. Next is preparing the wound bed, which may mean removing callus and dead tissue during visits. A dressing is chosen to match the amount of drainage, and it may change as the wound does. Infection, if present, is addressed with the testing and treatment the clinician orders. Finally, the plan names who changes the dressings, how often visits happen, and what finding at follow-up would prompt a different approach.

Arranging this care in Creve Coeur

Many people in Creve Coeur have lived in the same house for decades and intend to stay. A diabetic foot ulcer tests that plan. Older homes tend to have steps at every entrance, laundry in the basement and a tub to climb into, each one a moment of full weight on the wounded foot. During home visits the treating clinician can point out practical changes, and Gateway follows up on any equipment ordered. If care needs outgrow the house, skilled nursing and rehabilitation facilities are close by, and you can ask us about continuing wound visits there.

Creve Coeur sits where Olive Boulevard meets Interstate 270, a West County city that mixes medical offices and corporate campuses with established neighborhoods. Lindbergh Boulevard runs along its eastern side, and New Ballas Road runs north to south through the middle. Because two hospitals and many physician offices are inside the city limits, it is easy to assume care is always within reach. Yet a person with a slow-healing wound, a walker and no driver may find a one-mile trip as hard as a ten-mile one. Bringing care to the home or facility removes that trip.

Care at home

Most of the time a foot ulcer spends healing falls between visits, so the plan for those days matters. The treating clinician will spell out how often the dressing is changed, who changes it, how much walking is allowed and what goes on the foot indoors, including short trips to the bathroom at night. Keeping the offloading boot or shoe beside the bed makes those trips easier to do correctly. A simple daily routine helps: look at both feet, check whether drainage has soaked through the dressing, and write down anything new. If a question comes up, call Gateway and we will pass it to the treating clinician.

Care in skilled nursing and assisted living

Rehabilitation stays add a tension to foot ulcer care: therapy wants the person up and walking, and the wound needs pressure kept off it. The treating clinician and the therapy team work out how to do both, for example by setting weight-bearing limits, naming the device to be worn during sessions and deciding how transfers are done. Gateway shares the wound orders with therapy and nursing so the instructions match. Before discharge we help arrange what comes next, including wound visits at home, the supplies that leave with the resident and a clear handoff to whoever will change dressings after the move.

Changes to report

Some changes point to trouble with blood flow or to tissue that is dying. Report these to the treating clinician without waiting for the next visit:

  • Black, gray or dark purple skin on a toe, the heel or the wound edge
  • A wound that looks deeper, or one where bone or tendon can be seen
  • A toe that has become cold or discolored
  • Foot pain at rest or at night that eases when the leg hangs down

Call 911 if a foot or leg suddenly turns cold, pale or blue, or for chest pain, severe bleeding or loss of consciousness.

Primary care and overall health

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 Creve Coeur →

Getting care arranged in Creve Coeur

For a resident of a nursing home, assisted living or memory care community in Creve Coeur, 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.

Mercy Hospital St. Louis and Barnes-Jewish West County Hospital are both in Creve Coeur, and Missouri Baptist Medical Center in Town and Country is a short drive south. Gateway is not affiliated with these hospitals. A surgical or chronic wound often still needs attention after the patient goes home. Case managers can fax us a referral before discharge. Families can call with the hospital name and going-home date. Gateway requests the records, confirms the Creve Coeur address and setting, and arranges a follow-up visit with a treating clinician.

  • County: St. Louis County, Missouri
  • ZIP codes: 63141
  • Nearby hospitals: Mercy Hospital St. Louis in Creve Coeur; Barnes-Jewish West County Hospital in Creve Coeur; Missouri Baptist Medical Center in Town and Country (not affiliated with Gateway)
  • Nearby communities: Chesterfield, Maryland Heights, Chesterfield and West County, Ladue, Overland, Des Peres
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Creve Coeur

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

Common questions

My parent lives in a nursing home in Creve Coeur. 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.

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.

What should I have ready for the first visit?

Gather a current medication list, recent blood sugar readings if you keep them, and any hospital or clinic papers about the foot. Set out the shoes, inserts, boot or other devices you use, along with the dressing supplies you have on hand. Write down the names of your doctors and your questions. A chair with good light and a place to prop the foot make the exam easier.

Creve Coeur has hospitals with outpatient services. Why would someone choose visits at home instead?

It depends on the person. Outpatient care suits people who can travel comfortably. Visits at home or in a facility suit people for whom the trip is painful, risky or dependent on someone else’s schedule. Some patients use both at different times. If you live in Creve Coeur and are unsure, call us and describe the situation. The treating clinician can advise on the right setting after an assessment.

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.