Diabetic foot ulcer care in Downtown St. Louis.

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

At the first visit the treating clinician usually measures the length, width and depth of the ulcer and notes what the base looks like: pink or red tissue, yellow slough, dark dead tissue, or structures that should not be visible. The edges get attention too, because a thick rim of callus or skin that has been undermined changes the plan. The amount, color and odor of any drainage are recorded. The clinician may also check whether the wound reaches toward bone, since that raises the question of bone infection and may lead to imaging or lab work. These findings become the baseline that later visits are measured against.

Arranging this care in Downtown St. Louis

In Downtown St. Louis, a walk-up apartment or a house with the bedroom on the second floor turns offloading into a daily problem. Every trip up the stairs loads the front of the foot, and a removable boot is awkward on narrow treads. A treating clinician who visits at home can see the stairs firsthand and tailor instructions, for instance whether to limit trips or sleep downstairs for a while. Gateway asks about buzzer codes, elevators and parking before the visit, so the time goes to the foot and not to getting through the front door.

Downtown St. Louis is the central business district beside the riverfront, stretching west from the Gateway Arch through Downtown West. Many of its former warehouses and office buildings along Washington Avenue and the nearby streets are now lofts and apartments, and people of every age live among the stadiums, hotels and courthouses. Living downtown often means living without a car, in a building with elevators, secured doors and a front desk. For a resident with a wound or a chronic illness, care that comes up to the apartment is far simpler than arranging a ride out.

At home between visits

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.

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

A foot ulcer can affect the whole body, and sometimes the first warning shows up away from the wound. Tell the treating clinician about:

• Blood sugar readings that run higher than usual for no obvious reason
• Nausea, poor appetite or unusual tiredness
• New pain in a foot that normally feels very little
• A sore, crack or callus appearing on the other foot
• A fall, or an offloading device that is damaged or no longer fits

Call 911 for severe shortness of breath, chest pain, new confusion or a person who cannot be woken.

Why primary care matters here

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 Downtown St. Louis →

How to get started in Downtown St. Louis

Clinicians and facility staff referring a patient for diabetic foot ulcer care in Downtown St. Louis can call 314-325-0126 or fax 314-786-7966. Helpful to include: demographics and insurance, the working diagnosis, recent wound notes and measurements, current orders, the medication list and relevant test results. Please also tell us who should receive the treating clinician’s notes afterward. The online referral form takes contact details only, so clinical records should come by fax, not through the form. Gateway confirms that the referral arrived, checks availability for the patient’s address and lets your office know what has been scheduled.

The two hospitals people in Downtown St. Louis use most are SSM Health Saint Louis University Hospital, a couple of miles southwest on Grand Boulevard, and Barnes-Jewish Hospital in the Central West End. Gateway is not affiliated with either. If you are being discharged to a downtown apartment, ask your case manager to fax a referral, or call us yourself. Gateway requests the discharge records and wound orders, confirms building access, and arranges follow-up with a treating clinician. Discharge planners can help by noting the unit number and a contact who will answer the door.

• County: City of St. Louis, Missouri (an independent city)
• ZIP codes: 63101, 63102, 63103
• Nearby hospitals: SSM Health Saint Louis University Hospital; Barnes-Jewish Hospital (not affiliated with Gateway)
• Nearby communities: St. Louis City, Central West End, North St. Louis, South St. Louis
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Downtown St. Louis

Read the full guide to diabetic foot ulcers, or see everything Gateway arranges on the mobile wound care in Downtown St. Louis 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 the City of St. Louis
• Diabetic foot ulcer care in the Central West End
• Diabetic foot ulcer care in North St. Louis
• Diabetic foot ulcer care in South St. Louis

Common questions